Superbacteria

　　Today, the problem of bacterial drug resistance has launched a major challenge to the global public health field.

　　Every year, 700,000 people worldwide die from drug-resistant infections, and 230,000 newborns die. Studies have shown that bacterial drug resistance mainly comes from the abuse of antibiotics, including both human treatment abuse and excessive use of animals.

　　Antibiotics are "double-edged swords"

　　Antibiotics are a kind of secondary metabolites produced by microorganisms (including bacteria, fungi and actinomycetes) or higher animals and plants in the course of life, which have anti-pathogen or other activities and can interfere with the development function of other biological cells. At present, the commonly used antibiotics in clinic are genetically engineered bacteria, extracts from culture medium and compounds synthesized or semi-synthesized by chemical methods. If used reasonably, antibiotics are the bane of bacteria. If abused, bacteria will "immunize" it and become super bacteria, resulting in the final incurable infected person.

　　Superbacteria are bacteria that can’t be killed by using all antibiotics. This kind of bacteria can show resistance to almost all kinds of antibacterial drugs, even to powerful antibiotics such as carbapenem antibiotics and vancomycin, and some of them also show multiple resistance. Because patients are often unable to produce anti-bacterial antibodies from their own bodies after infection, the mortality rate is greatly increased.

　　Powerful antibiotics are usually regarded as the last line of defense against superbugs. Why is it so vulnerable? This will start with our daily medication habits. Generally speaking, we don’t have to use antibiotics in the face of common germs, but patients often ask doctors to cure them as soon as possible, so doctors will habitually use antibiotics in the face of minor illnesses. However, after taking the medicine, patients usually don’t use up all the drugs in a series of courses, and they will stop taking the medicine when their condition improves slightly, which is the main reason for the drug resistance of bacteria. In addition, excessive use of antibiotics in poultry and livestock feed is also a major cause of the outbreak of superbugs. At present, 80% of antibiotics in the world will flow into animal feed, and superbugs will be excreted with animal excrement, and these bacteria have evolved enough drug resistance in animal gallbladder before being excreted.

　　For example, a salmonella that can hardly be subdued by antibiotics can easily spread between people and animals. At present, we can only passively defend against this superbug, but we can’t actively attack it. The main source of this superbug is almost all the intestines, and we are all likely to come into contact with these bacteria that were originally parasitic in the intestines. The World Health Organization admits that it is a very difficult clinical problem that Enterobacteriaceae is resistant to many commonly used and widely effective antibiotics.

　　The influence affects all walks of life. In fact, bacterial drug resistance is not a problem that only exists in the health field. Statistics show that between 2000 and 2014, the standard dose of antibiotics used worldwide has increased by 50%. A research report published by the World Bank on September 19th, 2016 shows that by 2050, the medical expenses of drug-resistant infections will account for 1.1% ~ 3.8% of the world GDP. According to the current development trend, by 2050, the problem of bacterial drug resistance will kill 10 million people every year, and superbugs will also lead to global economic losses of $6.1 trillion. At the same time, problems such as labor shortage, rising medical costs and shrinking market will follow. At that time, the world economy may face a more serious blow than the 2008 financial crisis, especially for developing countries. By 2050, it is expected that the GDP of these countries will decrease by 5% as a whole.

　　According to the research results of the European Bureau for Disease Control, the development speed of modern medicine is nothing compared with the speed of preventing bacterial drug resistance and bacterial variation. The resistance of human body to antibiotics is increasing, and the tools that human beings can use to deal with drug-resistant bacteria are almost used up. If market forces are allowed to allocate resources by themselves, it is impossible to complete the research and development of a new generation of antibiotics on time, and the candidates for research and development of antibiotics will be basically exhausted.

　　The deadliest superbug.

　　On February 27th, 2017, based on the clinical drug resistance, the mortality caused by drug resistance, the frequency of people’s infections and the burden of these infections on the health care system, the World Health Organization released the list of 12 superbugs with the highest priority for the first time. They are Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacteriaceae, Enterococcus faecalis, Staphylococcus, Helicobacter pylori, Campylobacter, Salmonella, Neisseria gonorrhoeae, and Campylobacter. The researchers classified them into three categories according to their degree of danger: emergency, high priority and medium priority.

　　At present, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacteriaceae have been listed in the emergency level. These highly pathogenic bacteria will not only cause drug-resistant infections, but also bring a heavy burden to the existing medical system and take the lives of patients. Among them, Acinetobacter baumannii is resistant to carbapenem antibiotics, which is easy to cause serious infections in hospitalized patients, such as pneumonia, wound or blood infection. Pseudomonas aeruginosa is resistant to carbapenem antibiotics, which can easily lead to rash and ear infection in healthy people, and also lead to serious blood infection and pneumonia in hospitalized patients. Enterobacteriaceae bacteria inhabit human intestines and are resistant not only to carbapenems but also to cephalosporins. In 2014, among the samples of Escherichia coli (a common intestinal bacteria) collected by the World Health Organization, penicillin was ineffective in 60% of the samples, and about 25% of the samples were resistant to one or two other commonly used antibiotics.

　　Enterococcus faecalis, Staphylococcus, Helicobacter pylori, Campylobacter, Salmonella and Neisseria gonorrhoeae are classified into high priority categories, and their main feature is that they are easy to cause infection in healthy people. At present, there is no particularly effective method to combat this kind of infection. The remaining Streptococcus pneumoniae, Haemophilus influenzae and Shigella are given medium priority. The resistance of these three pathogens to existing antibiotics is still increasing, among which Streptococcus pneumoniae, which is insensitive to penicillin, is easy to cause pneumonia, ear sinus infection, meningitis and blood infection.

　　"Drug-resistant bacterial infections are posing a serious threat to our health care system today," said the head of the drug-resistant infection division of Wellcome Trust, a British medical charity. "The list of superbugs made this time is very important to guide the research and development of antibiotics against drug-resistant bacterial infections. If new antibiotics are not developed, 10 million people will die every year because of drug-resistant bacteria infection. In addition, if we fail to develop new drugs against deadly infections, then some treatments and means that could have saved lives, such as chemotherapy and organ transplantation, may also induce death. "

　　Superbacteria ravage many countries.

　　Recently, the European Bureau for Disease Control issued a warning against the current situation of bacterial drug resistance: a superbug is sweeping across Europe. In a physical examination report on animals and food published by the European Union, the name of bactericidal antibiotic clarithromycin appeared for the first time, which is almost the last line of defense antibiotic for those infected by super bacteria. Inspectors can find traces of them in animals and food, indicating that some people have easily used such drugs for some reasons.

　　The report also pointed out that in the pork tested in Europe this time, the staff have found a very small number of drug-resistant Escherichia coli. If these Escherichia coli or Salmonella are transmitted to humans by pigs or cattle, then we will not have any effective antibiotics to deal with them. The report also shows that people in northern and western European countries are generally less resistant to bacteria than those in southern and eastern Europe, which is probably caused by the abuse of antibiotics.

　　At present, Russia is being invaded by superbugs. Scientists have found three kinds of bacteria on the list of superbugs of the World Health Organization in 15 big cities, including Moscow and St. Petersburg. "Three kinds of superbugs were first discovered in the laboratory of St. Petersburg Institute of Children’s Clinical Infectious Diseases," pointed out Yuri Robzin, an academician of the Russian Academy of Sciences. "They can cause abscess, meningitis and septicemia. If we don’t take action now, in the next 10 to 15 years, human beings may die from the humble acne suppuration. "

　　On May 26, 2016, US health officials reported that the first case of bacterial infection resistant to all known antibiotics had been discovered in the United States. The patient was a 49-year-old woman from Pennsylvania. At that time, she went to the clinic because of urinary tract infection, and the doctor used colistin, an antibiotic specially used to fight "nightmare bacteria", but the condition was not controlled. The journal of American Society for Microbiology, Antimicrobial Agents and Chemotherapy, published a report on this infection case. The report said that this superbug itself was first infected by a small DNA molecule called Plasmid, and the plasmid carried the mcr-1 gene that was resistant to colistin. "This shows that there are truly pan-drug-resistant bacteria," warned Tom Freeden, director of the Centers for Disease Control and Prevention (CDC). "This is the first case of mcr-1 reported in the United States. We face the risk of being in the post-antibiotic world. If this super bacteria is allowed to spread freely, it may’ devour’ everyone in the future. "

　　Real countermeasures

　　However, some medical experts have pointed out that the term "superbugs" has actually existed for many years, and some superbugs have even become very common. But in our environment, superbugs are still a minority after all, so you don’t have to panic too much.

　　Facing the challenge of superbugs, we should change our thinking: instead of investing more powerful antibiotics to "exercise" them, we should let them return to the ecological competition of the original colonies. Among bacterial colonies, if there is no selective pressure of antibiotics, it will not optimize the "particularly powerful role."

　　In addition, we should strictly abide by the guidelines for the use of antibiotics in clinic: try not to use antibiotics for patients with bacteria who have no signs of infection. In fact, without the intervention of antibiotics, drug-resistant bacteria are more likely to be replaced by wild drug-resistant bacteria and then disappear from the human body. Abuse of antibiotics will only "strengthen" the strength of drug-resistant superbugs while killing other bacteria. Therefore, adhering to good hygiene habits and striving to improve physical fitness are the truly effective ways to avoid bacterial infection and combat superbugs. Although the iterative update of antibiotics can control the temporary disease invasion, it also gives birth to more powerful drug-resistant bacteria. I would like to ask, in the long run, when is the head?