While analyzing supermarket chicken meat and Dutch hospital patients, scientists found a worrisome similarity between the two: they both tested positive for the disease-causing bacteria Escherichia coli -- and the organisms carried the same genes conferring drug resistance, suggesting a passage from one to the other.

This was only one of several disturbing topics infection control specialists tackled at the 3rd annual World Healthcare-Associated Infection Forum in Annecy, France last month, as they pondered what the organization dubbed, "a world without antibiotics."

It's not, of course, that the world's running out of the drugs, tens of thousands of tons of which are used in both humans and animals every year: it's that we're running out of ones effective against microorganisms fast-evolving immunity to even last-resort antibiotics.

And few new drugs are on the horizon. Currently, only 15 antibiotics are in development that have a new mechanism of action, only two of which could work against multi-drug resistant Gram-negative bacteria, such as nasty strains of E. coli.

"There's no question we have to focus on developing new drugs," Dr. Arjun Srinivasan, associate director for Healthcare Associated Infection Prevention Programs with the Centers for Disease Control and Prevention, and a presenter at the conference, told DOTmed News. "We know that bacteria will always develop resistance to antibiotics, that's what they do, and they do it well, even if we do the best job of using antibiotics properly."

Taking its toll

According to the World HAI Forum organizers, bioMérieux, a French company that makes diagnostic devices for hospitals, the human cost of drug-resistant organisms in health care is high. In the U.S., Methicillin-resistant Staphylococcus aureus (MRSA), a notorious hospital-acquired infection and the bane of health care facilities, is thought responsible for 19,000 deaths every year, with a single case costing more than $60,000 to treat. Overall, antibiotic resistance could cost U.S. hospitals more than $20 billion. In Europe, drug-resistant germ infections have direct and indirect costs of nearly $2.1 billion.

What's being done?

Progress has been made in one of the critical areas of antibiotic use, incorrectly prescribed drugs in outpatient settings. The CDC, for instance, launched a program, Get Smart: Know When Antibiotics Work, and Srinivasan said it has worked to decrease the drugs getting prescribed by primary care doctors for, say, viral infections.

However, he said they've not done as good a job in inpatient settings, where some studies indicate nearly half of antibiotic prescriptions are unnecessary or inappropriate, according to CDC figures.

"We're giving antibiotics to people who don't need them, or for even those who do need them, we're giving the wrong one or giving the wrong dose," he said. "That's an area we haven't seen as much progress as we'd like."

The organization has, nonetheless, started a hospital-targeted program, called Get Smart for Healthcare.

Progress is also somewhat lacking when it comes to influencing the public. According to a 2010 European Commission report, nearly half of Europeans believe antibiotics kill viruses, and are effective against the cold and flu.

And in the developing world, there are unhappy trends: antibiotics can often be bought over the counter without a prescription. For instance, according to a recent World Health Organization study, 42 percent of Mongolian children get unprescribed antibiotics for respiratory tract infections.

"It's very easy for me to walk into a pharmacy in India, and say, 'Give me ciprofloxacin,'" said Narayan Krishnaswami, bioMérieux's global product manager for nosocomial infections. "You can easily get it without a prescription."

Proper incentives

But in addition to better use of antibiotics, we need new ones. And the challenge here is partly economic: convincing drug companies to invest in developing antibiotics.

A forum panelist, Aidan Hollis, professor of economics with University of Calgary in Canada, said one solution could be to change the incentive structure for pharmaceutical companies.

"We need a mechanism that's going to support firms developing drugs, but at the same time won't encourage them to just sell as much of the product as possible," he said in a video interview recorded by the forum organizers.

Generally, it's hard to convince pharmaceutical companies to invest in researching drugs that can take decades to reach a market already swamped with cheap generics. And once their drug does reach the market, if it's a new, last-resort antibiotic, then by its very nature, it's seldom prescribed.

But Hollis said one approach could use a mixture of long-period exclusivity rights to the drug maker, with payments based not just on selling the drug, but using it appropriately.

Those payments would come from a global public fund created by the world's richer countries. One condition of receiving payments from the fund would be that companies would have to sell their products at low prices.

"The idea is not to come up with huge amounts of money, but restructure the way we pay for [antibiotics], so firms are compensated for doing the things we want them to do," Hollis said.

The animal problem

But even fixing the drug pipeline doesn't eliminate one potentially major source of resistance: the animals bred to be food on your plate.

In fact, the majority of antibiotic use in America goes toward treating animals. According to material provided by the World HAI Forum, nearly 80 percent of antibiotic use in the U.S. is with animals. In 2009 alone, nearly 29 million pounds, or 13,000 tons, of antibiotics went to livestock, according to the Food and Drug Administration.

And some scientists worry this antimicrobial glut for farm animals is creating reservoirs for resistant organisms.

At the meeting, Prof. Jan Kluytmans, a microbiologist with the Amphia Hospital in Breda, and a professor of medical microbiology at VUmc Medical University in Amsterdam, documented the rapid spread of multi-drug resistant organisms in livestock, since Dutch researchers first found MRSA in pigs and calves in 2005.

"Now nearly all farms are positive for containing MRSA, and people who work with the animals and who live on the farm are very easily colonized," he said in a video interview with HAI forum.

Another resistance mechanism -- the production of Extended-spectrum beta-lactamase (ESBL) -- is also increasing among animals. Those retail chickens found infected with drug-resistant E.coli had the ESBL-producing variety. In fact, Kluytmans says a recent survey at Dutch stores found 85 percent of chicken meat had ESBL-making organisms.

"For healthy people, there's not a real risk, they don't get infections easily," he said. "In hospital, it's totally different," he noted, pointing out that patients could get infected by the strains they carried.

"At present, we only see things getting worse, and solutions will be to restrict the use of antibiotics in animal food production," he said. But as that could lead to higher meat prices, it's something consumers would have to be willing, of course, to swallow.

Watch for the special infection-control feature in the August issue of DOTmed Business News.