The rapid development of antibiotic resistance has swept the human and livestock fields

Health officials are horrified to find that bacteria are beginning to develop resistance to a powerful drug, carbapenem, which is the last few drugs available Photo source: Nature In general, high-ranking public health officials try to avoid early warning descriptions As a result, the warning recently issued by Thomas Frieden and Sally Davies is very worrying Frieden and Davies say a health "nightmare" and "catastrophic threat" are coming Organizations are concerned about the rapid growth of a little-known antibiotic resistant bacterium, which belongs to the family CRES Davies, Britain's chief medical officer, described CRES as a threat comparable to terrorism, Nature reported "We are facing a very serious problem, and we need to give early warning." Frieden, director of the Centers for Disease Control and Prevention (CDC), said Their terrible language is not sensational CRES can infect bladder, lung and blood, which may lead to fatal septic shock Almost half of the patients died They can escape almost all antibiotics, including carbapenems, which were once considered the ultimate means of bacterial treatment If antibiotics don't work, routine surgery, such as hip replacement, could end up with a sixth mortality rate, according to an analysis released in the UK And Davies hope to break the public's indifference to antibiotic resistance But Alexander Kallen, a CDC epidemiologist, said: "it's too late to intervene and stop the continued deterioration of the situation." Hindsight Hindsight plays a very important role in the story of CRES In, CDC researchers analyzed data from a surveillance program called "epidemiology of bacterial resistance in intensive care" (Icare) The project, which lasted six years, was designed to monitor unusual anti drug factors in intensive care units From a large number of biological samples stored in the Icare project, scientists have detected a special sample, Klebsiella The bacterium was taken from a patient in North Carolina At that time, it had little resistance to carbapenems The antibiotic, invented in the 1980s, is a powerful broad-spectrum antibiotic Doctors believe that careful use can ensure that the last drugs, such as carbapenems, will be effective in the next decade But this Klebsiella strain breaks the idea The bacteria can produce an enzyme called KPC, which can defeat the attack of carbapenems What's more, the gene encoding this enzyme exists in plasmids and can be easily transferred from one bacterium to another Resistance to carbapenems has emerged But microbiologists initially thought CRE was an isolated case Jean Patel, a microbiologist and deputy director of CDC drug resistance office, said that the samples collected four years ago, as well as the test results of other samples, did not reveal further drug resistance, which removed the doubts of CDC scientists "It's not the lack of interest of scientists to explore this," Patel said But the attitude at the time was, "we have a system that can identify drug resistance, it's very effective, and if more drug resistance occurs, we'll know." But the CDC's monitoring program is limited: it tracks only 41 of about 6000 hospitals, and its analysis lags far behind sample collection So when carbapenem resistance reappeared, a few years later, no one knew Terrible trends The downstead Medical Center at New York State University (SUNY) attracts patients from poor neighborhoods, making it a place where terrible health trends emerge It's not part of the CDC Icare project, but physicians here conduct their own bacterial monitoring to examine the new threat of infection In, collaborators at the center's microbiology laboratory and nearby hospitals concluded that they reflected something doctors in the city had never heard of In the past six years, a small number of patients have been diagnosed with Klebsiella pneumoniae infection, and some have developed resistance to carbapenems "These drug-resistant events are rare and mysterious." John Quale, a medical researcher at the donstadt medical center, said, "we just learned about the outbreak." These infections are very serious A massive infection broke out in a hospital in Brooklyn, New York, killing nine of 19 patients The microbe continues to spread, from Harlem Hospital in North Manhattan to mount Sinai Hospital in the upper east, to Saint Vincent, where despite all the drugs available to doctors, infected people die One of the reasons the drug-resistant strains spread so fast is that they are hard to find Most clinical microbiology laboratories no longer spend days culturing bacteria to determine which drugs they are sensitive to; instead, they use automated systems to come to a conclusion within hours But Quale and his colleagues realized that the experiments were so misleading that the drugs doctors gave patients no longer worked By 2007, 21% of Klebsiella bacteria found in New York City had carbapenem resistant plasmids About 5% of Klebsiella are resistant in other parts of the United States This rapid spread suggests that CRES is human to human rather than isolated in different regions In fact, when Alexander Fleming, the penicillin discoverer, won the Nobel Prize in 1945, he predicted that the effectiveness of antibiotics would continue to decline as long as people kept using them It's because of this that doctors are very careful about using the most effective drugs, such as very careful rationing of vancomycin Vancomycin is mainly used in the treatment of staphylococcal infection It will be used when other antibiotics are ineffective It is also one of the last first-line drugs Even so, there are still vancomycin resistant bacteria, and antibiotic resistance is not just a human nightmare Problems in agriculture Approaching a farm in Iowa, you can hear the clatter of 500 piglets, "that's the sound of healthy pigs." Said Mike male Male is a veterinarian who has worked in a pig farm for more than 30 years On a hot June afternoon, he picked up a piglet, tied its hind legs, and began to examine its abdomen Male explained that the navel of a newborn piglet is an easy entry point for bacteria If the pig is infected, it will have an abscess under its navel "It will have a raised navel instead of a concave one." He said About six years ago, an outbreak of "exoconvex" occurred in this pig farm, marking the first detection of methicillin-resistant Staphylococcus aureus (MRSA) infection in pigs in the United States Over the past 40 years, MRSA has disrupted hospitals around the world In the United States, it causes about 94000 infections a year, 18000 of which die In the European Union, about 150000 people are infected with MRSA every year We studied bacterial infection in pigs with Tara Smith, an epidemiologist at the University of Iowa Smith surveyed farms, food stores, even people's houses and pets Her conclusions will help put an end to a heated debate about whether agricultural antibiotics have led to an increase in drug-resistant bacteria that infect people Scientists and health experts fear that resistant bacteria will "escape" through farm workers or meat Last year, the US Food and Drug Administration (FDA) proposed increasing restrictions on the use of antibiotics in livestock But meat and agribusinesses have been fighting these restrictions They claim that MRSA and other resistant bacteria have led to an increase in human infections in hospitals However, the safety measures of meat production enterprises, such as the environmental health regulations of slaughterhouses, can prevent the spread of drug-resistant bacteria and human infection "It's a long journey from farm to table." Ron Phillips, a representative of the American Institute of animal health, said Limited measures The main problem of agricultural antibiotic related research is the lack of data Some farmers are reluctant to let scientists into their facilities, and many farm workers in the United States are illegal immigrants, wary of those who want to collect their own samples But Smith and a team of researchers are starting to fill in the gaps Christopher Heaney, an epidemiologist at Johns Hopkins University in Maryland, said they "started to develop the knowledge form of the United States" and that Smith's current research will help government officials "really know where these bacteria that infect humans come from" Although some progress has been made in the research of drug-resistant bacteria in both human and animal infections, the measures against these bacteria are still very limited Compared with CRES when it first appeared, clinical physicians did not have better drugs to treat infected patients Some bacteria respond to tegacyclin and myxomycetin, but none of them has any effect on every patient, and myxomycetin has great damage to kidney Now doctors find themselves choosing between using bad drugs or not It seems unlikely that new drugs will appear soon With the rapid development of drug resistance, doctors need to use existing drugs more carefully to avoid that pharmaceutical companies think antibiotics are no longer worth investment Infectious disease experts say this means that to protect the bacteria left behind by patients, their best tools depend on the implementation of personal health strategies: hand washing, using gloves and isolation clothing, and aggressive environmental disinfection But Eli perencevich, an epidemiologist and infectious disease doctor at the University of Iowa, points out that even if the research can find the best solution, it will not bring much change.