[Wild Fragaria]

Nature News Published online: 1 March 2006; | doi:10.1038/news060227-5

You may not be familiar with Acinetobacter, Aspergillus and enterococci. But perhaps you should be. They are part of a line-up of malicious microbes from which, infectious-disease experts say, we should be running scared.

Drug-resistant bacteria and fungi pose a growing threat to human health. Because these organisms have figured out how to shrug off many drugs, doctors are more or less helpless to battle the life-threatening infections they cause.

To focus attention on the nastiest of these drug-resistant organisms, and the ones against which we are least prepared, a group of scientists working with the Infectious Diseases Society of America (IDSA), based in Alexandria, Virginia, has come up with a short-list of the six microbes they say we should be most worried about.

The authors of the report say that these organisms should be a top priority for drug research because there are so few new medicines being developed to fight them. "These are the bugs that clinicians are seeing and that are causing the biggest problem," says George Talbot, the lead author, who advises pharmaceutical companies on this type of research from his Pennsylvania company, Talbot Advisors.

They announce the list today and publish it in the journal Clinical Infectious Diseases1.

The roster reads like a who's who of microbial villains (see *'Most wanted'). Many people are already familiar with one character: methicillin-resistant Staphylococcus aureus (MRSA), the bug that underlies most of the drug-resistant infections in hospitals.

Concerns about MRSA have spiralled with recent reports that it is causing an escalating number of infections in the wider community, such as in military facilities, prisons and schools. "It's an epidemic in cities," says Robert Daum at the University of Chicago, who studies Staphylococcus aureus infections. "We're hospitalizing children like crazy."

Also on the list is the fungi Acinetobacter baumannii. Virtually unheard of 30 years ago, this organism is behind a rising number of hospital-acquired pneumonia cases in the general population, and infections in wounded US soldiers.

The IDSA is urging policymakers and pharmaceutical companies to put more effort into finding new antimicrobial drugs. Experts warn that drug firms are pulling out of this area because finding such therapies is difficult and expensive; firms stand to make more money from a drug that is taken over a lifetime.

The superbug hit list follows a 2004 report from IDSA that spelled out ways to spur research and development of new antimicrobial drugs2. One of their proposals is that US lawmakers should grant tax breaks to companies that pursue this work.

But Baum reckons that the superbug crisis has yet to reach the point where many policymakers will sit up and take notice. And finding new antibiotics, he suggests, will require collaboration between academic research groups, biotechnology firms and pharmaceutical companies. "Somehow we need to create a community of people who think this is really important," he says.

*Most wanted
Researchers say we desperately need drugs to fight these microbes.

Staphylococcus aureus (MRSA): the bug that underlies a vast number of drug-resistant infections in hospitals.

Acinetobacter baumannii: a fungi behind a rising number of hospital-acquired pneumonia cases and infections in wounded US soldiers.

Escherichia coli and Klebsiella species: cause infections in the urinary tract, gut and wounds.

Aspergillus: a fungal infection that plagues people with poorly working immune systems such as those with HIV, cancer or organ transplants, and kills 50-60% of those it infects.

Vancomycin-resistant Enterococcus faecium (VRE): a bug responsible for infections of the bloodstream, heart and brain, among others.

Pseudomonas aeruginosa: a life-threatening bacteria that particularly plagues patients with the lung disease cystic fibrosis.

[aldo_14]

Experts warn that drug firms are pulling out of this area because finding such therapies is difficult and expensive; firms stand to make more money from a drug that is taken over a lifetime.

To me this kind of indicates a fundamental problem with moving towards research privatisation, where the bulk of medical research is developed (either from start or picked up from Phd, etc, projects and their creators) for a financial purpose, rather than being done in nation health service-type facilities or wholly in universities.  I'm not sure if this is as much a change in the pharmacuetical industry as I think it is from 50 years ago, or simply a sign of increasing medical knowledge leading to increasing scopes for treatment, but in any case I'd wager it would only be a good thing to have some form of policy rather than profit driven research.

[Martinus]

I'd wager it would only be a good thing to have some form of policy rather than profit driven research.

What? And interfere in their honest pursuit of astronomical amounts of money?!?

How un-capitalistic of you.

[karajorma]

Vancomycin-resistant Enterococcus faecium (VRE)

****! I didn't even know that there were any vancomycin resistant bugs out there apart from SA. I know that there are some new antibiotics being developed to take up the "last line of defence" places but I can see why people are worried about this particular bug.

[bfobar]

MRSA is teh suck. Damn near lost a foot to it when I was 12.

[karajorma]

They probably treated you with vancomycin. Which is why having a bacterium that is resistant to it is such a bugger.

[Martinus]

The thing that bothers me is that hospitals used to be a place that they took you when you were going to die, with the emergence of the so-called superbug it may just be the case again.

[karajorma]

Well the emergence of the superbug is mainly down to a few things.

1) Doctors giving out antibiotics for anything and everything (Any doctor who proscribes antibiotics should be taken out and beaten to death with a book on virology).
2) Patients deciding that they should stop taking the prescribed course of antibiotics because they feel better. (You stop taking them when the course is done you stupid ****s. Stop giving the bacteria a selection pressure in favour of resistance!)
3) Hospitals deciding that just cause we have better medicines these days that we can skimp on cleanliness

[perihelion]

I can only speak for the hospitals I've actually been in, but I don't think that the major hospitals in Houston are significantly more or less clean now than they were 10 - 15 years ago.  The first 2 problems you mention, though, those ought to be no-brainers.  Why the medical community hasn't been more firm is beyond me.  We've known this problem was brewing since before I was born, and since then it has, if anything, gotten easier to get perscriptions for drugs you shouldn't be taking!  I've walked out of the local doc-in-the-box with perscriptions for 3 different drugs for nothing more than a common cold once!  (I didn't fill them.)

This mutated strain of Staph is truly frightening.  I've lost one family member and a close friend to this bastard under almost the exact same circumstances.  Both were diagnosed with cancer and had to have chemotherapy.  With their immune system smashed to pieces, MRSA moved in.  First sign that anything was wrong was a rocketing fever.  Once the infection gets to your blood, the doctors can't do a damn thing.  It takes several days and is an extremely painful way to die.

Worse still, I'm not sure what they can do about it unless they can find a miracle drug.  No amount of hygiene improvement is going to get rid of this bug because it is everywhere.  You'd have to put the entire hospital inside a giant autoclave.

[bfobar]

They probably treated you with vancomycin. Which is why having a bacterium that is resistant to it is such a bugger.

Actually they treated me with a knife and a watersprayer. No antibiotic would touch it so they found the abscess in the joint, cut it open, and washed it out. The antibiotics didn't phase the stuff.

[Wanderer]

There was once something about potentiality of using bacteriophages ( = viruses) to kill bacteria inside human. As those semi-living and nicely selective killingmachines would target selective bacterial strains (or families) and get rid of them. I think Russians have used for some time now..

If it works as it has been described it would be extremely effective cure for bacterial infections. As viruses evolve alongside the bacteria resistance for the viruses would be difficult to achieve. Problem is the human immune system as it would target these viruses too..

[Kosh]

There was once something about potentiality of using bacteriophages ( = viruses) to kill bacteria inside human. As those semi-living and nicely selective killingmachines would target selective bacterial strains (or families) and get rid of them. I think Russians have used for some time now..

They don't use the phages themselves, instead they extract what ever chemicals the phages make. This way the immune system has no problems with it, and the bacteria is wiped out. Now why they don't do this in America is beyond me......

[Grug]

2) Patients deciding that they should stop taking the prescribed course of antibiotics because they feel better. (You stop taking them when the course is done you stupid ****s. Stop giving the bacteria a selection pressure in favour of resistance!)

[Wild Fragaria]

There was once something about potentiality of using bacteriophages ( = viruses) to kill bacteria inside human. As those semi-living and nicely selective killingmachines would target selective bacterial strains (or families) and get rid of them. I think Russians have used for some time now..

They don't use the phages themselves, instead they extract what ever chemicals the phages make. This way the immune system has no problems with it, and the bacteria is wiped out. Now why they don't do this in America is beyond me......

Don't see how and what kind chemicals could be extracted from the viruses 

Well the emergence of the superbug is mainly down to a few things.

1) Doctors giving out antibiotics for anything and everything (Any doctor who proscribes antibiotics should be taken out and beaten to death with a book on virology).
2) Patients deciding that they should stop taking the prescribed course of antibiotics because they feel better. (You stop taking them when the course is done you stupid ****s. Stop giving the bacteria a selection pressure in favour of resistance!)
3) Hospitals deciding that just cause we have better medicines these days that we can skimp on cleanliness

I know both doctors who have the habit prescribing antibiotics and, patients who love taking antibiotics.  I have often seen people taking antibiotics for common cold or flu.  Kara's right about the problem patients not following doctor's order and stop taking (or to start) the prescriptions.  Bottom line, I think the general public is still unaware of the seriousness of the superbug issue.  People have no idea (or simply do not care) about what a tiny antibiotics pills could do.

Last but not least, hospitals are not the only places battling the problem, nursing homes too are on the same page.

[Wanderer]

Don't see how and what kind chemicals could be extracted from the viruses 

Yeah, that kinda eludes me too... (and i'm supposed to be a biochemist) AFAIK they are injecting genuine viruses into the bloodstream to kill infectious microbes.

[aldo_14]

Reportedly one trialled use of a bacteriophage (from my old uni, nonetheless) to combat MRSA was to bond it with nylon strips, i.e. on bandages or sutures.  Apparently some bacteriophages can be tailored using existing bacteria (within the body) that the immune system ignores, or created to 'signal' an immune system response that protects the body from other pathogens (probiotic).

This suggests using a bacteriophage as a sort of carrier for medication, molecules, etc, and disguising it from the immune system using a polymer.  This also suggests (before the bacteriophage entry) using 'crippled' versions of harmful bacteria to block the harmful infections ability to access resources.

[karajorma]

I can only speak for the hospitals I've actually been in, but I don't think that the major hospitals in Houston are significantly more or less clean now than they were 10 - 15 years ago. 

That's cause they were sloppy 10-15 years ago too. I'm talking about 40-50 years ago when you would walk into a hospital and the place would reek of disinfectant cause that was the only way that had to keep the number of infections down.

It seems that in an effort to make hospitals seem like nicer places we've surrendered one of the first lines against transmission of germs.

I remember reading somewhere that a staggeringly high percentage of doctors don't even wash their hands between patients!

[Wild Fragaria]

Here's an article related to the hospital hygeine.  Looks like Kara's on top of the story 

Nature News Published online: 1 March 2006; | doi:10.1038/news060227-4

MRSA "hiding in hospital sinks and vases"

The deadly MRSA bug could be lurking in a hitherto unsuspected corner of hospital wards, by hiding away inside amoebae: single-celled organisms that flourish in settings such as hand-wash basins and vases of water.

British researchers have found that the deadly multidrug-resistant Staphylococcus aureus (MRSA) can live and reproduce inside amoebae, as well as being spread from person to person by bodily contact. The discovery, they argue, could mean that hospital personnel may find themselves fighting the killer bug on a new front.

"Amoebae are absolutely everywhere: on every sink in the hospital, and on any source of water," says Mike Brown of the University of Bath, who led the research. "If anyone touches the water, or doesn't wash their hands too well, they could find themselves tapping a new reservoir [of the bacterium]."

Doctors and nurses are currently advised to ensure that they wash their hands thoroughly, in an attempt to curb the spread of the MRSA bacterium, which severely affects around 7,000 hospital patients in Britain each year.

But Brown and his colleagues believe that this may not be enough. They advocate removing sources of water from patients' vicinity, including vases of flowers and open drinking vessels. Although the infection is generally spread from person to person, such reservoirs for amoebae could cause people to pick up the bug after they have disinfected themselves.

Brown and his colleagues make their recommendation after testing the growth of MRSA bacteria inside the amoeba Acanthamoeba polyphaga in the lab. As they report in the journal Environmental Microbiology1, the bacteria were able to infect and grow inside the amoebae, and numbers of free-living MRSA bacterial cells were around 1,000 times greater when cultured alongside A. polyphaga.

"This was certainly not known before," Brown says. And he fears that growing inside amoebae could even cause the MRSA strain to grow in potency. He points to the example of Legionnaire's disease, caused by the bacterium Legionella pneumophila, which becomes more virulent and more resistant to antibiotics after growing inside amoebae. "It's like a gymnasium for bacteria," he says.

It may nevertheless be premature to call for a change in hospital tactics, says MRSA expert Brian Austin of Heriot-Watt University in Edinburgh, UK. He recommends testing basins and other water sources in hospitals to see whether the processes spotted by Brown's team in the lab are actually occurring on the ward.

"I still think the greatest risk to hospitals is from human contact," he says. Austin stresses that the best advice is still to ensure that staff wash their hands properly, and ideally use the antimicrobial hand gel now found on many British hospital wards.

Brown, on the other hand, points out that there is still not enough awareness among hospital staff of how MRSA spreads. "I don't want to be too controversial, but people don't appreciate the ecology of a hospital; medics have very little microbiological training," he says.

He argues that the best people to consult are pharmacists, who have "ten times more time and experience than doctors" in working with bacteria-free conditions, such as in ensuring that drug preparations are not contaminated.

"Doctors are concerned with treating infections," Brown says. "But industrial pharmacists are more acutely aware of cross-contamination, and have the skills to deal with cross-infections."