A new Australian study has discovered that Enterococcus faecium, a bacteria already resistant to several drugs, has also evolved in response to the alcohol solutions used to disinfect in hospital settings. According to the study,

Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant Staphylococcus aureus and Enterococcus faecium. Despite this success, health care infections caused by E. faecium are increasing. We tested alcohol tolerance of 139 hospital isolates of E. faecium obtained between 1997 and 2015 and found that E. faecium isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates.”

Understanding Balance

Sanitation has been hailed as one way to combat antibiotic-resistant bacteria, particularly methicillin-resistant Staphylococcus Aureus (MRSA) and Clostridium difficile (C.diff). Sanitizers with at least 60 percent alcohol are recommended by both the World Health Organization (WHO) and the Centers for Disease Control (CDC). Both organizations cite alcohol-based disinfectants ability to annihilate bacteria. This leaves the microbiome like a blank slate, and like with any power vacuum, a new bacteria steps in to fill the void. In this case, it’s E. faecium.

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Enterococci bacteria are behind some of the most commonly experienced infections, particularly UTIs, pelvic infections, and endocarditis. Most of the E. faecium strains that cause these infections originate in the gut, which isn’t a surprise. Like another likely cause of infection, candida, E. faecium is found in 90% of human intestines. It isn’t an inherently harmful bacteria. The problem occurs when the gut isn’t able to balance out the microbes, and E. faecium takes over to the detriment of the entire system.

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Looking at It Right Side Up

This is the biggest problem with our understanding of microbes and antibiotics. We talk about how dangerous a bacteria is or how serious infections caused by that fungus are…but odds are good you have been living with those organisms all of your life without issue. What’s changed?

The importance of your gut bacteria and properly balancing them cannot be overstated. By killing all of the bacteria, antibiotics allow the quickest ones to take over more easily. Antibiotics also destroy the hard work of building up your beneficial bacteria. Think of them like a helpful two-year-old. They want to do the right thing and help clean up, but you’re left with an even bigger mess than you started with.

Sources:

• Increasing tolerance of hospital Enterococcus faecium to handwash alcohols – Science Translational Magazine
• 5 facts about Enterococcus faecalis – BioCote
• Hospital Superbugs are Evolving to Survive Hand Sanitizers – Ars Technic

The newest offender in the antibiotic-resistant bacteria epidemic is urgent care centers, where 46 percent of people who entered with conditions that don’t respond to antibiotics (viruses, etc…) left with a prescription anyway. That figure is significantly higher than emergency rooms (25 percent) and standard medical offices (17 percent). Those numbers are scary, as traffic to urgent care centers is on the rise and likely to increase as conventional healthcare becomes a luxury. Right now, urgent care centers and retail clinics account for 40 percent of all antibiotic prescriptions as well as a market share worth 26 billion dollars in the next 5 years.

Where the Numbers Come From

These numbers come from the 2014 Truven Health MarketScan Commercial Claims and Encounters Database and are from individuals under 65 with employer-sponsored health insurance. The database only accounts for those with insurance though. A survey from ten years ago found that uninsured patients at urgent care clinics account for 12 percent of all visitors. Since then, the number of customers at urgent facilities to has increased by more than 20 percent. If nothing changes, that figure will continue to rise. The number of unnecessary and inappropriate antibiotic prescribed will likely continue along with the number of visitors.

Related: How to Detoxify From Antibiotics and Other Chemical Antimicrobials

Saying No

While many people know that doctors prescribe unnecessary antibiotics, not everyone knows how inappropriate some of those scripts are. These are a big deal. In the new era of antibiotic-resistant superbugs, this negligence is unacceptable.

Some conditions are more likely to be given an antibiotic prescription than others. Many of these are viruses or infections that attack the lungs, like viral upper respiratory infection, bronchitis/bronchiolitis, asthma/allergy, influenza, and viral pneumonia. Always do your own research, as this study makes it clear that even doctors are not always clearly informed as to what they are giving you.

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The Bottom Falls Out

Antibiotic-resistant bacteria will be one of the major causes of death by 2050 if something doesn’t change. There are no new antibiotic breakthroughs on the horizon. The meat industry will be crippled without antibiotics, as it relies on those medications to make up for diseases that flourish in animals with poor quality food and living conditions. The changes to the medical industry will be as, if not more dramatic.

Every time you turn around, it feels like there is another, previously uninvestigated source of antibiotic-resistant bacteria. From the overuse of antibiotics in food animals, healthcare settings that serve as bacteria breeding grounds, a lack of new antibiotics, among other factors, this is a multi-faceted problem…and one that is here to stay.

That bell cannot be unrung.

Sources:

• Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States – JAMA Network
• Urgent care centers often prescribe unnecessary antibiotics – Reuters
• Urgent care center market on track to hit $26B by 2023 – Health Care Drive
• Urgent care centers in the U.S.: Findings from a national survey – NCBI
• Even Proper Use of Antibiotics Results in the Emergence of Superbugs – Mr. Said Blog
• Patients are flocking to urgent-care clinics. Now hospitals are, too – Modern Healthcare

The majority of bacteria found on supermarket meat is antibiotic resistant, according to the Environmental Working Group. The EWG follows the Food and Drug Administration’s yearly bacterial contamination and resistance tests, and the analysis of the most recently released year, 2015, shows that almost 80% of bacteria discovered on supermarket meats is resistant to antibiotics. The bacteria detected, including salmonella and Enterococcus faecalis, demonstrated resistance to crucial antibiotics like amoxicillin and tetracyclines. To listen to the FDA, antibiotic-resistant bacteria in the meat aisle at the grocery store is not an issue, but Dawn Undurraga, EWG’s nutritionist and author of the report, sees things differently.

Consumers need to know about potential contamination of the meat they eat, so they can be vigilant about food safety, especially when cooking for children, pregnant women, older adults or the immune-compromised…By choosing organic meat and meat raised without antibiotics, consumers can help reduce the amount of antibiotics used in farm animals and slow the spread of drug resistance…”

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What to Look For

Different types of meat registered at different levels of antibiotic-resistant bacteria, and the winner of the title most resistant goes to ground turkey. Seventy-nine percent of ground turkey tested positive for antibiotic-resistant bacteria. This continues a trend, as 73% of salmonella detected on turkey in 2014 was resistant to at least one antibiotic. Other types of meat tested also displayed antibiotic-resistant, though not on the same level, with pork chops at 71%, ground beef at 62%, and chicken breasts, leg, wings, and thighs at 36%.

Tetracyclines were another major point of concern. These are the most used class of antibiotics in food animals, and it shows in the percentage of bacteria that are resistant to that specific class. The bacteria responsible for an estimated 80 percent of human infections, Enterococcus faecalis, had significant resistance to tetracyclines across the different meats tested. Enterococcus faecalis on pork had the highest numbers, with 84 percent of bacteria present demonstrating tetracycline resistance. Chicken showed 71 percent resistance, and 26 percent of the bacteria found on beef registered resistance.

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The Resistance is Growing

The meat industry in the U.S. is deeply flawed. E.coli has developed resistance to all 14 of the antibiotics the FDA tested in 2014. Salmonella was not far behind, developing resistance to 13 of the tested antibiotics. Several countries have limited or banned meat imports from the U.S., either due to chemicals that are given to animals during their life (pork treated with ractopamine is rejected by China) or the final treatment of meat for sale (chlorine-washed chicken in the European Union). The recent report released from the FDA suggests that those things are unlikely to change in a timely fashion.

So how do you protect yourself? With how quickly antibiotic resistance is evolving, the only meat you can eat that’s guaranteed to be free of resistant bacteria is no meat. If that’s not an option you’re ok with, make sure you’re buying responsibly raised meat, not treated with antibiotics and free range. Find your local farmer and talk to him about his animal treatment practices. Know where your food is coming from.

Sources:

• Supermarket Meat Still Superbugged, Federal Data Show – EWG
• 2015 NARMS Integrated Report – FDA.gov
• Superbugs Found in Most U.S. Supermarket Meat – Organic Consumers
• Chlorine Wash Doesn’t Remove Salmonella on Chicken – Organic Lifestyle Magazine

Fungal infections are demonstrating resistance to fungicides in the same way that bacteria react to antibiotics, warns a new report in Science magazine. Many perceive fungal infections like candida, athlete’s foot, and others to be relatively harmless, but an estimated 1.5 million worldwide die from fungal related causes. These microbes have slowly been building resistance to traditional methods of treatment, and according to the report, that’s scary news.

Fungal infections on human health are currently spiraling, and the global mortality for fungal diseases now exceeds that for malaria or breast cancer.”

How Did We Get Here

These potentially devasting microbial evolutions follow the same pattern. People and animals are given large amounts of unnecessary antibiotics or fungicides. Even if these drugs kill all of the pathogens they are meant to (and they don’t always), they also eliminate the beneficial bacteria as well. Once the beneficial bacteria is cleared out, bacteria and fungus left untouched by the treatment have a clear field to thrive. This allows the microbes strong enough to withstand the medication with the best possible environment for it to colonize.

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Scientists predict a yearly death rate of 10 million people from antibiotic-resistant bacteria in the year 2050 if things continue as they are. Currently, deaths from those bacteria number 700,000 people a year. Estimates for deaths caused by fungal infections this year are at 1.5 million. Fungus and their spores are causing more deaths, and the most commonly used treatments for fungal issues are being used more frequently and diversely than antibiotics are.

Burying the Lede

There are two reasons to be incredibly concerned about antifungal-resistance. We are using azoles, the most commonly used family of antifungals, as medicine for people and animals, as crop protection, for preserving lumber, and as antifouling coatings applied to the outside of ships. These fungicides are everywhere, and if we’ve learned anything from the widely published antibiotic-resistant superbugs, this is bad news.

Another reason? The fungus is impossible to contain, and fungi are better at becoming airborne than other pathogens like bacteria and viruses. Every inhale contains multiple fungal infections waiting to happen. Much of our food is grown with fungus specifically added to it. There is no escape.

Related: How to Kill Fungal Infections

Taking It Seriously

Agriculture has known about fungus resistance to azoles for more than a decade. We’ve been on this train for a while now, and no one is activating the brakes. How bad is the crash going to be?

Immune System Importance

Dangerous mycotoxins (toxic substances produced by fungi) can develop in the compost pile, household mold, grains like wheat and sorghum, pet food, and dietary supplements. More people die from fungal infections than from tuberculosis. People who are taking antibiotics or who have compromised immune systems are especially susceptible. Which boggles the mind really…antibiotic use leaves you at a greater risk for a potentially dangerous fungal infection.

Related: How To Heal Your Gut

We can’t always control what we’re exposed to. The most common (and frustrating) fungal infections are caused by candida, a necessary digestive microbe! What we can control is how our body reacts to them. Balancing your microbes is key to a healthy immune system and avoiding serious illness.

Sources:

• Deaths from fungal infections exceeding malaria, say researchers in new drug resistance warning – The Independent
• Worldwide emergence of resistance to antifungal drugs challenges human health and food security – Science Magazine
• How fungi kill millions globally – CNN
• Genesis of Azole Antifungal Resistance from Agriculture to Clinical Settings – Journal of Agricultural and Food Chemistry
• Attacking fungal infection, one of world’s major killers – Science News

A new paper published in the American Journal of Infection Control examined reusable endoscopes cleared for patient use at three separate hospitals in California and found that sanitation procedures are lacking. At the best performing hospital, 62 percent of scopes had positive results for bacteria and potential pathogens. The other two had even higher percentages of bacteria with 85 and 92 percent. While researchers confirmed the lack of antibiotic-resistant superbugs on the scopes, that prospect is a when not an if.

What Is an Endoscope?

An endoscope is a thin, flexible tube with a light and a camera at the end, usually inserted into the body through the mouth or the anus. They are commonly used to navigate the colon, stomach, and esophagus, although they’ve also gained popularity as a way to examine the ears, throat, heart, nose, abdomen, urinary tract, and joints. Most of the people who experience endoscopy suffer from gastroesophageal reflux disease, GERD. According to the American Hospitals Association, the lifespans of endoscopes like gastroscopes and colonoscopes range from five to ten years.

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Why it’s Problematic

Not to activate your inner germaphobe, but this should make you wary of medical procedures where they insert something into you to figure out what’s going on. Doctors from the American College of Physicians reporting in the Annals of Internal Medicine found that the “Overuse of upper endoscopy contributes to higher health care costs without improving patient outcomes…” Numbers vary, but as many as forty percent of endoscopies don’t do anything to improve patient health. Is figuring out exactly what’s wrong with you worth inserting years of hospital bacteria into your system?

Not the First Warning

“Sadly, in the 10 years since we’ve been looking into the quality of endoscope reprocessing, we haven’t seen improvement in the field,” said Cori Ofstead, the study’s lead author and an epidemiologist in St. Paul, Minn., referring to how the devices are prepared for reuse.

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The issue of properly sterilizing this equipment has been and will continue to be a point of contention for hospitals and regulators. Researchers reported that the two hospitals that showed incredibly high numbers of bacteria reused towels when cleaning scopes, left the devices wet in dirty cabinets, and skipped necessary equipment washing procedures to save time. And they knew they were being watched.

No Quick Fix

There is no such thing a benign medical intervention. Being in the same room as someone who has taken antibiotics can affect your own microbiota, and a hospital is a fertile breeding grounds for hardy and potentially harmful pathogens like C. diff. A bacteria prone to antibiotic resistance, studies have shown rates of C.diff are greatly decreased in facilities that take sanitation seriously. This study found that the best of hospitals only eliminate less than half of bacteria left on reusable medical devices. Something to think about before you schedule your next colonoscopy, perhaps…

Sources

• Hospitals and device makers still struggle to rid medical scopes of infectious bacteria – LA Times
• Types of Endoscopy – cancer.net
• How C. Diff Infections Decrease With fewer Antibiotics – Organic Lifestyle Magazine
• Endoscopy Overused in Heartburn Patients – Web M.D

Antibiotic-resistant bacteria, particularly those included in the Enterobacteriaceae family like E.coli and salmonella, is one of the most urgent crises facing the healthcare industry. Figures predict 10 million deaths a year will occur worldwide by 2050 if nothing changes, and that doesn’t even take into account the long-term health issues those who survive will face. Currently, those who contract this kind of infection face a mortality rate of 40 to 50 percent. If that’s not enough to send a frisson of worry down the back of your neck, researchers at Emory University in Atlanta have discovered a strain of Enterobacteriaceae (CRE) where current diagnostic tests are unable to detect it’s resistance to medicine’s last line of defense. According to the study,

The data are worrisome, especially since the colistin heteroresistance was not detected by current diagnostic tests. As these isolates were carbapenem resistant, clinicians might turn to colistin as a last-line therapy for infections caused by such strains, not knowing that they in fact harbor a resistant subpopulation of cells, potentially leading to treatment failure.”

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Bacteria Evolution

The strain is called Klebsiella pneumoniae (CRKP), and it’s resistant to almost all available antibiotics, including carbapenems, a commonly used treatment for multidrug-resistant bacteria. Prior to this study, scientists thought it was still susceptible to colistin, the antibiotics of last resort, at a dose of 0.5 ml or less. A closer look at that bacteria has revealed that 1 in 1,000 CRKP cells can survive a dosage four times that (2 ml). Those cells are genetically identical to the antibiotic- susceptible bacteria, and scientists identified a protein in the cell’s membrane that signaled another protein inside the bacteria to turn resistance on and off. This communication system enables the bacteria to hide in plain sight, and our current health system has no way to counter it.

A New System

This is not the first and will not be the last study to reach the conclusion that something in the healthcare system is fundamentally flawed. Sick? Take antibiotics. Still not better? Here are stronger ones! Scientists have confirmed that current diagnostic tests can’t even properly determine how to treat these pathogens, and yet clinicians keep throwing the same pharmaceuticals at them. And even those practices are in serious danger, as the World Health Organization has confirmed recently that the world is running out of antibiotics.

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So much of our modern lifestyle is designed to be easy and convenient and it can be hard to see what the actual cost of it is. The bill has arrived for the antibiotics. Are we prepared to pay it?

Sources:

• Deadly superbug just got scarier—it can mysteriously thwart last-resort drug – Ars Technica
• Carbapenem-Resistant Klebsiella pneumoniae Exhibiting Clinically Undetected Colistin Heteroresistance Leads to Treatment Failure in a Murine Model of Infection – American Society for Microbiology
• WHO Says the World Will Run Out of Antibiotics Able to Treat Bacteria Superbugs – Organic Lifestyle Magazine

Researchers in the United Kingdom have found that supermarket chickens have a higher proportion of Campylobacter bacteria than they did ten years ago. Drug-resistant Campylobacter is a major cause of concern for health officials, with more than 300,000 infections a year in the U.S. causing symptoms like diarrhea, fever, abdominal cramps, and temporary paralysis. The elevated levels of this pathogen in supermarket protein confirm what scientists and medical professionals have increasingly been saying – treating food animals for long periods with antibiotics intended for human use has caused a major health crisis.

Dangerous Practices

If we are unable to find an answer to antibiotic-resistant pathogens, the World Health Organization predicts that they will kill more people than cancer does by the year 2050. Even major pharmaceutical companies like GlaxoSmithKline and Pfizer are beginning to recognize the severity of this issue, removing or adjusting sales incentives related to the sale of antibiotics. Yet British and European authorities still allow chickens to be treated with fluoroquinolone antibiotics, that have been restricted by the FDA for human use.

The Tipping Point

Pharmaceuticals have been slow to develop new antibiotics, and farmers continue to use medication intended for human use on their food animals. At some point, something will need to change. So what can you do right now?

The easiest and most obvious way to protect yourself is to avoid antibiotics, through what you consume and the medications you take. Conventionally raised meat and dairy are a key factor in the rise of antibiotic-resistant bacteria and should be avoided.  While antibiotics may be necessary in some cases, they are prescribed far too often in the modern medical system. Fortifying your immune system decreases the likelihood of catching a bug that would need antibiotic treatment.

Sources:

• Chickens From British Supermarket Show Record Levels of Antibiotic Superbugs – Collective Evolution
• Biggest Threats – CDC.gov
• Be Warned: FDA Issues New Stronger Warnings About Risks of Fluoroquinolone Antibiotics – Collective Evolution
• Four companies move to decouple antibiotic sales volumes from sales agents’ bonuses – Access to Medicine Foundation