Preventing pigsplosions

The bad news: Massive piles of pig manure are foaming up and then exploding and nobody is really sure why. The worse news: The only solution (other than, you know, not raising so many pigs all together) is to feed the pigs more antibiotics — a practice that contributes to antibiotic resistance.

Why did we start using antibiotics in animal feed?

In 1950, farmers praised the news that small amounts of antibiotics would help their livestock put on more weight, faster. Ironically, that same year, different scientists published some early evidence of antibacterial resistance. At Scientific American's new food blog, Maureen Ogle writes about the history of antibiotic use in agriculture. Her story provides some great context to recent headlines, helping us better understand why our society originally made the decisions that led to our current struggle against antibiotic resistance.

From the front lines in the fight against antibiotic-resistant bacteria

Bacteria are becoming resistant to one of the last classes of antibiotics available to treat them, writes Maryn McKenna at Nature. Carbapenem-resistant Enterobacteriaceae are a family of lung, blood, and bladder infections that can turn horribly deadly. Meanwhile, at Scientific American, Charles Q. Choi writes about other scientists looking for ways to turn bacteria against one another, unleashing predatory microbes that can destroy drug-resistant bacteria.

An unbiased view of what the meat industry looks like from the inside

Most of the time, when somebody goes undercover inside a meat processing facility, it's done with the express goal of convincing other people to stop eating meat. But that wasn't what journalist Ted Conover had in mind. He was more just curious, especially given the growing trend of state laws preventing undercover infiltration of agribusiness facilities. So, using his real name and address, Conover got a job as a USDA meat inspector at a Cargill plant.

What's fascinating here is that the problems he finds have less to do with animal abuse (Maryn McKenna reports that Conover was surprised to find himself in a clean, safe, humane facility) and more to do with the abuse of antibiotics — a trend that is a major contributor to antibiotic resistance.

You can't read the full story for free, unfortunately. Such is the way of Harpers. But Maryn McKenna has a summary, Conover has a blog post on agribusiness gag laws, and you can buy access to the full story with a Harper's subscription.

Antibiotics and gut health

I finally got around to reading Carl Zimmer's highly-recommended National Geographic article about antibiotics and their effect on our microbiome, the "100 trillion microbes that live in our healthy bodies."

Scientists are only now beginning to get answers to those questions. In a paper just published online in the journal Gut, Andres Moya of the University of Valencia and his colleagues took an unprecedented look at a microbiome weathering a storm of antibiotics. The microbiome belonged to a 68-year-old man who had developed an infection in his pacemaker. A two-week course of antbiotics cleared it up nicely. Over the course of his treatment, Moya and his colleagues collected stool samples from the man every few days, and then six weeks afterwards. They identified the species in the stool, as well as the genes that the bacteria switched on and off.

What’s most striking about Moya’s study is how the entire microbiome responded to the antibiotics as if it was under a biochemical mortar attack. The bacteria started producing defenses to keep the deadly molecules from getting inside them. To get rid of the drugs that did get inside them, they produced pumps to blast them back out. Meanwhile, the entire microbiome powered down its metabolism. This is probably a good strategy for enduring antibiotics, which typically attack the molecules that bacteria use to grow. As the bacteria shut down, they had a direct effect on their host: they stopped making vitamins and carrying out other metabolic tasks.

When You Swallow A Grenade

How we learned to mass-produce penicillin

Today, we are desperately trying to figure out how to combat and keep up with antibiotic resistance — the frustrating tendency for bacteria to evolve defenses against the drugs we depend on to kill them. Seventy years ago, researchers were faced with a very different problem — how to take penicillin, the antibiotic derived from mold, and turn it into something that could be produced in large quantities.

At The Body Horrors blog, Rebecca Kreston writes about this quest and how a single moldy cantaloupe helped launch the (unfortunately) brief era of antibiotic supremacy.

For something that grows so carelessly and freely on our fruits and breads, mass producing the white mold and its hidden wonder drug penicillin was devilishly difficult. After Alexander Fleming’s accidental discovery of a bacteria-killing mold contaminating his cultures of Staphylococcus aureus, it languished as a laboratory parlor trick until World War II and the desperate need for treatments to fight bacterial infections became quickly apparent

It would be another fluke – the discovery of a moldy cantaloupe - that would yield a particular strain of mold that could produce prodigious amounts of this “magic bullet” antibiotic. Factories with the expert know-how on man-handling yeast and fungi into yielding their strange fruits - alcohol distilleries and mushroom factories – were then tasked with the production of penicillin

I particularly dig this video she posted with the story, showing a behind-the-scenes look at how large quantities of penicillin were made during World War II.

Read Rebecca Kreston's full piece

What the FDA doesn't want to tell you about livestock antibiotic use

Short version: There is LOTS the FDA doesn't want to tell you about livestock antibiotic use. And that matters. As I reminded you yesterday, the antibiotics we use to keep ourselves alive and healthy are rapidly losing their effectiveness against a whole host of diseases. Antibiotic resistance to disease is driven by overuse of antibiotics — both in humans and in animals. And there are lots of antibiotics being used on animals. The trouble is, public health researcher know very little about that use. Because the FDA refuses to release more than the bare minimum of data. For added fun, last year, they stopped even trying to regulate antibiotic use on livestock — opting instead for voluntary self-control systems.

Resolution for 2013: Don't catch the clap

Over the weekend, during a conversation with "scary disease girl" (and amazing science journalist) Maryn McKenna, I was reminded of a public health issue that we've talked about here before, but which is still not getting enough attention. Gonorrhea (aka "the clap") has long been the STD you worried least about, thanks to easy treatment with antibiotics. But that time is over. Antibiotic resistance is turning gonorrhea into a superbug. As of August, we're down to one antibiotic that can reliably treat it. Your best defense is now, most definitely, offense. Get yourself tested. Make sure your sexual partners are tested (oral sex, too!). And use barrier protection (oral sex, too!)

The end of cheap STD control?

More than 700,000 people in the United States probably get gonorrhea each year. I say "probably" because the Centers for Disease Control doesn't know for sure. It's an estimate, because a lot of those cases go untested, unreported, and untreated.

The good news is that, since the 1940s, getting people to get themselves tested has been the hard part. Once you know the gonorrhea is there, antibiotics have made it both easy and cheap to treat. The (more) bad news: That's changing.

At her Superbug blog, Maryn McKenna talks about the threat of antibiotic-resistant gonorrhea—it's not just an issue of health, it's also an issue of how much health costs. So far, there's not been gonorrhea reported that's immune to all the drugs we can throw at it. Just the inexpensive drugs. Anticipating big problems when treating gonorrhea becomes a pricy proposition, the World Health Organization has put together a plan for improving treatment today.

The plan specifically calls out an aspect of the growing resistance problem that we highlighted at SciAm: Community control now depends on rapid molecular tests that identify the gonorrhea organism (Neisseria gonorrhaea) but cannot distinguish between drug-susceptible and antibiotic-resistant organisms. Hence, patients who were treated, and then went back to their doctors with the same symptoms, were assumed to have been cured and then reinfected. Physicians have not had the tools to identify ongoing infections that never responded to treatment — and patients who had those resistant, not-responding infections then went on to unknowingly infect others.

In order to address that problem, the plan calls specifically for improvements in lab capacity, diagnosis and surveillance, as well as asking for things that apply to the greater problem of antibiotic resistance: improved awareness, bigger efforts at prescribing antibiotics appropriately and better drugs. One thing that it particularly calls for — as the CDC did in the New England Journal last February — is for physicians to start applying a “test of cure,” actually checking microbiologically to see whether a patient who was prescribed an antibiotic for gonorrhea is clear of infection, or harboring a resistant strain.

Of course, that's expensive, too. The cheapest option is still to not get gonorrhea at all. Get tested. Make sure your partners are tested. And use protection. In the future, we're not going to be able to afford treating some STDs as "no big deal".

Read more about the WHO plan and antibiotic-resistant gonorrhea at the Superbug blog

How to: Replace unnecessary antibiotics with a good dose of empathy

A key component of antibiotic resistance is the over-use of antibiotics. We talk about this a lot in the context of over-the-counter antibacterial cleansers, but there's a doctor's office side to this story, as well.

When sick people come into a doctor's office, part of what they are looking for is psychological wellness. They want to feel like somebody has listened to them and is doing something to treat their illness. Sometimes, that means they ask their doctor for antibiotics, even if antibiotics aren't the right thing to treat what they have.

In the past, and sometimes still today, doctors go ahead and prescribe antibiotics almost like a placebo. It's hard to say no to something a patient really wants, especially when it's likely to make them feel better—just because taking anything, and treating the problem, will make them feel better. But that is definitely not a good thing in the long term.

At KevinMD, family physician Dike Drummond offers some really nice advice for doctors who are struggling with how to make a patient feel better, but also want to avoid contributing to the growing antibiotic resistance problem. What I like best about Drummond's advice: It starts with empathy.

If you have a major challenge working up some empathy one of two things is happening.

You are experiencing some level of burnout. Empathy is the first thing to go when You are not getting Your needs met. This is a whole different topic and “compassion fatigue” is a well known early sign of significant burnout.

You are not fully present with the patient and their experience. In many cases this can be addressed by taking a big relaxing, releasing breath between each patient and consciously coming back into the present before opening the door.

Read the rest at KevinMD

Via Nick Bennett

Antibiotic resistance is older than antibiotics

This came out while I was traveling, but I wanted to post it here in case you missed it. It is very cool, in that "maybe cool isn't the right word" sort of way. Our modern antibiotics are really just purified and pumped-up versions of naturally occurring compounds, right? So, it makes sense that, long before we started using them as antibiotics, bacteria had already started building defenses against the natural compounds. In other words: Antibiotic resistance is older than the use of antibiotics.