Monumental changes are needed in the way Americans use antibiotics, disinfect hospitals and treat disease if the growing threat of bacteria-caused infections called "superbugs" is to be contained, leading infectious disease experts warn in a scientific article to be published Thursday.
Dozens of strains of little-understood microscopic bacteria kill tens of thousands of people a year in the United States - largely because they have developed resistance to antibiotics from overuse in this country.
"We cannot confront resistance unless we stop exposing the environment to massive quantities of antibiotics and their resulting selective pressure," says the article published in the New England Journal of Medicine.
Los Angeles County health officials discovered a pervasive problem with drug-resistant bacteria last year when 356 "superbug" cases were detected in medical facilities from June to December. The culprit was a bacteria called Klebsiella pneumoniae or CRKP.
The most common type of deadly bacteria - methicillin-resistant staphylococcus aureus, or MRSA - is treatable. But many other bacterial strains - including CRKP - have no known treatment, said Dr. Brad Spellberg, a lead researcher at Los Angeles Biomedical Research Institute (LA BioMed) near Torrance.
Spellberg authored the article, titled "The Future of Antibiotics and Resistance," with two other infectious disease experts.
"There isn't one single thing that's going to fix this if we're going to get back ahead of the microbes," Spellberg said. "To me, the iceberg has already hit the ship. It's just how much water are we going to take on until we decide to push past the traditional and push the boundary in how we respond."
Their recommendations include developing:
Self-cleaning hospital rooms.
A public reporting system of antibiotic use and resistance data.
Waste-treatment strategies that remove antibiotics from sewage.
Treatments that don't kill bacteria, but rather alter its impacts on the body so it doesn't kill the host or cause disease.
Simply developing new antibiotics to kill bacteria is not sufficient because the microbes are too adept at developing antibiotic resistances, Spellberg said. A dramatic shift in the traditional way of fighting disease is needed, he said.
"Maybe we don't need to kill bacteria and maybe we need to change the way bacteria interacts with the host," Spellberg said. "If you're not killing the bacteria, you're not selecting for resistance. If all you're doing is modulating how bacteria interacts with the host, then there's no selective pressure."
The researchers also support federal legislation that would end the use of antibiotics for livestock growth, and create pathways for quicker federal approval of new drugs in order to more quickly combat new bacterial strains. Also, they said the lack of federal and private funding sources to research and develop new treatments is a major problem because pharmaceutical companies have stopped investing in these less-profitable areas.
"We need to invest in basic and clinical research and policy activities," Spellberg said. "There are pieces of legislation that are relevant that have never been voted on."
These harmful bacteria are often spread in hospital settings, so the article suggests prevention measures that include developing self-cleaning hospital rooms, and also making overall improvements in public health and health-care delivery.
"If we want a long-term solution, the answer is not incremental tweaking of these policies and processes," the article states. "Novel approaches, based on a reconceptualization of the nature of resistance, disease and prevention, are needed."
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