[AaronFriel]

The most understated portion of the article is that there is a method discovered that can kill biofilms. The discovery of new antibiotics and delivery techniques leaves me less optimistic for long-term change in the availability of life-saving antibiotics. I suspect bacteria can, and will, evolve around almost any mitigating technique we develop.

Yet I'm optimistic, because tools that crack biofilms are a new are of development and promise hope for exploring new attacks on bacteria. Current methods of biofilm dispersal are application of strong acids and bases or an autoclave. You can't treat a hospital room with an autoclave, and comprehensive treatment of a room with very strongly ionizing agents has its own risks. There are other, experimental methods, but all are worth examining.

I hope research like this continues.

[_Adam]

>I suspect bacteria can, and will, evolve around almost any mitigating technique we develop.

That's a baseless suspicion. Bacteria are ultimately bound by physical laws, and while they've proven resilient, there's no reason to suggest we will be unable to develop the means to annihilate them at will. Humans are creative - bacteria just evolve fast.

I agree about the importance of the biofilm claim, but what they don't explain is how they actually achieve this. Their method of disabling that particular protein doesn't directly address the problem of the biofilms having a less-permeable extracellular matrix.

[AaronFriel]

The problem of killing bacteria, as I see it, will increasingly become something akin to the demarcation problem of philosophy. Why would it not be? It is natural that the optimal situation for pathogenic bacteria to be in is one in which they are indistinguishable from necessary cells. It may take an extraordinarily long time, but until we are able to completely eradicate a pathogenic bacteria from the earth, we will remain in that arms race.

Humans are creative at killing bacteria, though it's already not difficult to "annihilate them at will". It's much harder to annihilate only the ones we don't like, only the ones that harm us, and only the ones that pose the greatest risk.

[HelloMcFly]

I feel a more likely future scenario is one in which we create cell-sized robotics that we can use for very narrowly targeted operations in the human body, like treating bacteria. As the bacteria mutates, so does the targeting mechanism in the software that programs the tiny robots.

[_Adam]

But as I said, they are ultimately bound by the laws of nature. Evolution can only happen so quickly; they can only evolve their genome so much in a given period of time.

What you're suggesting is they'll evolve to look like human cells. But that doesn't make sense. They would need to evolve that way in a single generation. Something that's "almost like" a human cell would just be wiped out.

Just consider how long it took for the last common ancestor (of humans and bacteria) to evolve into a single celled organism.

[joe_the_user]

I agree that we humans don't have to expect bacteria to always evolve methods to resist our medical interventions. However, I think the most effective thing, maybe the only, we can do is actually look at the process of bacterial evolution.

That is, unless antibiotics are wildly over-used and human pathogens are concentrated in one place facing constant medical intervention, human medical intervention is going to be a very small, unimportant part of bacterial evolution.

Unfortunately, antibiotics are widely over used and pathogens are concentrated in poor administered hospitals.

If we stop these practices and we could stop these practices, then antibiotic-resistant bacteria would have little evolutionary incentive to exist.

[DanBC]

> Unfortunately, antibiotics are widely over used and pathogens are concentrated in poor administered hospitals.

Some countries have people who sell incomplete courses of anti biotics, without a prescription.[1] Someone can buy a few days worth of pills - enough to get them over the illness, but also enough to promote anti biotic resistance.

For example, people in India die from pnumonia (largest killer of children in India) and these people need to use antibiotics. They often can't afford a complete course. And then other people misuse antibiotics for simple diarrhoea, which isn't helped with antibiotics.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3193708/

> The bacterial disease burden in India is among the highest in the world1; consequently, antibiotics will play a critical role in limiting morbidity and mortality in the country. As a marker of disease burden, pneumonia causes an estimated 410,000 deaths in India each year2, and it is the number-one killer of children3. Many of these deaths occur because patients do not have access to life-saving antibiotics when and where these are needed. At the other extreme, antibiotics are used in situations where these cannot be expected to improve the patient's condition, particularly as treatment for the common cold and uncomplicated cases of diarrhoea (which are appropriately treated with oral rehydration therapy).

[1] http://www.thehindu.com/sci-tech/health/policy-and-issues/an...

> The rise is substantial in the retail sector where antibiotics are mostly sold without a prescription,

[crusso]

Humans are creative - bacteria just evolve fast

Yeah, but once we get good enough to annihilate them at will we will also have a similar power to improve them through tinkering.

Just like computer viruses continue to be developed by people, biological agents will be developed as well.

Some human tinkering will be for the heck of it. Some will be government level projects that get out of control. Eventually, organized crime will be in on the action.

Imagine Cryptolocker (http://en.wikipedia.org/wiki/CryptoLocker) but with a biological agent.

[_Adam]

It's certainly possible that one day we'll have desktop genome-printers. Any technology can (and often is) abused, and that would be no exception. Hopefully, there will be a Kaspserky for this era. A "Gene Kaspersky", if you will.

[ImprovedSilence]

killing bacteria alone isnt a problem. Killing bacteria while keeping a human alive starts to complicate the problem. Killing certain bacteria while keeping a human and the rest of said humans helpful bacteria alive but not resistant to anti-bodies, is a whole different ballgame...

[coldtea]

>killing bacteria alone isnt a problem. Killing bacteria while keeping a human alive starts to complicate the problem.

Thank you Captain Obvious.

[Fomite]

You'd think this was "Captain Obvious", but this is genuinely a challenge for some bacterial infections. Its even worse for fungal infections, as fungi are eukaryotic and thus share a alarming number of potential drug targets with human cells.

[gnaffle]

What I'm more concerned about is that new, creative innovations (nanobots etc) can have more sinister uses and might ultimately prove a bigger risk than our current bacteria.

[sard420]

My guess nano-bots that save, will come after we've made them kill.

[rsync]

"You can't treat a hospital room with an autoclave"

Hmmm... that sounds like an awfully good idea, actually...

Build the hospital room with the ability to be airtight, make sure all materials can withstand 134 C (or remove things that can't for their own cleaning) ... and autoclave the room ...

[joe_the_user]

There are simpler things.

Like not having mega-hospitals that are impossible to keep entirely clean.

Growing up near the UCLA Medical Center, a vast, vast complex, I heard tales that there were diseases that existed there and nowhere else in the world. Most patients derive little benefit from the scale of the hospital and the fact that in a huge hospital getting all rooms clean at once is logistically very difficult means that scale can be very dangerous.

[Fomite]

I'm...not sure I agree with most of this.

First of all, the size and scope of the hospital has very little to do with whether or not any particular room can be cleaned. The things that are "hard" to clean in rooms are features of the rooms themselves, not the number of them. For example, even small hospitals have TV remotes, soft and absorbent surfaces like mattresses, toilets, etc.

For that matter, small hospitals can't benefit from the economies of scale that allow large hospitals to have dedicated specialist cleaning teams for high risk rooms, or for that matter dedicated infection prevention staff.

[joe_the_user]

First of all, the size and scope of the hospital has very little to do with whether or not any particular room can be cleaned.

Uh, you're right but you're missing the implication. Scale influences whether every room can be clean simultaneously. A given room being dirty and infected with a bug adapted to surviving in a hospital lets said bug be tracked or blown to a different room before the bug is eliminated from the first room.

As for dedicated teams, I don't see why such things couldn't exist on a city-wide basis if they were useful.

The question whether healthcare benefits economies of scale at all is open to question. It clearly doesn't benefit too much given the lack of price differentials. The lousy and getting-lousier quality of American healthcare just generally indicates that hospitals don't put profits from economies of scale or whatever else back to real improvements in safety - though they apparent put a lot of money into meals to entice returning patients (fancy meals - visible, real safety - invisible).

[Fomite]

I'm not missing the implication, because rooms don't have to be clean simultaneously. Bacteria aren't actually all that mobile - most transmission is from touch contact with surfaces (or patients, who are themselves surfaces). Major disinfection takes place when a room is vacated, and it gets done - there's no reason to suggest that a cleaning staff doesn't scale with hospital size.

What's far more important is the quality of the room disinfection, which again, is a property of the room, not the number of them.

As for dedicated teams, I don't see why such things couldn't exist on a city-wide basis if they were useful.

Because now all you've done is taken the same workload, and said "Now you need to deal with 5 different smaller hospitals, five administration schemes (two of which don't like you), travel time, etc. Smaller hospitals do do this, sharing their burden between them, but a dedicated team has been shown to perform better.

And for specialized high risk disinfection teams, you've now suggested both that rooms need to be cleaned simultaneously, and that having a team across town is A-OK. Pick one, you really can't have both.

The lousy and getting-lousier quality of American healthcare just generally indicates that hospitals don't put profits from economies of scale or whatever else back to real improvements in safety - though they apparent put a lot of money into meals to entice returning patients (fancy meals - visible, real safety - invisible).

This really isn't true at all. Because hospitals aren't reimbursed for hospital-acquired infections, it costs them real money, and there is intense interest in improving patient safety. MRSA rates have been dropping, antibiotic stewardship programs are better, hand-washing rates are much improved, etc.

Fancy meals might be visible, but a bad case of C. difficile will cost a hospital many, many thousands of dollars. They're interested in preventing those types of infections.

I know because I work with them doing exactly that.

[malandrew]

I'm honestly surprised we don't take a quarantine approach in hospitals. i.e The first sign of an infection gets you shipped out to a specialized hospital building (air gap) designed specifically to be able to keep patients in "solitary confinement" and able to be completely disinfected afterwards.

[joe_the_user]

Most infectious diseases are not so dangerous that this is necessary. The ones that are, they do something like that as the other poster mentioned.

The fact of the matter though, is that a hospital for those with whatever condition is a somewhat ideal breeding ground for germs, not all of which will be deadly of course. That's not something is likely to be completely eliminated but it's something we can mitigate in a variety of ways.

[Fomite]

...this is what many infectious disease and isolation wards effectively do.

[jlgreco]

Hospital rooms with built-in autoclaves would give horror movies a lot more material to work with...

[Fomite]

There's also some research into surfaces that combat the formation of biofilms.