As I suggested a few years ago, the Soviet Union did not use antibiotics
as widely as in the U.S. or even Europe. They attacked infections with
macrophages, a different biological approach. With so many former Soviet
doctors living in the United States, it might be wise for U.S. hospitals
to start employing them and their skills ....
Antibiotics Prove Powerless as Super-Germs
SpreadAntibiotics were once the wonder drug. Now, however, an
increasing number of highly resistant -- and deadly -- bacteria are
spreading around the world. The killer bugs often originate in factory
farms, where animals are treated whether they are sick or not. By
The pathogens thrive in warm, moist environments. They feel comfortable
in people's armpits, in the genital area and in the nasal mucous
membranes. Their hunting grounds are in the locker rooms of schools and
universities, as well as in the communal showers of prisons and health
The bacteria are transmitted via the skin, through towels, clothing or
direct body contact. All it takes is a small abrasion to provide them
with access to a victim's bloodstream. Festering pustules develop at the
infection site, at which point the pathogens are also capable of
corroding the lungs. If doctors wait too long, patients can die very
This is precisely what happened to Ashton Bonds, a 17-year-old student at
Staunton River High School in Bedford County, in the US state of
Virginia. Ashton spent a week fighting for his life -- and lost. This is
probably what also happened to Omar Rivera, a 12-year-old in New York,
who doctors sent home because they thought he was exhibiting allergy
symptoms. He died that same night.
The same thing almost happened at a high school in the town of Belen, New
Mexico. Less than two weeks ago, a cheerleader at the school was
hospitalized after complaining about an abscess. Twelve other female
students had been afflicted with suspicious rashes. All the students
tested positive for a bacterium that the US media has dubbed the
The school administration in Belen believes that the bacterium was spread
on mats in the school's fitness and wrestling rooms. The facility was
thoroughly disinfected 40 times, and yet the fear remains.
Fears of a Pandemic
Microbiologists refer to this bacterium as community-acquired
methicillin-resistant Staphylococcus aureus, or ca-MRSA. The terrifying
thing about it is its resistance to almost all common antibiotics, which
complicates treatment. And, in contrast to the highly drug-resistant
hospital-acquired MRSA (ha-MRSA) strains, which primarily affect the
elderly and people in hospitals and nursing homes, ca-MRSA affects
healthy young people. The bacterium has become a serious health threat in
the United States. Doctors have already discovered it in Germany,
although no deaths have been attributed to it yet in the
The two bacteria, ha-MRSA and ca-MRSA, are only two strains from an
entire arsenal of pathogens that are now resistant to almost all
available antibiotics. Less than a century after the discovery of
penicillin, one of the most powerful miracle weapons ever produced by
modern medicine threatens to become ineffective.
The British medical journal The Lancet warns that the
drug-resistant bacteria could spark a "pandemic." And, in
Germany, the dangerous pathogens are no longer only feared "hospital
bugs" found in intensive care units (ICUs). Instead, they have
About two weeks ago, consumers were alarmed by the results of an analysis
of chicken meat by the environmentalist group Friends of the Earth
Germany (BUND), which found multidrug-resistant bacteria on more than
half of the chicken parts purchased in supermarkets.
The dangerous bacteria have even been detected on one of Germany's
high-speed ICE trains. Likewise, more than 10 percent of the residents of
German retirement homes have been colonized by MRSA bacteria. In their
case, every open wound is potentially deadly. The pathogens have also
been found on beef, pork and vegetables.
Another alarming finding is that about 3 to 5 percent of the population
carries so-called ESBL-forming bacteria in the intestine without knowing
it. Even modern antibiotics are completely ineffective against these
highly resistant bacteria.
When the neonatal ICU at a hospital in the northern German city of Bremen
was infested with an ESBL-forming bacterium last fall, three prematurely
born babies died.
Infestation with multidrug-resistant bacteria is normally harmless to
healthy individuals because their immune systems can keep the pathogens
under control. Problems arise when an individual becomes seriously
"Take, for example, a person who is having surgery and requires
artificial respiration and receives a venous or urinary catheter,"
explains Petra Gastmeier, director of the Institute of Hygiene and
Environmental Medicine at Berlin's Charité Hospital. "In such a
case, the resistant intestinal bacteria can enter the lungs, the
bloodstream and the bladder."
This results in urinary tract infections, pneumonia or sepsis, which are
increasingly only treatable with so-called reserve antibiotics, that is,
drugs for emergencies that should only be administered when common
antibiotics are no longer effective.
The Spread of Killer Bugs
Recently, an even greater threat has arisen. With the spread of
ESBL-forming bacteria, reserve antibiotics have to be used more and more
frequently, thereby allowing new resistances to develop. In fact, there
are already some pathogens that not even the drugs of last resort in the
medical arsenal can combat.
In India, where poor hygiene and the availability of over-the-counter
antibiotics encourage the development of resistance, an estimated 100 to
200 million people are reportedly already carriers of these virtually
unbeatable killer bacteria. There is only one antibiotic left -- a drug
that is normally not even used anymore owing to its potentially fatal
side effects -- that is still effective against these killer bacteria. In
serious cases, people who become infected with these types of pathogens
die of urinary tract infections, wound infections or pneumonia.
The killer bugs have also reached England, presumably through medical
tourists who traveled to India for cosmetic surgery, and they have
reportedly already infected several hundred people. A few cases have also
turned up in Germany.
Israel even experienced a nationwide outbreak a few years ago. Within a
few months, about 1,300 people were afflicted by an extremely dangerous
bacterium that killed 40 percent of infected patients. Even today, the
same bacterium still sickens some 300 people a year.
The Post Antibiotic Era
This rapid spread has caused many to wonder whether more and more
people in Germany will soon die of infectious diseases that were
supposedly treatable, as happened in centuries past. Unfortunately, there
are many indications that this might ultimately be the case.
"We are moving toward a post-antibiotic era," predicts Yehuda
Carmeli of the Tel Aviv Sourasky Medical Center. "But it won't
happen on one day or at the same time in every part of the world. And
that's the tragedy, because this means that it is not perceived as a
The World Health Organization (WHO) recently warned against an impending
medical catastrophe. And, in The Lancet, leading healthcare
experts published an urgent appeal: "We have watched too passively
as the treasury of drugs that has served us well has been stripped of its
value. We urge our colleagues worldwide to take responsibility for the
protection of this precious resource. There is no longer time for silence
In fact, the carelessness with which doctors and farmers are jeopardizing
the effectiveness of one of the most important groups of drugs borders on
lunacy. Some 900 metric tons of antibiotics are administered to livestock
each year in Germany alone. Instead of treating only those animals that
are truly sick, farmers routinely feed the medications to all of their
animals. Likewise, some 300 metric tons of antibiotics are used to treat
humans each year, far too often for those merely suffering from a common
A Foe We Helped Become More Flexible
This large-scale use inevitably leads to the spread of resistant bugs.
Indeed, antibiotics offer ideal growth conditions to individual bacteria
that have naturally become resistant through a small change in their
genetic makeup. Simply put, they benefit from the fact that the
antibiotics still kill off their competitors, the non-resistant
In many cases, a genetic mutation isn't even necessary to allow a
resistant bacterium to develop. Bacteria can incorporate bits of genetic
material from other pathogens. For example, for millions of years, the
gene for ESBL resistance lay dormant in the ground, where it was part of
a complicated ecosystem of bacteria, penicillin-producing fungi and plant
roots. Again and again, the gene was incorporated by human intestinal
bacteria -- as useless ballast. It was only the large-scale use of
antibiotics that provided the ESBL-forming bacteria with the opportunity
Recent studies show that quantities of antibiotics much smaller than
previously thought can lead to the development of resistance. In
retrospect, the uncontrolled dispensing of antibiotics has proven to be a
huge mistake. "In the last 30 years, we have contaminated our entire
environment with antibiotics and resistant bacteria," says Jan
Kluytmans, a microbiologist at Amphia Hospital, in the southern Dutch
city of Breda. "The question is whether this is even reversible
anymore. Perhaps we can prevent only the worst things from happening
Shocking Levels of Antibiotic Abuse on Farms
Since a large share of resistant bacteria come from barns, it will be
critical to drastically reduce the use of antibiotics in agriculture.
Remarkably often, farmers, feedlot operators and veterinarians are
themselves carriers of multidrug-resistant bacteria. Kluytmans has even
demonstrated that the pathogens found in humans are very often
genetically identical with the bacteria detected on meat.
It's virtually impossible to become infected by eating such meat, at
least as long as it's well-cooked. The risk arises when raw meat comes
into contact with small wounds. What's more, even vegetable crops can
become contaminated when liquid manure is spread onto fields.
The exhaust gases emitted by giant feedlots for pigs and chickens could
also pose a danger greater than previously thought. These meat factories
blow bacteria, viruses and fungi into the air. The government of the
western German state of North Rhine-Westphalia has commissioned a study
to determine whether feedlots are discharging multidrug-resistant
bacteria, thereby endangering people in the surrounding areas.
Last year, North Rhine-Westphalia was also the first German state to
systematically investigate the use of antibiotics in chicken farms. The
horrifying conclusion was that more than 96 percent of all animals had
received these drugs -- sometimes up to eight different agents -- in
their short lives of only a few weeks. "That was the proof that the
exception -- namely, treating disease -- had become the rule," says
Johannes Remmel, a Green Party member and the state's consumer protection
Abysmal Feedlot Conditions
As the results of the investigation suggest, factory farming is to blame.
The bigger an operation, the more antibiotics are administered to
individual animals. Investigators also noted that the duration of
antibiotic use was usually very short -- shorter than specified in the
licensing requirements. This saves money, but it also promotes the
formation of resistance.
The fact that livestock farmers mix antibiotics into feed has to do with
production conditions in feedlots:
- To produce veal, animals from different sources that are too weak for
milk and beef production -- and likewise more susceptible to infectious
diseases -- are often jammed into enclosures.
- Pigs are usually kept in very small spaces, making them very
aggressive and causing them to fight. Their wounds have to be treated
- In the past, it took 80 days until a chicken was ready for slaughter.
Today it's only 37 days. Chicken farmers have a profit margin of only a
few cents per animal. To minimize losses through disease, poultry
producers and their veterinarian helpers use antibiotics as a preventive
However, factory farming is also possible without the uncontrolled use of
antibiotics. Dairy cows, for example, are usually not given these drugs
[in Europe, but this does not hold for the U.S. - MC] since antibiotics
would interfere with the production of cheese and yogurt. Nevertheless,
there are still plenty of inexpensive milk products on supermarket
"In the Netherlands," says Kluytmans, "the use of
antibiotics in feedlots was even reduced by about 30 percent within two
years -- partly as a result of stricter regulations for veterinarians.
That's more than we administer to humans." Unfortunately, he adds,
the use of antibiotics in feedlots is practically a matter of religious
Efforts to Combat Antibiotics Abuse
In early January, Ilse Aigner, Germany's minister of food, agriculture
and consumer protection, unveiled a package of measures aimed at curbing
the use of antibiotics in farm animals. The measures include stricter
controls that would make it more difficult to add antibiotics urgently
needed in human medicine to animal feed. Germany's federal government is
also considering suspending veterinarians' right to dispense medicine. In
contrast to doctors practicing medicine on humans, who prescribe drugs to
be purchased at pharmacies, veterinarians can even directly sell drugs to
farmers and feedlot owners, which means they stand to profit handsomely
from the large-scale use of antibiotics.
However, Remmel, the consumer protection minister of North
Rhine-Westphalia, believes that Aigner's proposals are "deceptively
packaged," and he is calling for exact specifications on the amounts
of antibiotics that can be used.
Similarly, there is also little control over the use of antibiotics in
human medicine. In Germany, in particular, doctors prescribe antibiotics
as they see fit, whereas in the Netherlands doctors must first consult
with a microbiologist.
"Just as in pain therapy, there really ought to be experts for
treatment with antibiotics," says Gastmeier, the director of the
Institute of Hygiene and Environmental Medicine at Berlin's Charité
Hospital "But young doctors, in particular, are often relatively
uninformed." Indeed, in medical school, they learn very little about
the proper use of antibiotics.
Little Research into New Antibiotics
Still, even more responsible prescribing practices will hardly be able to
stop the advance of resistant bacteria in the long term. What's more, no
new antibiotics can be seen on the horizon. Only four pharmaceutical
companies worldwide are still working on developing new agents.
"Antibiotics have a serious problem," says Wolfgang Wohlleben
of the Institute of Microbiology at the University of Tübingen, in
southwestern Germany: "They actually work." Indeed, the drugs
can get the better of an infection within a few hours or days, and then
they are no longer needed. By contrast, patients taking drugs to fight
high blood pressure or diabetes often have to take them for the rest of
their lives -- which translates into steady, reliable profits for
Yet another factor making antibiotic-related R&D unattractive is the
fact that doctors can only prescribe a new antibiotic in the most extreme
of emergencies lest it lose its efficacy within a short amount of time.
Given these circumstances, major pharmaceutical companies stopped
searching for new antibiotics years ago. Nowadays, only small start-ups
or university-based researchers are interested in the field.
Abandoned by Big Pharma
In reality, the search for new drugs should be getting easier rather than
more difficult. In the 1990s, the large pharmaceutical companies spent
several million euros searching for weaknesses in the genetic makeup of
bacteria. But although the researchers were actually successful, the
subsequently developed drugs never made the final leap into clinical
"In the end, the risks of antibiotic research were simply too great
for companies," says pharmacist Julia Bandow, who went into academia
to continue studying antibiotics after working for the US-based
pharmaceutical giant Pfizer for six years.
But without the large pharmaceutical companies, there can be little hope
of progress. After all, testing a drug in human subjects takes years and
costs millions. And, as Bandow says of her fellow academics, "We
can't do it alone."
If pharmaceutical companies refuse to invest in the necessary studies,
it's critical for the government to step in. At the least, politicians
could make the development of antibiotics more attractive, for example,
by extending the time before patents expire so as to allow companies to
earn returns on their investments for longer. But, so far, these are all
nothing but ideas.
"At some point in the coming years," says microbiologist
Kluytmans, "there will be a disaster involving resistant pathogens
with many casualties. Only then will something change."
BY PHILIP BETHGE, VERONIKA HACKENBROCH, LAURA HÖFLINGER, MICHAEL LOECKX
and UDO LUDWIG
Translated from the German by Christopher Sultan
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