tag:theconversation.com,2011:/ca/topics/mrsa-1585/articles
MRSA – The Conversation
2023-06-04T11:19:08Z
tag:theconversation.com,2011:article/206932
2023-06-04T11:19:08Z
2023-06-04T11:19:08Z
Removing antimicrobial resistance from the WHO’s ‘pandemic treaty’ will leave humanity extremely vulnerable to future pandemics
<figure><img src="https://images.theconversation.com/files/529846/original/file-20230602-27-nnu80l.png?ixlib=rb-1.1.0&rect=17%2C80%2C1680%2C1219&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antimicrobial resistance is now a leading cause of death worldwide due to drug-resistant infections, including drug-resistant strains of tuberculosis, pneumonia and Staph infections like the methicillin-resistant Staphylococcus aureus shown here.</span> <span class="attribution"><span class="source">(NIAID, cropped from original)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/removing-antimicrobial-resistance-from-the-who-s--pandemic-treaty--will-leave-humanity-extremely-vulnerable-to-future-pandemics" width="100%" height="400"></iframe>
<p>In late May, the latest version of the draft Pandemic Instrument, also referred to as the “pandemic treaty,” was shared with Member States at the <a href="https://www.who.int/about/governance/world-health-assembly">World Health Assembly</a>. The text was made available online via <a href="https://healthpolicy-watch.news/wp-content/uploads/2023/05/DRAFT_INB_Bureau-text_22-May.pdf">Health Policy Watch</a> and it quickly became apparent that all mentions of addressing antimicrobial resistance in the Pandemic Instrument were at risk of removal.</p>
<p>Work on the Pandemic Instrument began in December 2021 after the World Health Assembly agreed to a global process to draft and negotiate an international instrument — under the Constitution of the World Health Organization (WHO) — to protect nations and communities from future pandemic emergencies.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/drug-resistant-superbugs-a-global-threat-intensified-by-the-fight-against-coronavirus-135790">Drug-resistant superbugs: A global threat intensified by the fight against coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>Since the beginning of negotiations on the Pandemic Instrument, there have been calls from civil society and leading experts, including the <a href="https://www.amrleaders.org/docs/librariesprovider20/default-document-library/amr-as-substantive-element-of-the-international-instument-of-pandemic-prevention-preparedness-and-response.pdf?sfvrsn=300292c8_5&download=true">Global Leaders Group on Antimicrobial Resistance</a>, to include the so-called “silent” pandemic of antimicrobial resistance in the instrument.</p>
<p>Just three years after the onset of a global pandemic, it is understandable why Member States negotiating the Pandemic Instrument have focused on preventing pandemics that resemble COVID-19. But not all pandemics in the past have been caused by viruses and not all pandemics in the future will be caused by viruses. Devastating past pandemics of bacterial diseases have included <a href="https://www.who.int/news-room/fact-sheets/detail/plague">plague</a> and <a href="https://www.who.int/news-room/fact-sheets/detail/cholera">cholera</a>. The next pandemic could be caused by bacteria or other microbes.</p>
<h2>Antimicrobial resistance</h2>
<figure class="align-right ">
<img alt="Yellow particles on purple spikes" src="https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529862/original/file-20230602-19-rvxpbm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Microscopic view of Yersinia pestis, the bacteria that cause bubonic plague, on a flea. Plague is an example of previous devastating pandemics of bacterial disease.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Antimicrobial resistance (AMR) is the process by which infections caused by microbes become resistant to the medicines developed to treat them. Microbes include bacteria, fungi, viruses and parasites. Bacterial infections alone cause <a href="https://www.tropicalmedicine.ox.ac.uk/gram/news/bacterial-infections-linked-to-one-in-eight-global-deaths-according-to-gram-study">one in eight deaths</a> globally.</p>
<p>AMR is fueling the rise of drug-resistant infections, including <a href="https://www.cdc.gov/tb/publications/factsheets/drtb/xdrtb.htm">drug-resistant tuberculosis</a>, <a href="https://www.cdc.gov/drugresistance/pdf/threats-report/strep-pneumoniae-508.pdf">drug-resistant pneumonia</a> and drug-resistant Staph infections such as <a href="https://www.cdc.gov/mrsa/index.html">methicillin-resistant Staphylococcus aureus</a> (MRSA). These infections are killing and debilitating millions of people annually, and <a href="https://doi.org/10.1016/S0140-6736(21)02724-0">AMR is now a leading cause of death worldwide</a>. </p>
<p>Without knowing what the next pandemic will be, the “pandemic treaty” must plan, prepare and develop effective tools to respond to a wider range of pandemic threats, not solely viruses.</p>
<p>Even if the world faces another viral pandemic, <a href="https://theconversation.com/when-covid-19-or-flu-viruses-kill-they-often-have-an-accomplice-bacterial-infections-187056">secondary bacterial infections</a> will be a serious issue. During the COVID-19 pandemic for instance, large percentages of those hospitalized with COVID-19 required treatment for secondary bacterial infections. </p>
<p>New research from Northwestern University suggests that many of the deaths among hospitalized COVID-19 patients <a href="https://news.feinberg.northwestern.edu/2023/05/05/secondary-bacterial-pneumonia-drove-many-covid-19-deaths/">were associated with pneumonia — a secondary bacterial infection that must be treated with antibiotics</a>. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An illustrative diagram that shows the difference between a drug resistant bacteria and a non-resistant bacteria." src="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=558&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=558&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=558&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=701&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=701&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529852/original/file-20230602-29-ejrjyi.gif?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=701&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Antimicrobial resistance means infections that were once treatable are much more difficult to treat.</span>
<span class="attribution"><span class="source">(NIAID)</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Treating these bacterial infections requires effective antibiotics, and with AMR increasing, <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">effective antibiotics are becoming a scarce resource</a>. Essentially, safeguarding the remaining effective antibiotics we have is critical to responding to any pandemic.</p>
<p>That’s why the potential removal of measures that would help mitigate AMR and better safeguard antimicrobial effectiveness is so concerning. Sections of the text which may be removed include measures to prevent infections (caused by bacteria, viruses and other microbes), such as:</p>
<ul>
<li> better access to safe water, sanitation and hygiene; </li>
<li> higher standards of infection prevention and control; </li>
<li> integrated surveillance of infectious disease threats from human, animals and the environment; and </li>
<li> strengthening <a href="https://www.cdc.gov/antibiotic-use/core-elements/index.html">antimicrobial stewardship</a> efforts to optimize how antimicrobial drugs are used and prevent the development of AMR.</li>
</ul>
<p>The exclusion of these measures would hinder efforts to protect people from future pandemics, and appears to be part of a <a href="https://www.nature.com/articles/d41586-023-01805-4">broader shift to water-down the language in the Pandemic Instrument</a>, making it easier for countries to opt-out of taking recommended actions to prevent future pandemics. </p>
<h2>Making the ‘pandemic treaty’ more robust</h2>
<p>Measures to address AMR could be easily included and addressed in the “pandemic treaty.”</p>
<p>In September 2022, I was part of a group of civil society and research organizations that specialize in mitigating AMR who were invited the WHO’s <a href="https://inb.who.int/">Intergovernmental Negotiating Body</a> (INB) to provide an <a href="https://amrpolicy.org/resources/recommendations-to-the-intergovernmental-negotiating-body-inb-concerning-amr-the-pandemic-instrument/">analysis on how AMR should be addressed</a>, within the then-draft text. </p>
<p>They outlined that including bacterial pathogens in the definition of “pandemics” was critical. They also identified specific provisions that should be tweaked to track and address both viral and bacterial threats. These included AMR and recommended harmonizing national AMR stewardship rules.</p>
<p>In March 2023, I joined other leading academic researchers and experts from various fields in publishing a special edition of the <a href="https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/issue/DC40B54126C7B273BD62EBEED9641D2A"><em>Journal of Medicine, Law and Ethics</em>,</a> outlining why the Pandemic Instrument must address AMR. </p>
<p>The researchers of this special issue argued that the Pandemic Instrument was overly focused on viral threats and ignored AMR and bacterial threats, including the need to manage antibiotics as a common-pool resource and revitalize research and development of novel antimicrobial drugs. </p>
<h2>Next steps</h2>
<p>While <a href="https://apps.who.int/gb/inb/pdf_files/inb4/A_INB4_3-en.pdf">earlier drafts of the Pandemic Instrument</a> drew on guidance from AMR policy researchers and civil society organizations, after the first round of closed-door negotiations by Member States, all of these insertions, are now at risk for removal.</p>
<p>The Pandemic Instrument is the best option to mitigate AMR and safeguard lifesaving antimicrobials to treat secondary infections in pandemics. AMR exceeds the capacity of any single country or sector to solve. Global political action is needed to ensure the international community works together to collectively mitigate AMR and support the conservation, development and equitable distribution of safe and effective antimicrobials.</p>
<p>By missing this opportunity to address AMR and safeguard antimicrobials in the Pandemic Instrument, we severely undermine the broader goals of the instrument: to protect nations and communities from future pandemic emergencies.</p>
<p>It is important going forward that Member States recognize the core infrastructural role that antimicrobials play in pandemic response and strengthen, rather than weaken, measures meant to safeguard antimicrobials. </p>
<p>Antimicrobials are an essential resource for responding to pandemic emergencies that must be protected. If governments are serious about pandemic preparedness, they must support bold measures to conserve the effectiveness of antimicrobials within the Pandemic Instrument.</p><img src="https://counter.theconversation.com/content/206932/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Rogers Van Katwyk is a member of the WHO Collaborating Centre on Global Governance of Antimicrobial Resistance at York University. She receives funding from the Wellcome Trust and the Social Sciences and Humanities Research Council of Canada. </span></em></p>
Drug-resistant microbes are a serious threat for future pandemics, but the new draft of the WHO’s international pandemic agreement may not include provisions for antimicrobial resistance.
Susan Rogers Van Katwyk, Adjunct Professor, School of Global Health and Managing Director, AMR Policy Accelerator, York University, Canada
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/185568
2022-06-29T12:05:30Z
2022-06-29T12:05:30Z
What’s cellulitis? A dermatologist explains
<figure><img src="https://images.theconversation.com/files/470675/original/file-20220623-51937-2w9vtx.jpeg?ixlib=rb-1.1.0&rect=107%2C71%2C2862%2C2203&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The reddish pink rash spreads quickly.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/104346167@N06/44699141152/">jlcampbell104/Flickr</a></span></figcaption></figure><p>Your skin usually deflects any bacteria it encounters, protecting you from all sorts of infections. However, when you get a bug bite or a rash, some of that bacteria can sneak in, potentially causing serious consequences.</p>
<p>For example, you might develop <a href="https://doi.org/10.1093/cid/ciu444">cellulitis</a> – it’s the most common infection that occurs when bacteria breach the <a href="http://doi.org/10.1001/jama.2016.8825">skin barrier</a>. An estimated 1 in 503 people, or 0.2%, of the population get this painful red rash <a href="https://doi.org/10.4065/82.7.817">each year</a>. It may happen after a bite or cut or if your skin gets so <a href="https://www.nhs.uk/conditions/cellulitis">dry that it cracks and bleeds</a>.</p>
<p>When the infection happens, the area becomes painful, swollen, firm <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">and warm</a>. These symptoms can develop quickly, sometimes in <a href="https://www.pennmedicine.org/for-patients-and-visitors/patient-information/conditions-treated-a-to-z/cellulitis">less than 24 hours</a>. It usually affects the feet or legs, but it can affect <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">any part of the body</a> – even your face. You might see red streaks or blisters in the afflicted area, and the skin can become dimply and, above all, very tender.</p>
<p>Most people who get cellulitis are middle-aged or <a href="https://doi.org/10.1017/S095026880500484X">older adults</a>, but kids and younger adults can get it too. Aside from age and bad luck, risk factors include being overweight or having an immune system weakened from diabetes, cancer or HIV/AIDS. Circulation problems, such as long-standing <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">leg swelling</a>, also make people susceptible.</p>
<figure class="align-center ">
<img alt="Golden balls on a blue background in a scientific photo." src="https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/470856/original/file-20220624-25-24s6t2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Scanning electron micrograph of Staphylococcus aureus bacteria (gold) outside a white blood cell (blue)</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/scanning-electron-micrograph-of-staphylococcus-aureus-news-photo/1358939248?adppopup=true">BSIP/Universal Images Group via Getty Images</a></span>
</figcaption>
</figure>
<p>A variety of different bacteria can cause cellulitis. One of the most common culprits is <em>Staphylococcus aureus</em> – often called “staph.” Another common one is the same bacteria that is responsible for strep throat: <a href="https://doi.org/10.1001/jama.2017.5205">Group A <em>Streptococcus pyogenes</em></a>.</p>
<p>Cellulitis is an infection of the deeper layers of the skin, and you can’t catch it from <a href="https://www.nhs.uk/conditions/cellulitis">someone else</a>.</p>
<p>If you get it, your physician will prescribe antibiotics and the condition should improve within <a href="https://www.goodrx.com/conditions/skin-infection/er-for-cellulitis">one or two days</a>. However, the redness may take up to four weeks to fully go away. Do not be alarmed if your skin turns slightly scaly, <a href="https://www.nhstaysidecdn.scot.nhs.uk/NHSTaysideWeb/idcplg?IdcService=GET_SECURE_FILE&dDocName=PROD_212873&Rendition=web&RevisionSelectionMethod=LatestReleased&noSaveAs=1">flaky or wrinkly as the inflammation heals</a>.</p>
<p>Seek emergency care if the affected area doesn’t seem to be clearing up within three days, you run a fever of over 100.4 degrees Fahrenheit, you develop other flu-like symptoms, the <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">redness and pain rapidly worsen</a> or <a href="http://doi.org/10.1001/jama.2016.8825">an abscess forms</a>.</p>
<p>To prevent cellulitis, protect your skin by wearing appropriate clothing. You should also wash skin immediately after an injury with soap and water. If you tend to have dry skin, use moisturizers to prevent any cracking. </p>
<h2>Why cellulitis matters</h2>
<p>Cellulitis can become very serious.</p>
<p>Left untreated, it can spread to your lymph nodes or blood, causing a life-threatening <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">condition called sepsis</a>. <a href="https://theconversation.com/sepsis-still-kills-1-in-5-people-worldwide-two-icu-physicians-offer-a-new-approach-to-stopping-it-175650">Sepsis can affect and even shut down the internal organs</a>, which <a href="https://www.mayoclinic.org/diseases-conditions/cellulitis/symptoms-causes/syc-20370762">can be fatal</a>. The bacteria can also spread to the bones or the heart once they enter the blood, with possibly <a href="http://doi.org/10.1001/jama.2016.8825">long-term consequences</a>.</p>
<p>Doctors and other medical practitioners can diagnose cellulitis by examining your skin. In some cases, doctors may culture or sample the bacteria from the skin or <a href="https://doi.org/10.1007/s10096-006-0186-z">blood</a> to find the culprit. Occasionally, there can be concern that it will form deeper pockets of infection. In those cases a doctor may order a CT scan or <a href="https://doi.org/10.1001/jama.2017.5205">ultrasound test</a>.</p>
<h2>Is it cellulitis or something else?</h2>
<p>Just as there’s a danger of not catching cellulitis before it causes more serious problems, there is also a risk that other diseases will be mistaken for cellulitis. This confusion is something we frequently see as dermatologists.</p>
<p><a href="https://doi.org/10.5070/D39gn050rr">Stasis dermatitis</a>, which is caused by swelling of the legs from leaky vein valves, is the most common condition that looks like cellulitis. Fortunately, the two can typically be distinguished, as stasis dermatitis tends to affect both legs. Cellulitis almost always only affects <a href="https://doi.org/10.1136/bmj.318.7198.1591">one leg or arm</a> at a time.</p>
<p>A <a href="http://doi.org/10.1001/jama.2016.8825">hematoma</a>, a collection of clotted blood under the skin or other areas, can also occasionally mimic cellulitis. So can <a href="https://www.mayoclinic.org/diseases-conditions/gout/symptoms-causes/syc-20372897">gout</a>, a form of arthritis. Like cellulitis, it can be red and painful. However, gout most commonly occurs over a joint.</p><img src="https://counter.theconversation.com/content/185568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marjorie Montanez-Wiscovich is affiliated with the University of Florida. She serves as principal investigator in clinical trials with Kiniksa Pharmaceuticals and DermTech.</span></em></p><p class="fine-print"><em><span>Arthur Mark Samia does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
These infections require medical attention right away.
Marjorie Montanez-Wiscovich, Clinical Assistant Professor of Dermatology, University of Florida
Arthur Mark Samia, Postdoctoral Research Fellow in Dermatology, University of Florida
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/167354
2021-09-08T02:38:21Z
2021-09-08T02:38:21Z
The world is desperate for new antibiotics, and New Zealand’s unique fungi are a source of promising compounds
<figure><img src="https://images.theconversation.com/files/419899/original/file-20210907-12-1efw0kb.jpg?ixlib=rb-1.1.0&rect=11%2C0%2C1486%2C1122&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shara van der Pas</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>While we’re all rightly focused on the COVID-19 pandemic at the moment, the SARS-CoV-2 virus isn’t the only microbial threat we face. </p>
<p>Back in 2014, the World Health Organization (<a href="https://www.who.int/">WHO</a>) warned that within a decade, antibiotic-resistant bacteria could make routine surgery, organ transplantation and cancer treatment life-threateningly risky — and spell the <a href="https://abcnews.go.com/blogs/health/2012/03/16/antibiotic-resistance-could-bring-end-of-modern-medicine">end of modern medicine</a> as we know it.</p>
<figure class="align-right ">
<img alt="Petri dishes with fungi growing on them" src="https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419905/original/file-20210907-18-1i6y2tn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fungi produce compounds to fight bacteria.</span>
<span class="attribution"><span class="source">Manaaki Whenua</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Antibiotics are a cornerstone of modern medicine, used to treat infections and to protect vulnerable patients undergoing surgery or chemotherapy. The world desperately needs new antibiotics and COVID-19 has only exacerbated the problem.</p>
<p>In our search for new antibiotics, we have focused on fungi, especially those found only in Aotearoa New Zealand. Our latest <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2021.739995/full">research</a> describes the discovery of fungal compounds able to kill Mycobacteria, a family of slow-growing bacteria that includes another important global airborne killer — <em>Mycobacterium tuberculosis</em> — which causes the lung disease tuberculosis and kills thousands of people around the world each day.</p>
<p>While most people in Aotearoa know me as the “pink-haired COVID lady”, for the past six years my lab has been hunting for compounds that could make good antibiotics. We’ve focused on fungi from the International Collection of Microorganisms from Plants (<a href="https://www.landcareresearch.co.nz/tools-and-resources/collections/icmp-culture-collection/">ICMP</a>), cared for by the Crown Research Institute <a href="https://www.landcareresearch.co.nz/">Manaaki Whenua</a> and our collaborator <a href="https://www.landcareresearch.co.nz/about-us/our-people/bevan-weir">Bevan Weir</a>. </p>
<p>Our latest findings follow <a href="https://www.mdpi.com/1420-3049/26/4/1094">earlier research</a> which revealed a fungal compound with some activity against the hospital superbug methicillin-resistant <em>Staphylococcus aureus</em>, better known as MRSA. </p>
<h2>Why fungi?</h2>
<p>One of the earliest antibiotics ever discovered, penicillin, originally came from a fungus called <em>Penicillium rubens</em>. With more than 10,000 fungi in the ICMP database, we think this may be a treasure trove of potential new antibiotics.</p>
<p>For our latest <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2021.739995/full">study</a>, we tested 36 fungi collected between 1961 and 2016 from locations right across Aotearoa, including the Chatham Islands. Our first exciting finding is that nine of the fungi are not known species, suggesting they may well be unique to Aotearoa. </p>
<figure class="align-right ">
<img alt="Scientist looking down a microscope" src="https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/419907/original/file-20210907-23-zdpuq6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bevan Weir explores microorganisms derived from plants.</span>
<span class="attribution"><span class="source">Manaaki Whenua</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Aotearoa is well known for its iconic animal and plant species that aren’t found anywhere else in the world. Our fungi will be no different. And if they are unique, they may have come up with unique compounds able to kill bacteria. </p>
<p>Our second major finding is that 35 of the 36 fungi we tested had some form of antibacterial activity against Mycobacteria. In fact, when we first started doing this work, we thought we must have made a mistake. We’d never had anything like that kind of success rate when screening fungi against other superbugs. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-we-discovered-a-hidden-world-of-fungi-inside-the-worlds-biggest-seed-bank-156051">How we discovered a hidden world of fungi inside the world’s biggest seed bank</a>
</strong>
</em>
</p>
<hr>
<p>Taking a deeper dive into the chemistry of those fungal compounds, we found the majority are fatty acids which won’t make good antibiotics. But we did find several fungi, including two of our unknown species, whose antibacterial activity wasn’t due to fatty acids. </p>
<p>We’re currently working to identify these compounds, with our collaborators <a href="https://unidirectory.auckland.ac.nz/profile/mcad006">Melissa Cadelis</a> and <a href="https://unidirectory.auckland.ac.nz/profile/b-copp">Brent Copp</a>.</p>
<h2>Long road to discovery</h2>
<p>Physicist Jim Al-Khalili once said that most scientific progress is a “messy, complex and slow process”. Take the COVID-19 vaccines as a good example. While we’ve watched numerous vaccines come through clinical trials successfully and quickly, they are based on <a href="https://www.nature.com/articles/s41578-021-00358-0">decades of scientific study</a> of mRNA and lipid nanoparticles. </p>
<p>My lab’s search for antibiotics has its roots in work we did over a decade ago, making tools to make <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0010777">Mycobacteria glow in the dark</a>. Because these bacteria grow so slowly, it can take weeks to months for them to form colonies on a petri dish. </p>
<p>But they glow only when they are alive, and this technique allows us to measure the amount of light they produce instead of waiting for them to grow. This massively speeds up the antibiotic discovery process. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-technology-can-create-treatment-against-drug-resistant-bacteria-in-under-a-week-and-adapt-to-antibiotic-resistance-163710">New technology can create treatment against drug-resistant bacteria in under a week and adapt to antibiotic resistance</a>
</strong>
</em>
</p>
<hr>
<p>I started thinking about fungi as a potential source of new antibacterial compounds when Manaaki Whenua’s fungi expert Peter Buchanan told me about the collection. After a few years of rejected funding applications, we finally got a small grant-in-aid from <a href="https://curekids.org.nz/">Cure Kids</a> to get the project started in 2015. </p>
<p>One of their ambassadors, <a href="https://curekids.org.nz/ambassadors/eva/">Eva</a>, has battled superbug infections her whole life. Meeting Eva changed my relationship with my work and inspired me to do all I can to find new antibiotics. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/_g3x6AsU7EI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Eva is a Cure Kids ambassador who lives with MRSA and was born with a hole in her diaphragm.</span></figcaption>
</figure>
<p>We’ve still got a way to go before we have any compounds that might be suitable for further development as antibiotics. We also know that many compounds fail as they move through the pipeline that takes them from the lab to clinical trials in humans. </p>
<p>That’s why my lab will keep working its way through the fungal collection for as long as we can afford to. There are thousands more fungi to screen and hopefully many more unique compounds with antibiotic potential to discover.</p><img src="https://counter.theconversation.com/content/167354/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siouxsie Wiles receives funding from Cure Kids and NZ Carbon Farming. This work was previously supported by grants-in-aid from the Maurice Wilkins Centre for Molecular Biodiscovery and the University of Auckland.</span></em></p>
Penicillin originally came from a fungus, and with thousands of fungi to explore, Aotearoa New Zealand has a potential treasure trove of bacteria-killing compounds.
Siouxsie Wiles, Associate Professor in Microbiology and Infectious Diseases, University of Auckland, Waipapa Taumata Rau
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/135790
2020-04-20T13:31:01Z
2020-04-20T13:31:01Z
Drug-resistant superbugs: A global threat intensified by the fight against coronavirus
<figure><img src="https://images.theconversation.com/files/328554/original/file-20200416-192731-1hcrz6l.jpg?ixlib=rb-1.1.0&rect=5%2C32%2C1272%2C848&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Methicillin-resistant Staphylococcus aureus (MRSA) bacteria (coloured yellow) enmeshed within a human white blood cell (coloured red). MRSA is a major cause of hospital-associated infections.</span> <span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=18125">(NIAID)</a></span></figcaption></figure><p>With the world’s attention on COVID-19, I believe that now is the time to talk about another pandemic that’s been happening right under our noses: antimicrobial resistance (AMR). </p>
<p>When infections caused by bacteria, parasites, viruses or fungi stop responding to the medicines designed to treat them, that’s AMR. Resistance builds over time through overexposure to antimicrobial drugs, such as antibiotics, or disinfectants. With ineffective treatments, these infections persist in the body and ultimately spread to others.</p>
<h2>A major public health and economic risk</h2>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=628&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=628&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=628&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=789&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=789&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327321/original/file-20200412-51445-1qir6kq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=789&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Two methicillin-resistant Staphylococcus aureus (MRSA) bacteria, being enveloped by a white blood cell.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=18168">(NIAID)</a></span>
</figcaption>
</figure>
<p>AMR is a slower-moving pandemic than COVID-19, but one that is worsening every day. A <a href="https://cca-reports.ca/reports/the-potential-socio-economic-impacts-of-antimicrobial-resistance-in-canada/">recent report by the Council of Canadian Academies</a> said that in 2018, more than a quarter of all infections in Canada were resistant to first-line drugs. In that one year alone, 5,400 people died as a direct result of resistant infections. </p>
<p>Drug-resistant infections lead to longer hospital stays and potentially greater complications. Doctors might need to use alternative medicines with more side effects. These issues cost the Canadian health-care system 1.4 billion dollars, and this will only increase.</p>
<p><a href="https://theconversation.com/newsletter"><img src="https://images.theconversation.com/files/320030/original/file-20200312-116261-a6ugi0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=90&fit=crop&dpr=2" alt="Sign up to The Conversation" width="100%"></a></p>
<p>The <a href="https://www.un.org/press/en/2016/ga11825.doc.htm">United Nations</a>, the <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">World Health Organization</a> and even the <a href="https://www.worldbank.org/en/topic/health/publication/drug-resistant-infections-a-threat-to-our-economic-future">World Bank</a> recognize AMR as a public health and economic disaster waiting to happen. In 2016, United Kingdom economist Jim O’Neill and his team published <a href="https://amr-review.org">a report</a> stating that if we do not address the growing threat of AMR, by 2050 more people will die from drug-resistant infections than from cancer. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327754/original/file-20200414-117587-rhjhzk.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">If left unsolved, AMR will cause more global deaths than cancer by 2050.</span>
<span class="attribution"><span class="source">(Christy Groves, Michael G. DeGroote Institute for Infectious Disease Research, McMaster University)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>If left unsolved, AMR will cost the health-care system trillions of dollars and, more importantly, it will cost millions of people their lives. </p>
<h2>Lessons from SARS-CoV-2</h2>
<p>We can learn from COVID-19. The current pandemic shows that despite all of our medical advances, we remain incredibly vulnerable to infections for which we have no therapies. However, it shows that if sufficiently motivated, we can make huge changes in short timeframes. </p>
<p>While there is inspiring work being done in different parts of the world to address the issues surrounding AMR — including here at <a href="https://iidr.mcmaster.ca">McMaster University’s Institute for Infectious Disease Research</a>, where my group is based — there is a long road ahead of us.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327756/original/file-20200414-117573-1azvjmw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The author at work in the lab at McMaster University’s Institute for Infectious Disease Research.</span>
<span class="attribution"><span class="source">(J.D. Howell, McMaster University)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Despite significant efforts to educate policymakers and the public about the AMR crisis and offer possible solutions, it remains low on the priority list for many jurisdictions. On top of that, <a href="https://amr-review.org/sites/default/files/160525_Final%20paper_with%20cover.pdf">research on AMR is woefully underfunded compared to other areas of medicine</a>, such as cancer and cardiac disease. </p>
<p>Another major hurdle for the AMR response is loss of interest by big pharmaceutical companies. The need for expensive clinical trials and the risk of AMR rendering their products useless after a few years mean <a href="https://www.nytimes.com/2019/12/25/health/antibiotics-new-resistance.html">it’s challenging for them to recover their investment</a> into antibiotic research and development. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=464&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=464&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=464&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=583&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=583&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327324/original/file-20200412-196246-g0e86m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=583&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Drug-resistant Salmonella serotype Typhi bacteria, from the Centers for Disease Control and Prevention publication <em>Antibiotic Resistance Threats in the United States</em>.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=23251">(Illustration by James Archer)</a></span>
</figcaption>
</figure>
<p>Fortunately, antibiotics are only one strategy for fighting bacterial infections. Another common and highly successful approach is vaccination (think about routine <a href="https://link.springer.com/chapter/10.1007/978-94-007-7624-1_11">childhood immunizations against diphtheria</a> and <a href="http://www.health.gov.on.ca/en/pro/programs/immunization/docs/hcp_fact_sheets_hoemophilus_influenzae_typeb.pdf"><em>Haemophilus</em> <em>influenzae</em></a>), but vaccines are also challenging to develop and deliver in the face of a <a href="https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2020-46/issue-2-3-february-6-2020/article-5-best-practices-addressing-vaccine-hesitancy.html">growing hesitancy movement</a>. Novel treatments such as <a href="https://www.nature.com/articles/nrd.2017.162">immune boosters</a>, <a href="https://doi.org/10.1016/j.drudis.2019.03.002">therapeutic antibodies</a> or natural predators of bacteria called <a href="https://www.id-hub.com/2019/11/21/bacteriophages-2-0-old-solution-modern-problem/">bacteriophages</a> all show promise but are still in the early days of development.</p>
<h2>Antibacterial products contribute to AMR</h2>
<p>While the key players in the global response to AMR undoubtedly include researchers, food producers, policymakers and health-care professionals, the truth is every single person has a role to play.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327317/original/file-20200412-32369-1kpxyl9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antibacterial soaps and disinfectant cleansers can contribute to antimicrobial resistance.</span>
<span class="attribution"><span class="source">(Kelly Sikkema/Unsplash)</span></span>
</figcaption>
</figure>
<p>One thing we can all do to help combat the spread of AMR is to use regular — not “antibacterial” — soap. Good old-fashioned regular soap is antibacterial and antiviral; it dissolves the greasy membranes that surround bacteria and viruses such as SARS-CoV-2, killing them. </p>
<p>Conversely, antibacterial soaps usually contain additional chemicals that don’t add much in the way of hygiene, but can activate a microorganism’s efflux pumps. The pumps force disinfectants out before they can cause harm (picture someone bailing water out of a leaky boat so it doesn’t sink). They increase the ability of bacteria to fend off multiple types of toxic compounds, including antibiotics, and hasten the spread of AMR. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=628&fit=crop&dpr=1 600w, https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=628&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=628&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=789&fit=crop&dpr=1 754w, https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=789&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/327325/original/file-20200412-51445-16eao6a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=789&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Multidrug-resistant Klebsiella pneumoniae bacteria, which are known to cause severe hospital acquired nosocomial infections.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/Details.aspx?pid=18170">(David Dorward/NIAID)</a></span>
</figcaption>
</figure>
<p>While COVID-19 in its own right is indeed terrifying, its implications for the future of AMR might be even worse. Widespread use of antibacterial soaps and disinfectants aside, <a href="https://doi.org/10.1016/S0140-6736(20)30566-3">early studies out of China</a> show that almost all severely ill COVID-19 patients were given antibiotics (sometimes multiple antibiotics) to prevent or treat the secondary bacterial infections to which many ultimately succumbed. Unfortunately, the more antibiotics we use, the more we select for AMR. </p>
<p>But I choose to be an optimist. I hope that COVID-19 is a learning experience. I hope it will open the eyes of many to the life-altering power of microbes. I hope it teaches us that we need better (and faster) surveillance infrastructure for outbreaks. I hope it highlights the need for the rapid development, approval and scale up of effective diagnostics and new therapies.</p>
<p>To me, these steps would be encouraging progress in the global response to AMR.</p><img src="https://counter.theconversation.com/content/135790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lori L. Burrows receives research grants from the Canadian Institutes of Health Research, the Natural Sciences and Engineering Research Council of Canada, Glyconet, and the Ontario Research Fund. </span></em></p>
Antimicrobial resistance is a public health and economic disaster waiting to happen. If we do not address this threat, by 2050 more people will die from drug-resistant infections than from cancer.
Lori L. Burrows, Professor of Biocchemistry and Biomedical Sciences, McMaster University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/124506
2019-10-04T13:14:48Z
2019-10-04T13:14:48Z
This microbe is spreading antibiotic resistance to other bacteria
<figure><img src="https://images.theconversation.com/files/295592/original/file-20191004-118260-1ilpgm7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/enterococcus-faecalis-bacteria-known-streptococcus-these-299901821?src=xOOTPBDv9c2mKEC8gYDc1Q-1-2">royaltystockphoto/Shutterstock</a></span></figcaption></figure><p>Antibiotic resistance is spreading fast <a href="https://theconversation.com/antibiotic-resistant-superbug-genes-found-in-the-high-arctic-110636">all over the world</a>. When infectious bacteria mutate in a certain way and then multiply, they can become resistant to even the most powerful drugs. But research has revealed a worrying alternative way that antibiotic resistance can spread: an organism that passes on its resistance on to other living bacteria.</p>
<p>In June 2012, a 35-year old man from São Paulo found himself in hospital with a myriad of problems. Alongside a diagnosis of skin cancer, he was told he harboured a potentially lethal bacterial infection. The doctors placed him on a course of chemotherapy and antibiotics, and the bacteria-killing treatment appeared to do its work. But within a month the microbe-driven fever had returned.</p>
<p>The patient had contracted the well-known superbug MRSA (methicillin-resistant <em>Staphylococcus aureus</em>). So the medical team turned to one of the “last line of defence” antibiotics, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25753888">powerful compound vancomycin</a>. This strain of MRSA originally had no natural defence against vancomycin, but by August that year it had become resistant, rendering the treatment ineffective.</p>
<p>Scientists would <a href="https://www.ncbi.nlm.nih.gov/pubmed/24738669">later uncover</a> that rather than acquiring resistance through a simple mutation, the MRSA had instead been gifted a huge chunk of new DNA. Within this string of donated genetic code were the instructions for proteins that would keep the bacteria safe from the destructive work of the antibiotic. MRSA had been dealt a winning hand, but where had this DNA come from?</p>
<p>Enter <a href="https://www.ncbi.nlm.nih.gov/pubmed/22421879"><em>Enterococcus faecalis</em></a>. This bug is typically described as a commensal bacterium (one of our “good bacteria”), which lives happily in our guts causing no harm. Our digestive tracts are a hive of microbial activity, hosting single-celled organisms in their trillions. The so-named microbiome is incredibly important for maintaining a <a href="https://theconversation.com/you-are-what-you-eat-why-the-future-of-nutrition-is-personal-119477">healthy human gut</a>, but also helps to suppress the sinister side of bugs like faecalis.</p>
<p>When patients with weakened immune systems undergo antibiotic treatments, this undesirable side can flourish. When we are given antibiotics, they indiscriminately sweep away all bacteria that have no natural defences, sometimes clearing the gut microbiome of many of its friendly inhabitants. But faecalis is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3485979/">intrinsically equipped</a> with an arsenal of natural resistance mechanisms within its DNA, often allowing it to survive.</p>
<p>With no oppressive neighbours around or an able immune system to keep them in check, faecalis and its resistant peers proliferate and thrive, dividing happily to move into the newly available real estate of the gut. And before long they come into close contact with their resistant and potentially disease-causing neighbours.</p>
<h2>Swapping information</h2>
<p>When humans come together we often exchange ideas through language. But when bacteria come together they can exchange information through DNA-encoded instructions. This is known as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536854/">horizontal gene transfer</a>, where copies of DNA move from one cell to another. Unfortunately, <em>E. faecalis</em> and its superbug compatriots have all the best information to share, information that allows them to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2955785/">survive antibiotics</a>.</p>
<p>But faecalis has gone one step further on its evolutionary journey, becoming one of the ultimate dealers of antibiotic resistance. One defence mechanism used by bacteria to guard themselves against unwanted genetic code is the CRISPR-cas9 system, which scientists are also now using as a way <a href="https://theconversation.com/beyond-just-promise-crispr-is-delivering-in-the-lab-today-77596">to edit DNA</a>. The system originated as a means for bacteria to chop viral DNA and other potentially dangerous genetic code to pieces before it caused them harm.</p>
<p><em>E. faecalis</em> once harboured the important CRISPR-cas9 system but, amazingly, sacrificed the defence mechanism so that all manner of DNA could enter and remain within the walls of the cell. This was a risky strategy but ultimately proved worthwhile, unlocking the means for faecalis to acquire, and subsequently pass on, swathes of genetic knowledge. It was through this gain-and-exchange design that faecalis bestowed <a href="https://mbio.asm.org/content/9/3/e00414-18">vancomycin resistance upon MRSA</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/295594/original/file-20191004-118260-aibe0b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Antibiotic resistance threatens our ability to treat serious infections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-adjust-infusion-pump-set-iv-1358772878?src=aFpgnaZpAZ0anHbWiyW32w-1-5">Titikul B/Shutterstock</a></span>
</figcaption>
</figure>
<p>Antibiotics perform a critical role in modern medicine. They’re used routinely to treat infectious disease, administered pre-emptively after surgery, and have contributed to raising the average life expectancy by an average of 20 years across the globe. This makes tackling antibiotic resistance one of the <a href="https://theconversation.com/humanity-under-threat-from-antibiotic-resistant-infections-106682">most pressing issues</a> faced by our species today. Yet, in bacteria such as faecalis, scientists have discovered microbes colluding to escalate the danger presented by evolved antibiotic resistance.</p>
<p>This makes understanding <em>E. faecalis</em> of paramount importance. Yet much of the microbe’s natural, intrinsic resistance remains shrouded in mystery. Frustratingly, faecalis often has an ace up its sleeve when challenged by antibiotics. If we delete an integral piece of DNA, for example, we often find that faecalis has another section of DNA that can perform the same role, providing antibiotic resistance regardless. However, we don’t yet fully understand which pieces of DNA have genetic back-up plans and which do not.</p>
<p>A piece of DNA without any backups would make for an ideal drug target. And fortunately, we’re able to identify these vital pieces in the lab by incrementally deleting segments of DNA. One by one, each deletion will bring us a step closer to identifying key portions of genetic code that are critical for <em>E. faecalis</em> to survive. This makes us confident that we’ll soon be able to stack the deck in our favour against this thrifty opportunistic pathogen, and eventually remove the dealer from the game.</p><img src="https://counter.theconversation.com/content/124506/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sali Morris receives funding from the GW4 BioMed MRC DTP. The funding is for basic research into the regulatory networks that control antibiotic resistance in Enterococcus faecalis.</span></em></p><p class="fine-print"><em><span>James S. Horton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Enterococcus faecalis can on pass its antibiotic resistant genes.
Sali Morris, PhD Candidate, University of Bath
James S. Horton, PhD Candidate, University of Bath
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/111908
2019-03-06T11:40:41Z
2019-03-06T11:40:41Z
Are viruses the best weapon for fighting superbugs?
<figure><img src="https://images.theconversation.com/files/261720/original/file-20190301-110134-1u7yr0g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">These are viruses called bacteriophages that infect only bacterial cells. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-render-bacteriophage-viruses-infecting-bacterial-479306521">Ewa Parylak/shutterstock.com</a></span></figcaption></figure><p>Antibiotics won the battle against resistant bacteria, but they may not win the war.</p>
<p>You probably know that antibiotic-resistant bacteria, also known as superbugs, have hampered physicians’ ability to treat infections. You may also be aware that there has been a steep <a href="https://www.cdc.gov/drugresistance/pdf/11-2013-508.pdf">decline in the number of new antibiotics</a> coming to market. Some headlines suggest humanity is doomed by antimicrobial resistance; <a href="https://www.cnn.com/2019/01/24/health/antibiotic-resistance-climate-change-gbr-scli-intl/index.html?no-st=1551070126">even politicians and governments have weighed in</a>, comparing rising antimicrobial resistance to other popular crises such as climate change. Although I believe these assertions are exaggerated, antimicrobial resistance is a serious problem. </p>
<p><a href="http://www.thepridelaboratory.org">I am a physician scientist</a> with a <a href="http://www.thepridelaboratory.org/publications.html">specialty in infectious diseases</a>. I have been fascinated by the role that bacteria play in human health, and the potential for using viruses to treat bacterial infections. </p>
<h2>What causes antimicrobial resistance?</h2>
<p>One significant factor contributing to antimicrobial resistance is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/25859123">excessive use of antibiotics</a>. In the U.S., where antibiotics are widely available, some patients demand these drugs for many different illnesses. Many physicians appease their patients because they <a href="https://www.pewtrusts.org/en/research-and-analysis/articles/2017/06/30/why-doctors-prescribe-antibiotics-even-when-they-shouldnt">don’t understand when and when not</a> to use them and because there is <a href="https://www.cddep.org/wp-content/uploads/2017/06/antibiotic_legislation_timeline.pdf">no regulatory structure to limit their use</a>. Anyone with a prescription pad can prescribe any antibiotic to treat any condition and rarely, if ever, face any consequences. There are some <a href="https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html">efforts to reduce antibiotic</a> use, but the scope of the problem in the U.S. remains large.</p>
<p>Some countries, <a href="https://www.who.int/bulletin/volumes/95/11/16-184374/en/">such as Sweden</a>, use incentives to encourage doctors to improve antibiotic uses. But there is no counterpart for this system in U.S. hospitals and clinics. </p>
<p>The problem goes beyond humans; 70 percent of all antibiotics <a href="http://www.cidrap.umn.edu/news-perspective/2016/12/fda-antibiotic-use-food-animals-continues-rise">are actually used on animals</a>. This means that humans can be exposed to antibiotics by <a href="http://doi.org/10.3390/antibiotics6040034">just handling animal products</a>. The drumstick you are preparing for dinner might also have <a href="https://doi.org/10.1093/jac/dkg483">antibiotic-resistant bacteria</a> <a href="http://doi.org/10.1177/003335491212700103">tagging along</a>. </p>
<p>Once antimicrobial resistance develops in a bacterium, it doesn’t always go away. For example, methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) evolved resistance to multiple different antibiotics; yet, despite efforts to reduce its spread by <a href="https://doi.org/10.1086/500664">limiting the use of antibiotics</a> that led to its emergence, <a href="https://doi.org/10.1086/597296">MRSA still persists</a> in hospitals and the community.</p>
<h2>An alternative to antibiotics</h2>
<p>Another reason for finding alternatives to antibiotics is that <a href="http://doi.org/10.7554/eLife.00458">we share our microbes with the people and pets who live around us</a>; thus, others can acquire one of these superbugs without ever taking an antibiotic.</p>
<p>A not-so-obvious reason for developing new therapies is that our bodies are home to a large community of microorganisms, including bacteria, called our microbiome. These microorganisms are necessary to maintain our health. Those same antibiotics that kill harmful bacteria also kill the good ones. </p>
<p>There is an alternative to antibiotics, but it was dismissed by medicine years ago. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=307&fit=crop&dpr=1 600w, https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=307&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=307&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=386&fit=crop&dpr=1 754w, https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=386&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/261739/original/file-20190301-110143-1ch0sto.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=386&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Antibiotics or wrong diet damage the good and bad bacteria flora living in the gut.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/antibiotics-wrong-diet-damage-good-bad-1225328413">Soleil Nordic/Shutterstockcom</a></span>
</figcaption>
</figure>
<h2>The original phage therapy story</h2>
<p>That alternative was something called phage therapy, which uses viruses that infect bacteria, called bacteriophages, to kill disease-causing bacteria. Bacteriophages, or phages, were used frequently in the <a href="http://doi.org/10.4161/viru.25991">early- and pre- antibiotic eras</a> between the 1920s and ‘40s to treat life-threatening infections. </p>
<p>But phage therapy had many disadvantages. The first was that phages were unpredictable. One type of phage might wipe out the bad bacteria in one individual but not another’s. So hospitals had to keep a broad collection of phages to kill disease-causing bacteria from all their patients. An antibiotic such as vancomycin, by comparison, predictably kills entire groups of bacteria. </p>
<p>Another downside is that phage collections require maintenance. So not only did hospitals have to keep a large variety of phages on hand, but they had to keep them in shape. So medicine chose antibiotics for convenience, and hadn’t looked back in any meaningful way, until recently.</p>
<h2>Making a comeback?</h2>
<p>So, why is phage therapy making a comeback? Antibiotic resistance is an obvious answer, but doesn’t explain the full story. </p>
<p>As a specialist in infectious diseases, I have been interested in phage therapy as long as I can remember, but only recently have I felt comfortable saying this out loud. Why? A physician might be considered a “quack” just for mentioning phage therapy because the early attempts were neither a rousing success or a colossal failure. Like any therapeutic, it had its strengths and weaknesses. </p>
<p>However, now scientific advances can guide us toward which phage is best for destroying a particular microbe. With the rising antimicrobial resistance crisis, physicians and scientists have a well-timed opportunity to work together to develop effective phage therapies. </p>
<p>The proof of this comes from recent landmark phage therapy cases. The successful treatment of a <a href="http://doi.org/10.1128/AAC.00954-17">physician with a life-threatening infection and a grave prognosis caused by a multi-drug resistant bacterium</a> at my institution serves as a great example. Another pivotal case <a href="https://www.buzzfeednews.com/article/azeenghorayshi/phage-therapy-follow-this">circulating in popular media</a> has kept this trend going. We physicians may be able to treat just about any disease-causing bacterium; it is just a matter of finding a suitable phage. </p>
<p>A big part of phage therapy research is devoted to “<a href="https://seaphages.org/">phage hunting</a>,” where we microbiologists scour the soil, the oceans and the human body to identify phages with the potential to kill the bacteria that ail us. While the pace of these studies has been slow, the new research is revealing the therapeutic potential of phages in medicine.</p>
<p>You might think that with all the phage hunting and landmark cases that we would start using phage therapy all the time, but we don’t. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/261740/original/file-20190301-110110-8ixh81.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Bacteriophages target only specific stains of bacteria.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-illustration-bacteriophage-infecting-bacterium-1126283543">Design_Cells/Shutterstock.com</a></span>
</figcaption>
</figure>
<h2>The case for using phages</h2>
<p>One advantage of antibiotics is that since they have been used for decades, we know a lot about their safety. Physicians make simple calculations every day about the risk-benefit ratio of using antibiotics, but aren’t equipped to make the same calculations about phages. Does anyone really want a doctor injecting them with a virus to cure a bacterial infection? I doubt that would be anyone’s choice when the question is posed that way. </p>
<p>But, remember that phages are natural. They’re on every surface of your body. They are in the ocean and soil, and in your toilet and sink. They are literally everywhere. Thus, putting a phage into your body to kill a bacterium quite frankly is something that nature does to us every single day, and as far as we know, we are no worse for the wear. </p>
<p>Phages are estimated to <a href="https://daily.jstor.org/fighting-bacterial-infection-with-viruses/?utm_source=marketing&utm_medium=social&utm_campaign=twitter">kill half the world’s bacteria</a> every 48 hours and are probably the most potent antibacterial agents out there. Is there really a compelling reason to be concerned when a doctor gives us a phage instead of us acquiring that same phage from our sink at home? Only time will tell. Unfortunately, as antimicrobial resistance continues to rise, time may not be on our side.</p><img src="https://counter.theconversation.com/content/111908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Bacteria are becoming resistant to even the most powerful antibiotics. These expensive, hard-to-treat infections are prompting physicians to reassess using viruses to destroy bacteria.
David Pride, Associate Director of Microbiology, University of California, San Diego
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/86930
2018-02-01T17:57:00Z
2018-02-01T17:57:00Z
What are school sores and how do you get rid of them?
<figure><img src="https://images.theconversation.com/files/203007/original/file-20180123-182965-1180o5w.jpg?ixlib=rb-1.1.0&rect=0%2C1334%2C3538%2C1528&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The usual culprit is the bacterium _Staphylococcus aureus_, better known as “golden staph”.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/698395990?src=5oGzvQ_ZB3yKGJB3Xjhv3g-2-30&size=huge_jpg">Shutterstock</a></span></figcaption></figure><p>Impetigo, or “school sores”, is a contagious infection of the very top layer of skin. It’s <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0136789">most common</a> in children aged two to six, and ends up spreading from child to child in schools and daycare centres, but can affect children and adults of all ages. </p>
<p>The good news is that it’s unlikely to cause serious harm. It usually clears up within a few weeks, without any scarring. </p>
<p>The usual culprit is the bacterium <em>Staphylococcus aureus</em>, better known as “golden staph”. <em>S. aureus</em> can cause serious infections, and has a fearsome reputation. But the bacteria <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/staphylococcus-aureus-golden-staph">commonly lives on skin</a>, lurking in the groin and nostrils without causing problems.</p>
<p>A second type of bacteria that causes impetigo is <em>Streptococcus pyogenes</em>, commonly known as “strep”. <em>S. pyogenes</em> can cause other infections such as tonsillitis and pharyngitis. In fact, it is often the “strep” responsible for “strep throat”. </p>
<p>Strep impetigo is more prevalent in rural and remote communities. It is also more common in institutional settings such as aged care facilities, boarding schools, and prisons.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-simple-school-sores-often-lead-to-heart-and-kidney-disease-in-indigenous-children-86066">Why simple school sores often lead to heart and kidney disease in Indigenous children</a>
</strong>
</em>
</p>
<hr>
<p>Impetigo <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/impetigo-school-sores">appears on the skin</a> one to three days after being infected by staph, or four to ten days after catching strep. It can occur on sores from scratches, insect bites and eczema, or on healthy skin. </p>
<p>The sores begin as red areas, or crops of small blisters, most commonly around the nose and mouth, and on the arms and legs. The sores then burst and begin to weep, before drying with a golden-coloured scab, often referred to as a “honey-crust”.</p>
<h2>Treatment</h2>
<p>While impetigo is unlikely to cause problems in healthy people, it’s important to <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">see a GP for an accurate diagnosis</a>.</p>
<p>If only a small crop of sores is present, frequent washing with soap and water might be all that is needed. A prescription antibiotic ointment can also be used. </p>
<p>If the sores are more widespread, or there is evidence of infection spreading into the deeper skin (cellulitis), oral antibiotics are often necessary.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/when-should-you-take-antibiotics-42751">When should you take antibiotics?</a>
</strong>
</em>
</p>
<hr>
<p>Parents can speed up the healing process by removing the crusts two to three times a day. This is done by soaking the skin in a warm bath, then wiping the scabs away gently with a clean face washer and patting dry with a fresh towel. Sores should be completely covered by waterproof bandages.</p>
<p>To prevent other family members catching the infection, don’t share any towels, face washers, clothes and bed linen, and put them on a hot wash. The infected person should use a fresh towel and washer every time they bathe, and keep their nails short. </p>
<p>Kids are generally ready to go back to school once they’ve had 24 hours of antibiotics and if the sores are covered with dressings. For children not taking antibiotics, public health authorities recommend that <a href="https://www.rch.org.au/kidsinfo/fact_sheets/Impetigo_school_sores/">children only return to school</a> when the sores are completely healed.</p>
<h2>Complications</h2>
<p>Impetigo can occasionally lead to a further, dangerous infection. If children are feverish or lethargic, sores are spreading despite antibiotics, or you’re concerned your child looks unwell, see a doctor. </p>
<p>Newborns and babies are also at higher risk of serious complications due to their immature immune systems, and so get it checked out at the first sign of infection.</p>
<p>One possible reason for sores not improving on standard antibiotics is infection by an antibiotic-resistant bacteria. Infections due to antibiotic-resistant golden staph, MRSA (methicillin-resistant <em>Staphylococcus aureus</em>), are becoming more widespread, largely due to the widespread use of antibiotics. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaccine-for-strep-throat-and-rheumatic-fever-to-be-trialled-in-humans-63390">Vaccine for strep throat and rheumatic fever to be trialled in humans</a>
</strong>
</em>
</p>
<hr>
<p>An <a href="https://www.mja.com.au/journal/2017/207/9/increasing-importance-community-acquired-methicillin-resistant-staphylococcus">Australian study</a> in the Hunter area of New South Wales looked at all staph infections diagnosed in the region from 2008 to 2014. Nearly 20% were drug-resistant strains. </p>
<p>For most children, though, the infection is mild and fleeting. Keep an eye on the sores, and see your GP for a diagnosis, but try not to worry if it’s a standard case. </p>
<hr>
<p><em>Dr Kristen Ochs, a GP registrar at the academic General Practice Unit, Fairfield Hospital and Ingham Institute of Applied Medical Research, co-wrote this article.</em></p><img src="https://counter.theconversation.com/content/86930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Tam does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
School sores usually clear up within a few weeks, without any scarring. Here’s what to do if you suspect your child has them.
Michael Tam, General Practitioner, and Senior Lecturer, University of Sydney
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/80887
2017-08-24T23:28:34Z
2017-08-24T23:28:34Z
Speaking with: John Gerrard on preventing infectious diseases
<figure><img src="https://images.theconversation.com/files/182051/original/file-20170815-5720-148bqen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">John Gerrard says a developed city like Sydney could not cope with an epidemic of the scale of the recent Ebola outbreak.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/unmeer/16409791605/">UNMEER/Martine Perret/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The Spanish Flu of 1918 is estimated to have infected around 500 million, and killed between 20 and 40 million, people around the world - all within the space of a year. It is perhaps the deadliest pandemic in human history.</p>
<p>We have seen nothing as devastating since, but outbreaks such as <a href="https://theconversation.com/h1n1-h5n1-h7n9-what-on-earth-does-it-all-mean-14815">influenza</a>, <a href="https://theconversation.com/aids-epidemic-no-longer-a-public-health-issue-but-hiv-still-is-62287">HIV/AIDS</a>, <a href="https://theconversation.com/does-zika-virus-pose-a-threat-to-australia-53557">Zika</a> and <a href="https://theconversation.com/how-ebola-started-spread-and-spiralled-out-of-control-32137">Ebola</a> highlight that infectious diseases are a <a href="https://theconversation.com/four-of-the-most-lethal-infectious-diseases-of-our-time-and-how-were-overcoming-them-78101">constant threat</a>.</p>
<p>William Isdale spoke with Dr. John Gerrard about predicting the next major infectious disease threat, and how we can prevent a pandemic from establishing itself in Australia.</p>
<hr>
<p><em><a href="https://itunes.apple.com/au/podcast/speaking-with.../id934267338">Subscribe</a> to The Conversation’s Speaking With podcasts on Apple Podcasts, or <a href="http://tunein.com/radio/Speaking-with---The-Conversation-Podcast-p671452/">follow</a> on Tunein Radio.</em></p>
<p><strong>Additional Audio</strong></p>
<ul>
<li><a href="https://www.youtube.com/watch?v=oMIZ4eYLNFY">Next News - Return of Ebola </a></li>
<li>9 News: A Perth mother of three dying after being struck down by a tick</li>
<li><a href="http://edition.cnn.com/videos/health/2017/03/30/unseen-enemy-excerpt-pandemic-predicted-bird-flu-new.cnn/video/playlists/unseen-enemy/">CNN News: There will be a pandemic</a></li>
<li><a href="https://www.youtube.com/watch?v=RUuRqa-XU8A">BBC News: Ebola Virus: Film reveals scenes of horror in Liberia</a></li>
<li><a href="https://www.youtube.com/watch?v=JNiH18JNmqA">The Daily Conversation: Ebola explained</a></li>
<li><a href="https://www.youtube.com/watch?v=UFiEQhbvejA">CNN News: The Situation Room - MRSA</a></li>
<li><a href="https://www.youtube.com/watch?v=mGpFANXkpXI">BBC News: Antibiotic resistance</a></li>
</ul>
<p><strong>Music</strong></p>
<ul>
<li><a href="http://freemusicarchive.org/music/Blue_Dot_Sessions/Union_Hall/Union_Hall_Melody">Free Music Archive: Blue Dot Sessions - Union Hall Melody</a></li>
<li><a href="http://freemusicarchive.org/music/Blue_Dot_Sessions/Union_Hall/Janitor">Free Music Archive: Blue Dot Sessions - Janitor</a></li>
</ul><img src="https://counter.theconversation.com/content/80887/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Isdale does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
William Isdale speaks to Dr. John Gerrard about the constant threat of infectious diseases and what we can do to prevent a deadly pandemic from establishing itself in Australia.
William Isdale, Research Assistant, Melbourne Law School, The University of Melbourne
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/74490
2017-04-17T22:56:16Z
2017-04-17T22:56:16Z
Medieval medical books could hold the recipe for new antibiotics
<figure><img src="https://images.theconversation.com/files/165279/original/image-20170413-11758-10u9ffg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recipe for an eyesalve from 'Bald's Leechbook.'</span> <span class="attribution"><span class="source">© The British Library Board (Royal MS 12 D xvii)</span></span></figcaption></figure><p>For a long time, medieval medicine has been dismissed as irrelevant. This time period is popularly referred to as the “Dark Ages,” which erroneously suggests that it was unenlightened by science or reason. However, some medievalists and scientists are now looking back to history for clues to inform the search for new antibiotics.</p>
<p>The evolution of <a href="http://www.who.int/mediacentre/factsheets/fs194/en/">antibiotic-resistant microbes</a> means that it is always necessary to find new drugs to battle microbes that are no longer treatable with current antibiotics. But progress in finding new antibiotics is slow. The drug discovery pipeline is currently stalled. <a href="https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf">An estimated 700,000 people</a> around the world die annually from drug-resistant infections. If the situation does not change, it is estimated that such infections will kill 10 million people per year by 2050.</p>
<p>I am part of the <a href="https://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx">Ancientbiotics team</a>, a group of medievalists, microbiologists, medicinal chemists, parasitologists, pharmacists and data scientists from multiple universities and countries. We believe that answers to the antibiotic crisis could be found in medical history. With the aid of modern technologies, we hope to unravel how premodern physicians treated infection and whether their cures really worked. </p>
<p>To that end, we are compiling a database of medieval medical recipes. By revealing patterns in medieval medical practice, our database could inform future laboratory research into the materials used to treat infection in the past. To our knowledge, this is the first attempt to create a medieval medicines database in this manner and for this purpose. </p>
<h2>Bald’s eyesalve</h2>
<p>In 2015, our team published a <a href="http://mbio.asm.org/content/6/4/e01129-15.full">pilot study</a> on a 1,000-year old recipe called Bald’s eyesalve from <a href="http://blogs.bl.uk/digitisedmanuscripts/2016/01/balds-leechbook-now-online.html">“Bald’s Leechbook,”</a> an Old English medical text. The eyesalve was to be used against a “wen,” which may be translated as a sty, or an infection of the eyelash follicle. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=625&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=625&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=625&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=785&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=785&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164606/original/image-20170410-29390-1gtp4f5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=785&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Human white blood cells (in blue) take on <em>Staphylococcus aureus</em> bacteria.</span>
<span class="attribution"><a class="source" href="https://phil.cdc.gov/phil/details.asp?pid=18140">Frank DeLeo, National Institute of Allergy and Infectious Diseases</a></span>
</figcaption>
</figure>
<p>A common cause of modern styes is the bacterium <a href="https://www.cdc.gov/hai/organisms/staph.html"><em>Staphylococcus aureus</em></a>. <a href="https://www.cdc.gov/mrsa/">Methicillin-resistant <em>Staphylococcus aureus</em> (or MRSA)</a> is resistant to many current antibiotics. Staph and MRSA infections are responsible for a variety of severe and chronic infections, including wound infections, sepsis and pneumonia. </p>
<p>Bald’s eyesalve contains wine, garlic, an <em>Allium</em> species (such as leek or onion) and oxgall. The recipe states that, after the ingredients have been mixed together, they must stand in a brass vessel for nine nights before use. </p>
<p>In <a href="http://mbio.asm.org/content/6/4/e01129-15.full">our study</a>, this recipe turned out to be a potent antistaphylococcal agent, which repeatedly killed established <a href="http://www.radiolab.org/story/best-medicine/"><em>S. aureus</em></a> <a href="https://wwwnc.cdc.gov/eid/article/8/9/02-0063_article">biofilms</a> – a sticky matrix of bacteria adhered to a surface – in an in vitro infection model. It also killed MRSA in mouse chronic wound models.</p>
<h2>Medieval methods</h2>
<p>Premodern European medicine has been poorly studied for its clinical potential, compared with traditional pharmacopeias of other parts of the world. Our research also raises questions about medieval medical practitioners. Today, the word “medieval” is used as a derogatory term, indicating cruel behavior, ignorance or backwards thinking. This perpetuates the myth that the period is unworthy of study. </p>
<p>During our eyesalve study, chemist Tu Youyou was awarded the <a href="https://www.nobelprize.org/nobel_prizes/medicine/laureates/2015/press.html">Nobel Prize in Physiology or Medicine</a> for her discovery of a new therapy for malaria after searching over 2,000 recipes from ancient Chinese literature on herbal medicine. Is another “silver bullet” for microbial infection hidden within medieval European medical literature?</p>
<p>Certainly, there are medieval superstitions and treatments that we would not replicate today, such as purging a patient’s body of pathogenic humors. However, <a href="http://www.loc.gov/preservation/outreach/tops/connelly/index.html">our work</a> suggests that there could be a methodology behind the medicines of medieval practitioners, informed by a long tradition of observation and experimentation. </p>
<p>One key finding was that following the steps exactly as specified by the Bald’s eyesalve recipe – including waiting nine days before use – was crucial for its efficacy. Are the results of this medieval recipe representative of others that treat infection? Were practitioners selecting and combining materials following some “scientific” methodology for producing biologically active cocktails? </p>
<p>Further research may show that some medieval medicines were more than placebos or palliative aids, but actual “ancientbiotics” used long before the modern science of infection control. This idea underlies our current study on the medieval medical text, “Lylye of Medicynes.” </p>
<h2>A medieval medicines database</h2>
<p>The “Lylye of Medicynes” is a 15th-century Middle English translation of the Latin “Lilium medicinae,” first completed in 1305. It is a translation of the major work of a significant medieval physician, <a href="https://www.amazon.com/Doctor-Bernard-Gordon-Studies-Texts/dp/0888440510">Bernard of Gordon</a>. His “Lilium medicinae” was translated and printed continuously over many centuries, until at least the late 17th century.</p>
<p>The text contains a wealth of medical recipes. In the Middle English translation, there are 360 recipes – clearly indicated with Rx in the text – and many thousands more ingredient names. </p>
<p>As a doctoral student, I prepared the first-ever edition of the “Lylye of Medicynes” and compared the recipes against four extant Latin copies of the “Lilium medicinae.” This involved faithfully copying the Middle English text from the medieval manuscript, then editing that text for a modern reader, such as adding modern punctuation and correcting scribal errors. The “Lylye of Medicynes” is 245 folios, which equates to 600 pages of word-processed text. </p>
<p>I loaded the Middle English names of ingredients into a database, along with translations into modern equivalents, juxtaposed with relationships to recipe and disease. It is very time-consuming to format medieval data for processing with modern technologies. It also takes time to translate medieval medical ingredients into modern equivalents, due in part to multiple synonyms as well as variations in modern scientific nomenclature for plants. This information has to be verified across many sources. </p>
<p>With our database, we aim to find combinations of ingredients that occur repeatedly and are specifically used to treat infectious diseases. To achieve this, we are employing some common tools of data science, such as <a href="http://epubs.siam.org/doi/pdf/10.1137/S003614450342480">network analysis</a>, a mathematical method to examine the relationships between entries. Our team will then examine how these patterns may help us to use medieval texts as inspiration for lab tests of candidate “ancientbiotic” recipes. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=222&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=222&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=222&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=279&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=279&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164608/original/image-20170410-7394-1xdr57r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=279&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Word cloud from the Lylye of Medicynes.</span>
<span class="attribution"><span class="source">Erin Connelly</span></span>
</figcaption>
</figure>
<p>In March, we tested a small portion of the database to ensure that the method we developed was appropriate for this data set. At present, the database contains only the 360 recipes indicated with Rx. Now that the proof-of-concept stage is complete, I will expand the database to contain other ingredients which are clearly in recipe format, but may not be marked with Rx. </p>
<p>We are specifically interested in recipes associated with recognizable signs of infection. With Bald’s eyesalve, the combination of ingredients proved to be crucial. By examining the strength of ingredient relationships, we hope to find out whether medieval medical recipes are driven by certain combinations of antimicrobial ingredients. </p>
<p>The database could direct us to new recipes to test in the lab in our search for novel antibiotics, as well as inform new research into the antimicrobial agents contained in these ingredients on the molecular level. It could also deepen our understanding of how medieval practitioners “designed” recipes. Our research is in the beginning stages, but it holds exciting potential for the future.</p><img src="https://counter.theconversation.com/content/74490/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Erin Connelly does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
A team of medievalists and scientists look back to history – including a 1,000-year-old eyesalve recipe – for clues to new antibiotics.
Erin Connelly, CLIR-Mellon Fellow for Data Curation in Medieval Studies, University of Pennsylvania
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/72044
2017-03-06T02:18:02Z
2017-03-06T02:18:02Z
Why artificial turf may truly be bad for kids
<figure><img src="https://images.theconversation.com/files/156241/original/image-20170209-8646-8j5v4k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Soccer player on artificial turf. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/synthetic-soccer-field-467227091?src=9j3C6qf-X6FT0S9dElf_bw-1-40">From www.shutterstock.com</a></span></figcaption></figure><p>If you want to get a soccer mom’s attention, bring up the subject of artificial turf, the preferred playing surface for children from pre-K to college – or at least preferred by school boards and parks and recreation departments.</p>
<p>From concerns about <a href="https://www.ncbi.nlm.nih.gov/pubmed/12394868">concussions</a> to <a href="http://www.cnn.com/2017/01/27/health/artificial-turf-cancer-study-profile/">cancer</a>, parents have become alarmed by reports in the media of increased injuries and illnesses. </p>
<p>And there is the further question of who is responsible for assuring the safety of these fields: the <a href="https://www.epa.gov">Environmental Protection Agency</a>? The <a href="https://www.cpsc.gov">Centers for Disease Control</a>? The<a href="https://www.cpsc.gov"> Consumer Product Safety Commission</a>? </p>
<p>As an environmental health professor who has examined a variety of environmental problems and as a soccer dad who watched my son play on these fields for years, I think it’s worth examining the facts and myths about artificial turf fields and what hazards may or may not be associated with playing on them. Based on studies I have reviewed and conducted, I believe there is a potential health risk, because of the chemicals in tires, which are recycled into crumbs to support the plastic blades of synthetic grass.</p>
<h2>Just what is it, anyway?</h2>
<p>Artificial turf is made up of three major parts: </p>
<ol>
<li>Backing material that will serve to hold the individual blades of artificial grass.</li>
<li>The plastic blades themselves.</li>
<li>The infill, those tiny black crumbs, that helps support the blades.</li>
</ol>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=506&fit=crop&dpr=1 754w, https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=506&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/155703/original/image-20170206-18529-18ehj5y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=506&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The crumbs of artificial turf.</span>
</figcaption>
</figure>
<p>Various pigments are used to provide the green color of the blades. These can include lead or titanium for the white lines and still other metals for school logos on the field.</p>
<p>Those little black crumbs are the problems. Tires can be toxic.</p>
<p>Modern tires <a href="https://www.scientificamerican.com/article/greener-tires/">are a mixture</a> of natural and synthetic rubber, carbon black – a material made from petroleum – and somewhere between four and 10 gallons of petroleum products. They also contain metals, including cadmium, lead, which is neurotoxic, and zinc. </p>
<p>Some of the chemicals in tires, such as dibenzopyrenes, are known <a href="https://www.ncbi.nlm.nih.gov/pubmed/22352997">carcinogens</a>. </p>
<p>Also, in addition to chemicals used in the manufacture of the tire, any chemical the tires were exposed to in their use can become absorbed on the carbon black in the tires. </p>
<h2>More to the problem than crumbs</h2>
<p>Even though artificial turf does not have to be mowed,<br>
it turns out that <a href="http://www.simpleturf.com/artificial-lawn-turf-maintenance-warranty/">crabgrass and other weeds</a> can start growing in it. To keep its finely manicured appearance, <a href="https://www.washingtonpost.com/national/health-science/what-to-know-before-you-spray-your-lawn-with-pesticides/2014/07/07/77d719a2-f63c-11e3-a606-946fd632f9f1_story.html?utm_term=.763d7c159726">weedkillers</a> need to be applied, a relatively common practice. </p>
<p>Unfortunately, a variety of <a href="https://www.scientificamerican.com/article/weed-whacking-herbicide-p/">health concerns</a> have been linked to these products.</p>
<p>Also, artificial turf is often treated with biocides, as turf has been associated with increased risk of infections from Methicillin Resistant Staphylococcus aureus (MRSA). <a href="https://www.cdc.gov/mrsa/">MRSA</a> is a dangerous infection because it is resistant to many antibiotics. It can lead to pneumonia, sepsis and bloodstream infections that can prove fatal. An MRSA infection can happen after skin is scraped or cut, which can occur from sliding on artificial turf.</p>
<p>Biocides, however,<a href="https://ehjournal.biomedcentral.com/articles/10.1186/1476-069X-9-7"> may have toxic effects of their own</a>. And, they may also contribute to increased resistance of bacteria to the efficacy of these agents. </p>
<h2>The list of drawbacks goes on…and on…</h2>
<p>Fields with artificial turf tend to get far hotter than grass fields. <a href="http://plantscience.psu.edu/research/centers/ssrc/documents/temperature.pdf">Field surface temperatures</a> can reach as high as 200 degrees Fahrenheit. At these temperatures, even with athletic shoes on, children can get burned feet. It is rare, even on a very hot day, that natural grass exceeds half that (100°F).</p>
<p>While manufacturers recommend spraying fields with water to keep the temperature down, this improvement can vanish in as little as 20 minutes.</p>
<p>Because it is laid over either concrete or compacted earth, artificial turf is a harder surface than grass. This can increase the risk of injuries, particularly concussions.</p>
<p>The unit used to describe hardness is <a href="http://plantscience.psu.edu/research/centers/turf/extension/factsheets/playing-surfaces/gmax">Gmax</a>. While different numbers have been reported for the Gmax for artificial turf, ranging from the high 60’s to over 125, it is important to keep in mind that these numbers are highly dependent on the substrate, temperature, age and maintenance of the field. The key is that the higher the number, the higher the likelihood of concussion. </p>
<h2>Can the tire chemicals get into kids?</h2>
<p>The key question on exposure is: Do these chemicals get into children playing on these fields? </p>
<p>While it is true that the tire crumbs are large, it is easy to show that they don’t necessarily remain large over the life of the field. <a href="http://www.nj.gov/dep/dsr/publications/artificial-turf-report.pdf">In a New Jersey study</a> we employed a robot we call <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4311520/">PIPER</a> (Pretoddler Inhalable Particulate Environmental Robotic) to study if there were inhalable exposures from the artificial turf. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/155035/original/image-20170131-3285-t8fxn3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">PIPER collecting air sample on artificial turf field.</span>
<span class="attribution"><span class="source">Personal photo</span></span>
</figcaption>
</figure>
<p>We showed the tiny particles from the turf can become suspended in air above the field and inhaled by children playing on the field. What has become apparent is that <a href="http://www2.mst.dk/udgiv/publications/2008/978-87-7052-866-5/html/images/fig6_1.jpg">microscopic carbon black particles</a> break off from the crumb rubber and are small enough to be inhalable. Additionally, the blades of grass can also break down into microscopic particles over years of exposure to sunlight and weather, forming a respirable dust. </p>
<p>How do these particles get into a child? </p>
<p>Think of the “Peanuts” comic strip character Pig Pen, the child always followed around by a visible cloud. The truth is that all children – indeed, all people – have a cloud around them of microscopic particles. This personal micro-environment of dust particles, invisible to the naked eye, is just as real as Pig Pen’s. </p>
<p>These small particles and their chemicals can be inhaled or swallowed by a child.</p>
<h2>And if so, do they cause illness?</h2>
<p>A clear answer on whether artificial turf increases the risk of injury or illness is far more challenging. </p>
<p>Let’s consider the two major concerns with regard to artificial turf: cancer and neurologic effects. </p>
<p>The question of cancer and artificial turf gained significant national attention in the U.S. with a series of news stories on NBC Nightly News regarding a cluster of cancers in <a href="http://www.nbcnews.com/storyline/artificial-turf-debate/how-safe-artificial-turf-your-child-plays-n220166">young women soccer players</a>. </p>
<p>A cancer cluster is the appearance of an unusually high rate of cancer in one location in a particular time frame. The story, while dismissed by the turf industry, again resurfaced in the <a href="http://www.nbcnews.com/storyline/artificial-turf-debate/mom-cancer-stricken-soccer-player-wants-answers-artificial-turf-n435146">fall of 2015</a>. </p>
<p>Information has continued to accrue on this cancer <a href="https://www.cancer.gov/about-cancer/causes-prevention/risk/substances/cancer-clusters-fact-sheet#q1">cluster</a>. While as many as <a href="https://www.cancer.org/cancer/cancer-causes/general-info/cancer-clusters.html">80 percent of suspected cancer clusters are determined not to be true increases in cancer cases</a> and due only to random chance, the problem is that, without detailed and often expensive scientific investigation, whether it is real or not cannot be determined. </p>
<p>Just recently the <a href="http://www.doh.wa.gov/Portals/1/Documents/Pubs/210-091.pdf">Washington State Department of Health issued a report</a> on its study of the reported cancer cluster in these soccer players. Their report found no evidence of a causal effect of playing on artificial turf and cancer. As they acknowledge, that does not mean there is no risk, only that this study did not find one. They also suggested there is still room for broader investigation on this question.</p>
<p>What about the potential risk of neurologic impairment from ingestion or inhalation of any lead present in the turf? The lead can be present in both the blades, as a color pigment for logos and white lines, as well as in the infill crumb rubber. For more information on lead, see <a href="https://theconversation.com/toxic-lead-can-stay-in-the-body-for-years-after-exposure-53607">my earlier article for The Conversation</a>.</p>
<h2>What’s the bottom line on safety?</h2>
<p>While the turf <a href="http://www.fieldturf.com/en/innovation/research-and-studies">industry says it’s safe</a>, we know that <a href="http://www.calrecycle.ca.gov/publications/Documents/Tires%5C43296029.pdf">tires</a> contain established carcinogens. If we considered only what tires are made of, we would think they should be classified as hazardous waste, though currently EPA classifies tires as municipal waste. </p>
<p>The EPA has been conducting research into the question of <a href="https://www.epa.gov/chemical-research/tire-crumb-questions-and-answers">toxicity of crumb rubber</a>, but the jury is still out.</p>
<p>There is little question in the mind of many scientists that crumb rubber should not be a first choice material for children to play on. Parents should be able to just enjoy watching their children playing sports and not worry that they are being put unnecessarily at risk.</p>
<p><em>A correction was made to this article March 23, 2017 to accurately describe MRSA, which is Methicillin Resistant Staphylococcus aureus, not Multi-drug Resistant Staphylococcus aureus, as was originally stated. In addition, MRSA is not flesh-eating bacteria. It can cause serious consequences, including sepsis and bloodstream infections.</em></p><img src="https://counter.theconversation.com/content/72044/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stuart Shalat received funding from New Jersey Department of Environmental Protection.</span></em></p>
Artificial turf has become popular for kids’ sports as well as for professional players. The little black crumbs that help support the blades of fake grass may not be so harmless.
Stuart Shalat, Professor and Director of the Division of Environmental Health, School of Public Health, Georgia State University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/45810
2015-10-22T05:10:41Z
2015-10-22T05:10:41Z
How patient experiences can be used to solve common hospital problems
<figure><img src="https://images.theconversation.com/files/97308/original/image-20151005-28766-1xu20t2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ask and you shall learn.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-284569547/stock-photo-woman-undergoing-chemotherapy-with-nurse.html?src=PIaWF7AeDRLV3LoCzkcmVg-1-1">Nurse by Shutterstock</a></span></figcaption></figure><p>Person-centred care means talking to patients to understand their needs, sharing information with them and involving them in decisions that affect the care they receive. It is a cornerstone of delivering high quality healthcare and doctors and other practitioners <a href="http://www.health.org.uk/sites/default/files/PersonCentredCareMadeSimple.pdf">are encouraged to do this</a> in every interaction with every patient. However, healthcare policy and practice needs to be based on evidence. </p>
<p>Researchers can use different types of data of patient experience to inform policy and practice, for example national surveys of recently discharged patients can give the bigger picture view of <a href="http://www.kingsfund.org.uk/projects/bsa-survey-2014/satisfaction-nhs-overall?gclid=CMjllazDqMgCFUGg2wodds4Prw">what patients think</a> about <a href="http://www.gov.scot/Resource/0045/00458511.pdf">aspects of their care</a>.</p>
<p>This data is then fed back to individual NHS boards to inform the quality improvement plans that they draw up. However, this approach has some limitations. The data is based on what those who have designed the survey have decided is important to ask about (although sometimes the questions are based on focus groups). There is also little opportunity for patients to explain why they have given a particular score or what they think might improve the situation. </p>
<h2>Noisy bedtimes</h2>
<p>This is where qualitative or mixed methods studies are useful, as individuals or small groups of patients are asked what is important to them. Survey questions can be then be designed based on this bottom-up approach of what matters to patients. </p>
<p>We successfully used this approach to find evidence about how patient experience related to very different aspects of care, for example in relation to screening for the superbug MRSA and the impact of reducing avoidable night time noise. </p>
<p>In this second example, NHS Scotland’s <a href="http://www.careexperience.scot.nhs.uk/">surveys of patient experience</a> showed that night time noise was consistently highlighted as a problem by patients. However we didn’t know what caused the noise, how often this happened or how disruptive the noise was. So although we knew night time noise was a problem, we didn’t have enough detail to begin to improve this situation for patients. </p>
<p>Working in collaboration with a large NHS board – NHS Greater Glasgow & Clyde – we conducted a research project that involved interviewing patients to obtain much more detail about what actually disturbed their sleep. This showed that patients were disturbed by noise from staff, by talking or walking past with noisy shoes for example, or from trolleys being wheeled, telephones ringing, other patients snoring, being confused, emergency admissions, and the environment, lights being switched on. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/97309/original/image-20151005-28775-1qrewv2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A special case. For most it’s not that easy to get some kip.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>We then worked with patient involvement groups and ward staff to develop solutions to these problems. A follow-up evaluation <a href="https://www.researchgate.net/publication/245022634_Improving_the_Patient_Experience_Reducing_Avoidable_Noise_at_Night">showed improvement</a> in those causes of noise where ward staff had most influence, such as staff talking, delays in answering call buzzers. The project illustrated how different kinds of patient experience data can be used to create solutions to a common problem.</p>
<p>Infection rates in hospitals are also often used as an indicator of the quality of patient care, and avoiding spread of infection between patients is important. Screening for common infections, such as MRSA is common policy. However, <a href="https://www.researchgate.net/publication/234128503_A_mixed_methods_study_of_the_acceptability_of_MRSA_screening_in_NHS_Scotland_Pathfinder_Boards_from_the_perspective_of_patients_visitors_the_wider_community__NHS_staff">a study we conducted</a> of the patient experience of MRSA screening showed that patients were not always given information about why they were being screened, were rarely given the result of the screening test, and did not have good information about how the infection would be managed if they were found to have MRSA present. </p>
<p>Patient experience data from that study was used to develop an education tool for NHS staff to improve communication around MRSA screening. Changes in policy guidance emphasised the importance of effective information for patients to improve the quality of care. </p>
<p>These two examples of the use of research data to provide evidence on the patient experience of care demonstrate the importance of finding out what matters to patients in very different contexts. In the same way that individual clinicians must listen to individual patients to provide excellent care at that one-to-one level, healthcare policy must be based on robust evidence of the patient experience of different aspects of care if we aspire to provide a service that is truly centred around patients.</p><img src="https://counter.theconversation.com/content/45810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kay Currie receives funding from the Scottish Government Chief Scientist Office for research and NHS Scotland. </span></em></p>
Noisy bedtimes and MRSA – how patient experiences can address issues during hospital stays.
Kay Currie, Reader in Applied Health Research, Glasgow Caledonian University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/47294
2015-09-10T05:33:19Z
2015-09-10T05:33:19Z
Deadliest superbugs are not the most toxic, new study shows
<figure><img src="https://images.theconversation.com/files/94257/original/image-20150909-18653-mds2ng.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Staphylococcus aureus has confused researchers about how superbugs cause deadly infections. </span> <span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Vancomycin-resistant_Staphylococcus_aureus#/media/File:Staphylococcus_aureus_VISA.jpg">Janice Haney Carr/wikimedia</a></span></figcaption></figure><p>Infamous bacteria such as MRSA are considered “superbugs” because not only can <a href="https://theconversation.com/explainer-what-are-superbugs-and-how-can-we-control-them-44364">they kill us</a> using a wide range of virulence mechanisms, but they can also resist the effects of antibiotics. However, some superbugs reside on the skin and in the noses of a huge proportion of the human population causing only negligible problems for the majority. </p>
<p>Exactly why certain bacteria cause more severe infections than others is unclear. But for decades we have believed that the more toxins a bacteria produces, the worse infections it causes.</p>
<p>However, <a href="http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1002229">our latest study</a> shows that, in the case of the bacterium <a href="https://theconversation.com/golden-staph-the-deadly-bug-that-wreaks-havoc-in-hospitals-39790"><em>Staphylococcus aureus</em></a> (the SA in MRSA but also known as “golden staph”), quite the opposite is true.</p>
<h2>The role of toxins</h2>
<p>It is vitally important that we understand the link between superbugs and infections in detail. While infections due to <em>S. aureus</em> residing in the nose and skin can be mild and superficial, they can be life-threatening if they get in the bloodstream. Blood is normally a sterile environment, but bacteria can occasionally enter it during surgery or <a href="http://www.ncbi.nlm.nih.gov/pubmed/16308227">complications due to infections like pneumonia or other underlying health conditions such as diabetes</a>. This serious condition, called bacteraemia, has mortality rates <a href="https://books.google.co.uk/books?id=bde6I_3gsPQC&pg=PA157&lpg=PA157&dq=bacteraemia,+has+mortality+rates+40%25&source=bl&ots=aYRbOkqc-_&sig=8wHgQpAGgjTYD-G6pOi4LIX2FO8&hl=en&sa=X&ved=0CCQQ6AEwAGoVChMIs5XqzfvpxwIV6m7bCh3qIgH3#v=onepage&q=bacteraemia%2C%20has%20mortality%20rates%2040%25&f=false">as high as 40%</a>.</p>
<p>To try to understand this difference in severity, we focused on the ability of these bacteria to secrete toxins: proteins that physically <a href="http://www.ncbi.nlm.nih.gov/pubmed/3281562">destroy the membrane of human cells</a>. The effect of bacteria-producing toxins on blood cells can be seen in the figure below. On the left we have highly toxic bacteria growing and a halo of broken-down blood cells can be seen, whereas on the right non-toxic bacteria are growing and the blood cells remain intact.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/94262/original/image-20150909-18658-1cm26au.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">High and low toxic MRSA growing on the surface of horse-blood agar plates.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Given the destructive nature of bacterial toxins, we have for decades believed that the more toxic a bacteria is, <a href="http://www.nejm.org/doi/full/10.1056/NEJM199808203390806">the worse the severity of infection</a> it can cause. To study this we examined two large collections of isolated <em>S. aureus</em> bacteria. One was from a patient before and after they developed bacteraemia. The second was from a wide range of patients, some isolated from their noses and some from their bloodstream after they developed bacteraemia. </p>
<p>Surprisingly, we found that in both cases, the bacteria from the bloodstream, which cause the most severe disease, were the least toxic. We also discovered that the fitness of the bacteria is key to this effect. Secreting toxins expends high levels of energy by the bacteria. And the bloodstream, where the majority of the human immune system exists primed and ready to respond to invasion, is a highly stressful environment for it. </p>
<p>We therefore believe that the energy required to produce toxins is too high for the bacteria to be able to also adapt to the high-stress environment of the bloodstream. This is why the less toxic bacteria get in there, causing the most severe of infections. </p>
<h2>Challenging the dogma</h2>
<p>This leaves us with the question of why we have for decades believed toxins to be so critical for bacteria to cause disease, to the extent that they have been the focus of numerous research labs across the globe and one of the major <a href="http://m.jid.oxfordjournals.org/content/203/11/1692.full">protein targets</a> for vaccination programmes. Unfortunately, it’s a question to which there is no simple answer. </p>
<p>Toxins <a href="http://textbookofbacteriology.net/proteintoxins.html">are important</a> to many aspect of <em>S. aureus</em>’ life style. They kill off competitor bacteria, they release nutrients from human cells, they dampen down the human immune system allowing the bacteria to reside happily on our bodies as part of our normal flora. When they cause minor infections toxins are responsible for producing lots of pus, which is a great material for transmitting from one person to another … after all, who can resist popping a pimple?</p>
<p>But as there is no way to mimic all the complex interactions that occur in the body for serious bacterial infections, we are <a href="http://www.nature.com/nrmicro/journal/v12/n8/full/nrmicro3308.html">reliant on animal models</a> to try to understand them. For <em>S. aureus</em> these are typically small rodents who do not naturally succumb to this pathogen. As such 10-100 million bacterial cells need to be injected directly into the rodent’s bloodstream to get experimentally reproducible infections. Compare this to the small handful of bacteria required to cause such infection in humans (<100) and it is clear to see where misinterpretations of such research findings can occur.</p>
<p>At a superficial level, the implications of our research are somewhat depressing in that despite decades of research we still have much to learn about how bacteria such as MRSA cause life-threatening disease. However, identifying the limitations to our knowledge, rather than blindly pursuing hypothesis based on misleading animal experiments has got to be a better starting point for the future of infectious disease research.</p><img src="https://counter.theconversation.com/content/47294/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ruth Massey receives funding from the medical research council (MRC). </span></em></p>
A narrow focus on bacteria that produces high levels of toxin may have misled researchers in the pursuit to understand superbugs.
Ruth Massey, Reader, department of biology & biochemistry, University of Bath
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/46224
2015-08-18T05:32:14Z
2015-08-18T05:32:14Z
How DNA detectives are helping solve the rise of superbugs
<figure><img src="https://images.theconversation.com/files/92167/original/image-20150817-28357-187tg5c.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">royaltystockphoto.com/</span></span></figcaption></figure><p>It is now 12 years since the first set of genetic instructions in a human <a href="https://www.genome.gov/11006929">was sequenced</a>. Many of our hopes for using knowledge about the human genome to better fight the likes of heart disease and cancer still lie years and decades in the future, but DNA sequencing in healthcare is not all about tomorrow. It is already revolutionising clinical microbiology. Most exciting of all, it is giving us an important tool in our battle with drug-resistant strains of bacteria. These strains are one of the <a href="http://www.bbc.co.uk/news/health-27204988">major growing threats</a> to human health, and have <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/soft-touch-gps-told-to-stop-giving-antibiotics-to-pushy-patients-so-as-to-curb-rise-of-drugresistant-superbugs-10459183.html">just prompted</a> new guidelines in the UK on how GPs should prescribe antibiotics. </p>
<p>Clinical microbiology is the branch of medicine concerned with preventing and treating infectious diseases. It depends on rapidly identifying the pathogens that cause illness – bacteria, virus and fungus. Identification makes it possible to treat patients individually and monitor the outbreak and spread of a disease effectively. </p>
<p>The traditional way of identifying most bacterial pathogens is to grow a patient’s specimen in a culture, testing its susceptibility to antimicrobial drugs and comparing it with other bacterial strains. It <a href="http://www.nature.com/news/health-care-bring-microbial-sequencing-to-hospitals-1.15282">can take</a> days in the case of rapidly growing bacteria such as <em>E.coli</em>, and months in the case of slower developers like <em>Mycobacterium tuberculosis</em>.</p>
<p>In the early years of the 21st century <a href="http://www.sciencedirect.com/science/article/pii/S1198743X14631979">there were</a> some major technical advances in this field, but challenges remain. Identifying the exact strain of pathogen continues to be difficult, while there are also many obstacles to tracking their routes of transmission and monitoring mutations. </p>
<p>DNA sequencing could well be the answer. Developed in 1975 by a group led by Fred Sanger – whose work is the subject of a <a href="http://www.whatisbiotechnology.org/exhibitions/sanger">new online exhibition</a> – DNA sequencing was not routinely used in clinical microbiological laboratories until very recently. It was very expensive and entailed laborious manual laboratory work and painstaking reading of the results. Yet cheaper rapid DNA sequencers and large reference databases are increasingly changing this situation. </p>
<p>The <a href="http://www.nature.com/nrg/journal/v13/n9/full/nrg3226.html">average cost</a> of bench-top sequencers is now US$125,000 (£80,000). Such machines can sequence several bacterial genomes in a day at a cost of about $150 per sample. As recently as 2007 the cost of sequencing just one bacterial genome could be $800,000. It is <a href="http://genome.wellcome.ac.uk/doc_WTX056439.html">now possible</a> to sequence 100 bacterial genomes in a single run. </p>
<h2>Rosie Hospital</h2>
<p>The technology’s potential with drug-resistant infections first <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/mrsa-outbreak-at-cambridges-rosie-hospital-halted-by-new-dna-profiling-technology-8315755.html">came to the fore</a> during an MRSA outbreak at the Rosie Hospital in Cambridge, UK in 2011. When three babies all tested positive at the same time in the baby unit, the hospital’s infection-control team reviewed the previous six months’ records and found babies had been infected sporadically by MRSA – sometimes months apart. </p>
<p>But was this an outbreak of MRSA or merely unrelated infections? Since conventional methods were little help, experts in whole genome sequencing at the <a href="https://www.sanger.ac.uk">Wellcome Trust Sanger Institute</a> and Cambridge University were called in. They quickly established that the samples were all related at the genome level, suggesting an outbreak. By sequencing other bacteria in the hospital’s microbiology laboratory database with the same antibiotic susceptibility profile, <a href="http://www.thenakedscientists.com/HTML/interviews/interview/1000023/">they confirmed</a> this was a new strain of MRSA with twice as many infections as first thought and that it was also prevalent in the wider community. </p>
<p>Two months after the previous infections were discovered, another baby tested positive despite the unit having just been thoroughly cleaned. So the team sequenced bacteria from swabs taken from staff on the unit and discovered that a particular individual was carrying the same strain of MRSA. Once that staff member was treated, the outbreak ended.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92123/original/image-20150817-5121-1ht1pqy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">MRSA free thanks to DNA sequencing: Rosie Hospital, Cambridge.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/shelley_dave/2782342702/in/photolist-2jCbxs-2jCedu-2jCd5J-2jxUCP-2jCfqw-5eSexU-dCtqD1-dCtqFs-dCtqHG">Dave Gunn</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>Developments since</h2>
<p>There was much talk at the time about the potential for this success to be duplicated elsewhere – and this looks to be bearing out. In 2014 the same Cambridge team <a href="http://www.cam.ac.uk/research/news/using-genome-sequencing-to-track-mrsa-in-under-resourced-hospitals">working together</a> with researchers from Thailand and Australia demonstrated using whole genome sequencing to track and identify MRSA on two intensive-care units in an under-resourced hospital in north-east Thailand. </p>
<p>What was striking was how many different variants of the infection the team detected in the hospital at the same time, something conventional typing had failed to pick up. The work also helped identify clinically important genes such as those coding for antiseptic resistance and antibiotic resistance. Drug-resistant bacteria <a href="http://genome.cshlp.org/content/early/2014/12/01/gr.174730.114">are particularly</a> a problem in poorer countries, so the results looked especially important. </p>
<p>Beyond MRSA, <a href="http://www.genomemedicine.com/content/6/11/70">whole genome sequencing thwarted</a> another type of drug-resistant bacteria at the Queen Elizabeth Hospital in Birmingham, UK in 2013. This was an outbreak of <em>Acinetobacter baumannii</em>, an opportunistic bacteria which causes pneumonia and bloodstream infections in critically ill patients with compromised immune systems. A new strain of the bacteria had been plaguing the hospital for more than 18 months. Once it was sequenced, researchers at Warwick and Birmingham universities were able to show that the previous theory that the infection was being transmitted within one ward had been wrong: they were picking it up from a specialised burns-care bed elsewhere. </p>
<p>This year Imperial College London researchers <a href="http://wwwnc.cdc.gov/eid/article/21/6/14-1903_article">were able</a> to solve a tuberculosis mystery concerning two patients who had contracted drug-resistant strains of the infection. The first had worked in healthcare in South Africa in an area where there had been a serious outbreak of drug-resistant TB in 2005, but had been healthy when coming to England. The second had never travelled abroad and, as is common with TB, experienced no symptoms for four years. It was only through whole genome sequencing that they could be linked together: it turned out they had spent eight days on the same medical ward in 2008. With drug-resistant TB <a href="http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_23-3-2015-14-36-31">cases rising</a> in the UK from 28 cases in 2000 to 81 in 2012, this too is an important development. </p>
<p>Despite all these positives, a major obstacle <a href="http://www.nature.com/news/health-care-bring-microbial-sequencing-to-hospitals-1.15282">blocks the</a> widespread adoption of whole genome sequencing against drug-resistant bacteria. Currently there are few tools to automatically analyse and interpret sequenced data from clinical samples so that it can be understood and clinically applied by non-specialists. This makes it difficult to roll out the system and prevents costs from falling even lower. </p>
<p>Stanford University in California might be pointing the way to a solution, however. Researchers there <a href="http://hivdb.stanford.edu/DR/webservices/">have</a> developed a web-based system for tracking drug-resistant HIV. If this can be applied to other infections, including bacterial ones, genome sequencing could become routine in hospitals worldwide.</p><img src="https://counter.theconversation.com/content/46224/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lara has received funding from the UK Medical Research Council. She has research affiliations with Cambridge University, King's College London and University College London.</span></em></p>
While many of the fruits of the human genome project could be decades away, DNA sequencing of drug-resistant bacteria has been striding forwards
Lara Marks, University of Cambridge
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/44054
2015-07-15T05:22:22Z
2015-07-15T05:22:22Z
We need more than just new antibiotics to fight superbugs
<figure><img src="https://images.theconversation.com/files/87657/original/image-20150707-1277-hu589r.jpg?ixlib=rb-1.1.0&rect=1%2C36%2C1022%2C663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">MRSA</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/niaid/11854196633/in/photolist-j4vREz-j4MspC-dRtGwW-dQorNR-bpCfQR-a2HASi-fyXRic-a2Ltvs-dQjFSx-bpzxT4-p2NgtV-j4uLGn-9y7kCs-4bAWxg-fCw4hb-fA93i1-cMVemo-8WBni-oY1BkX-6qd3wK-4oM6JD-nGHMGu-5QXCmd-fN98g7-53wmHs-fzTQ3p-6JBQwo-iQPVjT-7PdUP3-prZ47n-4shAE2-dxHLyi-oKwbaA-9hccVD-brTWRK-4CSaNS-qN5dKM-4BwpQM-4BAQFW-7XJUBs-4BATUY-4BwtJZ-8XzGVW-4BwA38-4BAEnC-4BAA3q-4BwwQB-4BwrAe-4BACiY-4BwyXT">NIAID</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>By 2050, drug resistant diseases could be killing more people than cancer, <a href="http://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf">an extra 10m deaths</a> per year. They could also cause a loss to the global output of US$100 trillion dollars – equivalent to a sum greater than the size of the current global economy.</p>
<p>A potential future catastrophe in healthcare, where even routine surgical procedures and easily treated infections <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf">become significantly more hazardous</a>, is commonly attributed to the appearance of new strains of antibiotic-resistant bacteria. It is often argued that the answer is more funding for the development of new antibiotics.</p>
<p>What is less commonly recognised is the possibility of a future catastrophe in food production. Modern practice means the <a href="http://www.ncifap.org/_images/PCIFAPFin.pdf">extensive use of antibiotics</a> in the farming of fish, poultry and meat. In the US, 70% of all antibiotics enter the food chain.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88343/original/image-20150714-21743-1jyj3q3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Feeding in.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/szdl/11470482203/in/photolist-itBdJx-nSBJMe-cUEpQq-oL7wqq-h482U4-cWhG9o-cWhG3y-7XBsv6-e59ATC-e53XxR-3kNkeL-iRcGZ-j5CcQX-iBTdgE-fUoFsz-g47ReA-kuBzz9-eWzmsQ-g9SoNm-2QxB2E-fwHhEs-iSsaXJ-odnfMz-nmUJj8-foaFTV-aq2XNw-aq2UWY-aq2WXA-drfLzr-9DAdVn-mmEgNk-cKgfG7-mGP9tK-e53XSt-e53YVD-e59A2A-o84LE3-ddNDjs-edfRwS-8sJCUg-hgtu5a-fJ1nga-7SgnAg-awmE6A-fnMob6-pGmL2V-ehgsdT-7RXSVU-f1jw2X-j2AsVS">sszdl</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>An arms race against natural selection</h2>
<p>Antibiotics are effective against bacteria, just one class of microbe, while the term antimicrobial resistance (AMR) covers the development of resistance in a wider group of bacteria, fungi, viruses and protozoa (such as <a href="http://www.malariajournal.com/content/12/1/269/figure/F2">malaria</a>) to the various measures used to combat them.</p>
<p>The development of new antimicrobial drugs is an arms race against natural selection that cannot be won: when antimicrobials (not just antibiotics) are applied, microbes of all types (not just bacteria) have proven to be adept at developing resistant strains from the survivors. If the drug kills 99.99% of a population of microbes, it is the genetic makeup of the survivors that goes forward to the next generation. To mitigate against potential catastrophes in healthcare and food production, measures over and above the development of new antibiotics have to be undertaken. </p>
<p>These include two key elements. One is infection prevention. If a dangerous microbe never enters the body, no antimicrobial is required. The development of new <a href="http://www.southampton.ac.uk/namrip/research/bill-keevil.page">microbe-resistant materials</a> and <a href="http://www.southampton.ac.uk/namrip/research/Sandra%20wilks.page">products</a>, as well as the development of minimally invasive procedures in hospitals and clinics, improvements in waste disposal and a revolution <a href="http://www.southampton.ac.uk/engineering/research/projects/starstream.page?">in cleaning</a>, are some of the measures already being researched.</p>
<p>However, this does not just involve scientists and clinicians. To take just one example, despite all efforts, <a href="http://www.bbc.co.uk/news/magazine-19834975">many in the UK</a> and <a href="http://www.dailymail.co.uk/health/article-2339422/Just-5-wash-hands-long-kill-harmful-germs.html">the US</a> persist in washing their hands lamentably short of the <a href="http://www.cdc.gov/features/handwashing/">20 seconds</a> in warm soapy water that experts recommend. We need better leadership to rectify this by implementing advice from those who understand behaviours in workplaces and homes, and we need to invest in <a href="https://www.youtube.com/watch?v=ElxcBn7-t8s">science and engineering that makes proper handwashing easy for the public to adopt</a>.</p>
<p>The second element to reducing the use of antimicrobials is the removal of environments that encourage resistant strains to develop, for example in the body of the patient or <a href="http://www.southampton.ac.uk/namrip/research/emma-roe.page">farm animal</a>, with simple measures such as ensuring a full prescription is taken rather than stopping early when symptoms disappear – a practice that encourages the survival of resistant microbes. Other measures include the invention of <a href="http://www.southampton.ac.uk/namrip/research/rob-eason.page">sensors to detect infection early and identify the specific microbe present</a>, so that targeted antimicrobials can be used in place of broad-spectrum agents, one example of responsible antimicrobial stewardship. </p>
<p>We must understand how society, climate, land and water resources interact to alter the risk of microbes moving from one host to another. It is a realistic scenario that a resistant strain in a UK hospital might have emerged because of livestock practices half way across the world, where increased flooding, cultural practices, conflict, the movement of money and populations, and the accepted patterns of behaviour, create an environment very different to our own. Conversely, we could find that resistant strains <a href="http://www.who.int/mediacentre/factsheets/fs194/en/">in far-off countries</a> might have their roots in the use of antibiotics in intensive farming in the UK.</p>
<h2>The way to do it</h2>
<p>The figure below illustrates how the problem extends geographically, and across the workforce and society. The patient in the hospital bed has a reduced risk of infection if the surgeons use a minimally invasive procedure illuminated with <a href="http://www.mediplacements.com/article-801362776-ultraviolet_light_could_be.html">lights</a> that deter microbes, and if the surgical instruments, the trays, the rooms, and the tubes that enter the patient (the catheters, nasal drips, endoscopes and so on) are made of materials on which microbes do not readily adhere, and are properly and promptly cleaned (<a href="http://www.nhslanarkshire.org.uk/Services/InfectionControl/Documents/Control-of-Infection-Manual/Sect-T.pdf">weekend closure</a> of sterile services departments might appear to save costs <a href="http://www.bristolpost.co.uk/Scores-Southmead-Hospital-patients-hit-op-delays/story-22880433-detail/story.html">in the short term</a> but must avoid allowing Friday’s contamination to <a href="http://www.cdc.gov/hicpac/Disinfection_Sterilization/5_0cleaning.html">dry on</a> before washing on Monday). </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=403&fit=crop&dpr=1 600w, https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=403&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=403&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/87656/original/image-20150707-1311-1xysd2n.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The anti-resistance movement.</span>
<span class="attribution"><span class="source">University of Southampton.</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For the patient shown in the figure, wounds can be cleaned and dressed <a href="https://theconversation.com/biofilms-the-bacterial-wound-communities-that-protect-themselves-from-attack-42218">with materials that deter microbes</a>. If infection does occur, it can be promptly targeted with a specific (as opposed to broadspectrum) antimicrobial if it is detected early and rapidly identified (with instruments that feed into a communications hub that alerts the doctor’s phone, which is already becoming equipped with <a href="http://www.southampton.ac.uk/namrip/research/kieran-hand.page">apps containing guidance informed by local susceptibility data</a>). </p>
<p>Treatment of the waste from this patient (solid, fluids and materials contaminated with them) alters the possibility of AMR spreading. Achieving the right hospital environment requires far more than the development of new drugs, and their use by healthcare workers. It goes into the management and maintenance of the hospital, and in to the practices of the people who implement these. New technologies and practices must be designed to ensure that their use will be adopted, which requires understanding design and understanding people.</p>
<p>Indeed, the world outside of the hospital (in the lower half of the figure above) provides an enormous reservoir in which AMR can develop. Analysis and, if necessary, change of our processes and technologies are required in water and waste treatment, and in the production, transport, packaging and retail practices in the food industry.</p>
<p>In many parts of the world, climate change and flooding, war, corruption, politics, received wisdom, traditions and religious practices, and the supply of fuel and money, play a far greater role in food, water, waste treatment, healthcare and the transport of microbes from one host to another, than do the outputs of the drug companies.</p>
<p>The twin potential catastrophes are global, and so are the causes. The solutions lie with scientists and engineers to develop new technologies and embed new practices in the public and workforce; they lie with farmers, plumbers, office workers, water and sewage workers, medical practitioners, food retailers, innovators in business … indeed most of us. And they lie with those who are responsible for shaping behaviour across the world – not just the pharmaceutical companies.</p><img src="https://counter.theconversation.com/content/44054/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tim Leighton FREng FRS is Chair of the Network for AntiMicrobial Resistance and Infection Prevention (NAMRIP - <a href="http://www.southampton.ac.uk/namrip/index.page">http://www.southampton.ac.uk/namrip/index.page</a>?) that has received funding from the University of Southampton, the Medical Research Council, and the Engineering and Physical Sciences Research Council (via EPSRC's Network for Antimicrobial Action 'Bridging the Gap' call EP/MO27260/1). The University of Southampton has licensed the StarStream ultrasonic cleaning technology to Ultrawave Ltd.</span></em></p>
Antibiotic resistance is pressing issue in medicine but the extensive use of antibiotics in farming is part of the problem.
Tim Leighton, Professor of Ultrasonics and Underwater Acoustics, University of Southampton
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/39719
2015-04-09T11:50:31Z
2015-04-09T11:50:31Z
Why I wasn’t excited about the medieval remedy that works against MRSA
<figure><img src="https://images.theconversation.com/files/77352/original/image-20150408-18075-e93l6g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Good thing we don't have superbugs in hospital yet.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/snake3yes/272408110/in/photolist-q5ary-dW2vkW-9v2jPx-5Pjz2N-9v2iDv-4utkg-5Dwti-8trAJL-dVVWuR-7jN551-7H3T7J-dW2xif-86aVWg-7GYXuT-6dWHxr-6nyemC-6YX9k9-btZ9sD-aDiZqV-5ePAf-nx1FV-pYep3-6dWJei-73rsf8-nx1BW-GSHYb-63TyTJ-5Vz8q9-6ZdY7c-63Pmnz-73VAdn-nx1Ar-aoX6na-6SHgpF-aoX2yc-cBi52-4EWozt-6GM723-7TJ4pX-cBhYY-kQguYg-5CHPb7-8toyan-cjm5Co-7UFQkx-4MpuAE-7xfd25-7zUBwp-8HFEzw-qgLH6">Snake3yes</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>It’s not often that medievalists get as excited as they have been over <a href="http://www.newscientist.com/article/dn27263-anglo-saxon-remedy-kills-hospital-superbug-mrsa.html">the revival of a medieval remedy</a> for eye conditions involving garlic, onions, wine and ox gall, prepared in a bronze vessel. The concoction, mixed up by a team from Nottingham University, appeared to <a href="http://bit.ly/1NzG1jo">show promising results</a> in the battle against MRSA. It didn’t kill it all, but it apparently killed 90%. This has revived enthusiasm for trawling ancient texts for the solutions to modern problems. </p>
<p>The remedy comes from <a href="http://britishlibrary.typepad.co.uk/science/2015/04/a-medieval-medical-marvel.html">Bald’s Leechbook</a>, a 10th-century manuscript, and the powers of the separate ingredients of the remedy have been known for some time: <a href="http://www.ncbi.nlm.nih.gov/pubmed/10594976">garlic</a> has anti-fungal, anti-viral, anti-parasitic and anti-microbial qualities. </p>
<p>The idea of subjecting medieval recipes to modern methods of testing is also not new. In 1993, in his book Anglo-Saxon Medicine, the biologist ML Cameron singled out this very remedy as “an outstanding example of a remedy likely to have been helpful”. And it was this same remedy that was reconstructed by a team from Wheaton College, although their results, published in 2005, found that it had no effect. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77353/original/image-20150408-18063-pkwysn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">But beware the garlic breath.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mdid/199386734/in/photolist-iBUJj-pUAibC-8j2EkN-wV2LV-ciDorC-3Fe6Q-6NJDv8-8KwHZn-6KGh1d-7t29ma-ozFaJ-Eiqk-nULCok-cEoZK1-4BDRwv-yAC9f-pNtje6-4pK1yV-74z9Wx-3tquqZ-4zXoaU-9mx7Cq-JoyTL-c26HwA-89JsHY-7zPS15-9aHh7R-7i7hVQ-59D9kR-aaWjRa-rBmFRo-dgM72Y-7PnLms-foEyJ8-onWue-8kb2Lf-dNamZ7-5KTVj5-64f4bm-5uVFUB-8p1Hxy-c9pSQG-7AEXDP-dhecMr-ZHTr-f3KfEN-oW4vNC-foFEUy-bytCeJ-caH4ys">David Pursehouse</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=430414&fileId=S0263675105000086">They concluded</a> that “some of the Anglo-Saxon recipes take biologically efficacious ingredients and process them into ineffective mixtures”. So while the garlic would work on its own, the compound remedy prepared over nine days, wouldn’t.</p>
<p>The 2005 research was part of a rehabilitation of the Anglo-Saxons, which aimed to show they were considerably more learned and deserving of more respect than had previously been thought. But, for the Wheaton College team, the remedies did nothing to support that view. </p>
<h2>The problem with revival</h2>
<p>There are also some serious problems with the new, more positive, claims for the eye salve. And these apply to all such attempts to rediscover ancient remedies.</p>
<p>First, can we really identify the ingredients? For the eye remedy for example, the Anglo Saxon word <a href="http://oldenglish-plantnames.org/index">“cropleek”</a> found in the ingredients can mean leek, garlic or shallot, or perhaps a specific part of a leek. Websites that have attempted to translate the remedy have also listed onions. So what plant should a modern researcher select for their trials? And do modern plant descendants have the same properties now as their ancestors did?</p>
<p>Second, in compound recipes, how do we know which ingredients are worth testing? <a href="http://britishlibrary.typepad.co.uk/digitisedmanuscripts/2013/10/anglo-saxon-medicine.html">Descriptions of 10th-century medicine</a> sometimes suggest that we can easily decide which ingredients are “improbable” and which are “feasible”. An example seen as combining the two is a remedy for a burn including “silver filings, bear’s grease, thyme, rose petals and verbena”. </p>
<p>From a modern perspective, bear’s grease is unlikely to differ from other animal fats or have any health benefits beyond acting as a lubricant or protective barrier.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=833&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=833&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=833&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1047&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1047&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77349/original/image-20150408-18053-mlcqji.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1047&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A page from Bald’s Leechbook.</span>
</figcaption>
</figure>
<p>Third, what’s the medical problem that the remedy in the Leechbook is designed to treat? One announcement of the discovery suggests that the <a href="http://www.medievalists.net/2015/03/30/anglo-saxon-medicine-is-able-to-kill-modern-day-superbug-researchers-find/">many conditions</a> it could treat are “clearly bacterial infections (weeping wounds/sores, eye and throat infections, skin conditions such as erysipelas, leprosy and chest infections)”. But is that really “clear”? We could decide that if pus is mentioned, then there must be an infection. </p>
<p>But even here we need to be sensitive to different beliefs about the body. The history of medicine includes the concept of “laudable pus” – pus which is a good thing, a stage of healing rather than a complication. This idea was still <a href="http://www.bmj.com/content/2/2904/286">around in 1916</a> but there was always debate over this – <a href="https://books.google.co.uk/books?id=yq2W6dwJa5gC&pg=PA39&dq=laudable+pus&hl=en&sa=X&ei=fSUcVYTbMsj3UNe3hLAJ&ved=0CCoQ6AEwAw#v=onepage&q=laudable%20pus&f=false">even in the Middle Ages</a>. </p>
<p>Some scholars interpret the condition for which the eye salve is used as being a stye, but a stye is normally self-limiting and so goes away regardless of what is put on it.</p>
<h2>Flying venom, hidden nightgoers</h2>
<p>In many cases we can’t really match a modern diagnosis to an ancient one. Bald’s Leechbook also offers us “a salve against elf-kind and nightgoers, and the people with whom the devil has intercourse”. Or what about the <a href="http://www.indiana.edu/%7Epsource/PDF/Archive%20Articles/Spring2012/2012%20-%20Spring%20-%207%20-%20Kinney,%20Shirley.pdf">Anglo-Saxon condition called “flying venom”</a>?</p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=736&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=736&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=736&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=925&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=925&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77350/original/image-20150408-18086-jbj8q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=925&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">All sorts.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/30591976@N05/3966528842/in/photolist-73vuQj-5CDvTn-pFa5jG-6dWHxr-kQguYg-6NxtbW-dSmaGn-dLHXSX-bviyq7-7H3MMd-n8rsde-6gZwn5-5CHPb7-73rsf8-biUsFg-98JNDg-fm1p1K-7Ru3dG-6M543v-6XWdi6-e4Cejx-87jpFR-dmCqu5-6XWeMc-prayAM-ao4AEU-ek8Wag-e4CkJa-e4HWu1-e4HZ6U-qgLHx-e4HQdY-q5aVd-7Ru3e7-6M99t5-94ivvg-aph6z7-4utb1-bu2EXc-btZb3v-bux3SZ-nx1y6-4EWozt-e4HNjs-e4HVWj-cjm5Co-e4Cctc-e4HPtJ-e4Ceti-prcoUG">Paul Walker from Cyril Bunt, 1955.</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>In the ancient Greek medical tradition, the wandering womb was a condition. If we analyse remedies for the wandering womb in terms of their ingredients, what do we get? Puppies stuffed with aromatics feature in <a href="https://theconversation.com/floating-wombs-and-fumigation-why-gwyneth-paltrow-has-steam-douching-all-wrong-37006">fumigations</a>. Garlic was also used. If we study the chemical constituents of ancient remedies and if one ingredient turns out to be antibacterial, then does that mean we have to conclude that the wandering womb was an infection? But if we decide that, then what do we do about those puppies?</p>
<h2>Ancient medicine to the rescue?</h2>
<p>So I remain a sceptic here, especially when the announcement of the remedy remade came at the same time as a crowd-sourcing appeal for a tiny sum to pay for an undergraduate student to help out in the lab. </p>
<p>Even more importantly, we see a mixture of arts and science academics <a href="http://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx">on the video</a>. Teamwork is certainly important. As is the very real <a href="http://www.theguardian.com/education/2015/mar/29/war-against-humanities-at-britains-universities">threat to humanities</a> subjects in the face of science, technology, engineering, and mathematics (STEM) funding. </p>
<p>Maybe that’s why so many in the arts and humanities seem to be enthusiastic about the eye disease remedy. But while it’s interesting that ancient remedies can be put together, ultimately there’s a danger that we simply replace the view that the only medicine worth knowing about is what we have today, with a misguided idea that the past holds all the answers.</p><img src="https://counter.theconversation.com/content/39719/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helen King has received funding from the Wellcome Trust</span></em></p>
Reviving old remedies doesn’t tell us anything we don’t already know.
Helen King, Professor of Classical Studies, The Open University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/39790
2015-04-08T20:06:24Z
2015-04-08T20:06:24Z
Golden staph: the deadly bug that wreaks havoc in hospitals
<figure><img src="https://images.theconversation.com/files/77283/original/image-20150408-26496-157nml2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Staph aureus bloodstream infection has a 12-month death rate of between 20 and 35%.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-265697000/stock-photo-close-up-a-hand-of-an-old-woman-patient-in-hospital-with-saline-intravenous.html?src=H98rKKx8knVfVLK3fpuViw-2-39">Joe Techapanupreeda/Shutterstock</a></span></figcaption></figure><p>Take this quick medical pop quiz: which of the following conditions would you prefer to have during your next stay in hospital? A. <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Staphylococcus_aureus_golden_staph">Staphylococcus aureus</a> (golden staph) bloodstream infection; or B. a heart attack?</p>
<p>I am guessing most non-medical readers voted for the Staph option and, if my experience is anything to go by, the majority of medical readers will have also made a microbial choice. </p>
<p>The disturbing truth is that a Staph aureus bloodstream infection has a <a href="https://www.mja.com.au/journal/2006/184/8/health-care-associated-staphylococcus-aureus-bloodstream-infections-clinical">12-month death rate</a> of between 20 and 35%, compared with 3-5% for a <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1208200#t=article">heart attack</a> in hospital. Although <a href="http://www.mayoclinic.org/diseases-conditions/mrsa/basics/definition/con-20024479">antibiotic-resistant Staph aureus</a> (MRSA) infections carry a slightly higher death rate, even the drug-sensitive Staphs are among the most potent of pathogens. </p>
<p>Staph aureus lives on our skin and in our nose where it usually causes no harm. But if we are admitted to hospital and have an intravenous catheter inserted through our skin, the Staph aureus can be carried on the tip of the needle into the vein. </p>
<p>Usually our immune system mops up any stray microbes but the reason for coming to the hospital in the first place may have weakened our defences. Infections such as pneumonia, the effects of cancer and its treatment, diabetes, drugs that suppress the immune system and surgery make us more vulnerable to hospital-acquired infections. </p>
<p>Very sick patients often require long-term intravenous access through central venous catheters (which are inserted into a large vein at the chest, neck or groin). These carry a higher risk of infection than small peripheral cannulas, usually inserted in veins of the hand or arm. </p>
<p>Patients with bloodstream infections develop chills, fever, headache, muscle and back pain and may go on to develop failure of one or more organ systems. </p>
<p>The complications of Staph aureus bloodstream infections (which, going back to our quiz, include a <a href="http://www.sciencedaily.com/releases/2013/08/130820083755.htm">heart attack</a>) may take weeks or months to develop; by the time the patients who survive have been discharged from the intensive care unit, the original infection may have been forgotten. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77284/original/image-20150408-26507-12lv6sz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The national benchmark for Staph aureus bloodstream infections is two cases per 10,000 patient days.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-257946281/stock-photo-abstract-of-blurred-people-in-the-hospital.html?src=ny5mCpiAqMiud8E5gVy1dA-1-115">surasaki/Shutterstock</a></span>
</figcaption>
</figure>
<p>Today the <a href="http://www.nhpa.gov.au/internet/nhpa/publishing.nsf">National Health Performance Authority</a> released its report on health care associated Staph aureus bloodstream infections in Australia in 2013-14. This is the third year the data has been reported nationally and the news is mildly encouraging. In 2013-14, there were 1,621 bloodstream infections caused by Staph aureus, which is 100 fewer than in 2012-13. </p>
<p>Nearly 90% of the infections occurred in the 115 major and large Australian public hospitals. To make sensible comparisons, hospitals are grouped by their size and the complexity of the patients they treat. Patients with burns, cancer, HIV and those who have undergone surgery are considered to be more vulnerable to infection. </p>
<p>For the 36 major Australian hospitals with more vulnerable patients, the average rate of infection was 1.28 per 10,000 patient bed days, although the rate was more than three time higher in some of these hospitals than in others. At the 40 major hospitals with fewer vulnerable patients, the average rate was 0.78 per 10,000 patient days. </p>
<p>The agreed national benchmark is less than 2.0 per 10,000 patient days and only a handful of hospitals exceeded this rate.</p>
<p>While these data show that the risk of Staph aureus infection for an individual patient is low, when considered across the entire health system it reveals an important and costly problem. </p>
<p>These figures only relate to infections that have been acquired in a health-care setting. Staph aureus can also originate in people in the community who have had no contact with the health system and these infections also carry a high risk of death. </p>
<p>There isn’t much we can do to reduce community Staph aureus blood stream infections but we can influence the number of hospital-associated infections – as these data so happily show. One important reason for the reduction is the increasing compliance of health-care workers with hand hygiene. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=480&fit=crop&dpr=1 600w, https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=480&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=480&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=603&fit=crop&dpr=1 754w, https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=603&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/77285/original/image-20150408-26518-jogyjk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=603&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Nurses’ hand hygiene compliance is at 85.5%.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-67964344/stock-photo-human-hands-being-washed-with-soap.html?src=ru59pR05ZctCVyus7Asi9A-1-46">topseller/Flickr</a></span>
</figcaption>
</figure>
<p>The <a href="http://www.hha.org.au/LatestNationalData.aspx">most recent data</a> from Hand Hygiene Australia show that average compliance in Australian hospitals is now 81.9% across the <a href="http://www.hha.org.au/home/5-moments-for-hand-hygiene.aspx">five “moments” of hand hygiene</a>. Even my recalcitrant doctor colleagues have lifted their game – from an average of 59.6% in 2011, they have now reached 70.2% (which, I am ashamed to say, is still 15.3% behind our much cleaner nursing colleagues). </p>
<p>Other reasons for the reduction include the implementation of protocols for the insertion, maintenance and early removal of central venous catheters and, possibly, the increased preference for peripherally inserted central catheters.</p>
<p>Staph aureus is only one of many bacteria that can invade the bloodstream but, for the moment, it is the only centrally monitored and reported bacteria in Australia. <a href="http://www.niaid.nih.gov/topics/antimicrobialresistance/examples/gramnegative/Pages/default.aspx">Gram-negative bacteria</a> such as <a href="https://theconversation.com/explainer-what-is-e-coli-17503">E. coli</a> are increasingly common causes of serious infections and antibiotic resistance is arguably a more important problem in these organisms. We need to watch this medical space.</p>
<p>Nevertheless, the modest 6% reduction in the number of bloodstream infections indicates that something as banal as keeping your hands clean can make a real difference. The 100 hospitalised patients who didn’t get a Staph aureus blood stream infection last year will never know how lucky they were.</p><img src="https://counter.theconversation.com/content/39790/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Frank Bowden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Which of the following conditions would you prefer to have during your next stay in hospital? A. Staphylococcus aureus (Golden Staph) bloodstream infection; or B. a heart attack?
Frank Bowden, Professor at ANU Medical School; Senior Staff Specialist Infectious Diseases, ACT Health
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/28474
2014-06-26T05:06:38Z
2014-06-26T05:06:38Z
Longitude Prize worth £10m to go to researchers who target antibiotic-resistant bugs
<figure><img src="https://images.theconversation.com/files/52249/original/t2vd4wrc-1403705467.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">MRSA balls.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/niaid/11854196633/sizes/l/in/photolist-j4vREz-9y4sDM-a2Ltvs-dRtGwW-a2HASi-j4uLGn-9yy9Lu-fyXRic-bzHVKx-456Vk-6EPqYz-bpCfQR-j4MspC-dQorNR-a5tw3L-dQjFSx-draSwB-4bAWxg-f5JqSP-fCw4hb-a37qt3-fA93i1-ae7SZe-8Su9Fe-9y7kCs-wEoJP-ai5T9q-8WBni-khRmaX-nsAfUx-5WGSdf-4oM6JD-nGHMGu-9MpHZe-5QXCmd-4heuSy-fN98g7-8PaXmj-8P7Run-kf8QR-biid2k-cMVemo-5unTQy-5unTDJ-4B1BzU-5unNEq-6Q2MdB-8P7S72-8PaXGC-8P7S1Z-8PaXDJ/">NIAID</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Following a public vote, the 2014 <a href="http://www.longitudeprize.org/">Longitude Prize</a> to develop an idea that <a href="http://www.telegraph.co.uk/science/science-news/10926683/Longitude-Prize-to-focus-on-the-battle-against-antibiotic-resistance.html">will help solve</a> one of the greatest issues of our time will go to a project working on antibiotic resistance. The focus of the £10m award will go <a href="http://www.longitudeprize.org/challenge/antibiotics">to the best idea</a> for a cheap, fast and accurate detector for bacteria and their associated antibiotic resistance mechanisms that could help better guide treatment.</p>
<p>Antimicrobial resistance is one of the most serious health threats to the global community. Microbes that are resistant to multiple classes of antibiotics are the cause of common infections including skin and soft tissue infections, urinary tract infections, pneumonia, diarrhoea and sexually transmitted infections. </p>
<p>Added to this, multi-drug resistant bacteria are making it increasingly difficult to treat infections in vulnerable or at risk groups like the elderly, organ transplant patients and premature babies. Globally, resistance in microbes that cause tuberculosis and malaria, Candida (a fungus that commonly causes serious infections in hospitalised patients) and viruses such as HIV and influenza is prevalent and on the rise. It’s not a pretty picture.</p>
<p>In the US, the Centers for Disease Control (CDC) <a href="http://www.cdc.gov/drugresistance/threat-report-2013/">conservatively estimates</a> that more than 2m illness are caused by antibiotic resistant bacteria and fungus each year with 23,000 associated deaths – mostly in hospitals and other medical settings, although they can occur anywhere. Methicillin resistant <em>Staphylococcus aureus</em>, more commonly known as MRSA, was associated <a href="http://www.ncbi.nlm.nih.gov/pubmed/24043270">with more than than 80,000</a> invasive infections in 2011. <em>Clostridium difficile</em>, a bacteria that causes severe recurrent diarrhoea, is linked to antimicrobial use and resistance and estimated to be associated with 250,000 illnesses and 14,000 deaths every year.</p>
<p>Antibiotic-resistant organisms develop from selective pressure caused by the use of antibiotics during patient therapy or in food animals. The CDC has proposed four core actions to fight the spread of antibiotic resistance, including tracking resistant bacteria, improving the use of antibiotics, and promoting the development of new antibiotics and new diagnostic tests for resistant bacteria.</p>
<p>All of these actions are crucial to controlling global spread and discovering new ways to treat antibiotic resistant microbes. Health care providers need to prescribe appropriately and patients need to finish their full course of therapy so that bacteria don’t have the opportunity to survive and develop resistance.</p>
<p>But diagnostic testing to rapidly identify microbes and their resistance genes is one feasible option that could improve targeting of antibiotic drugs. This approach would pave the way for more intelligent antibiotic use. Currently, initial therapy of an infection is often empirical, with antibiotics selected to treat the most common microbes associated with that type of infection.</p>
<p>Rapid diagnostics could also help the effort to detect and prevent the spread of antibiotic resistant organisms. Diagnostics <a href="http://www.ncbi.nlm.nih.gov/pubmed/24841135">are being developed</a> by groups and companies in a bid to reliably detect numerous pathogens from a <a href="http://www.ncbi.nlm.nih.gov/pubmed/24848132">single biological sample</a> and the presence or absence of genes that encode for antibiotic resistance. </p>
<p>While diagnostics will be an important part of helping us to move beyond resistance, the discovery and development of new antibiotics and therapeutics that target the ability of microbes to cause infections are critical. This is based on a more basic understanding of how these organisms cause infections via the secretion of toxins that disrupt the human immune system or direct toxicity to host cells, which is the case with MRSA and <em>C. difficile</em> infections. This is important to the development of new therapeutics that can target these molecules and increase the efficacy of currently available antimicrobials. </p><img src="https://counter.theconversation.com/content/28474/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marnie Peterson receives funding from a range of sources for her research including the National Institutes of Health (NIH)/National Institute of Allergy and Infectious Diseases (NIAID), National Center for Advancing Translational Sciences of the NIH Award and 3M</span></em></p>
Following a public vote, the 2014 Longitude Prize to develop an idea that will help solve one of the greatest issues of our time will go to a project working on antibiotic resistance. The focus of the…
Marnie Peterson, Associate Professor in Experimental and Clinical Pharmacology, University of Minnesota
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/26831
2014-05-18T23:09:35Z
2014-05-18T23:09:35Z
Vapour from e-cigarettes makes MRSA bacteria more aggressive
<figure><img src="https://images.theconversation.com/files/50080/original/twg7t75j-1401773119.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Second thoughts?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/nnova/11388575763/sizes/l">Nicolasnova</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>Smoking weakens the immune system and lowers the ability of human cells to fight infection – research <a href="http://www.ncbi.nlm.nih.gov/pubmed/21737564">has shown</a> this over and over again. Smoking cigarettes, and breathing in second-hand smoke, puts people at risk for developing severe lung and respiratory track infections. Smokers are two to four times <a href="http://www.ncbi.nlm.nih.gov/pubmed/15534156">more likely</a> to develop pneumococcal pneumonia than non-smokers. Cigarette smoking also increases the rates and severity of influenza infection and increases the risk of tuberculosis.</p>
<p>But what if the problem isn’t just that cigarette smoke weakens the immune system, but actually makes the bacteria more aggressive?</p>
<p>Antibiotic resistant bacteria are a growing problem worldwide. MRSA (Methicillin Resistant <em>Staphylococcus aureus</em>) is one of the most common, causing thousands of deaths every year. About 20% of people are <a href="http://www.rbch.nhs.uk/assets/templates/rbch/documents/our_services/clinical/infection_control/easy_read_advice_about_mrsa_not_in_hospital.pdf">colonised by MRSA</a>, and the nasal passages are the most common site for these bacteria to live. Because this organism inhabits an area that is exposed to inhaled substances and is a common cause of invasive disease, we began studying it in the lab. I hypothesised that cigarette smoke would put stress on bacterial cells, just as it does on human cells, and that the bacteria would respond by protecting and arming themselves.</p>
<p>Our research, recently presented at the American Thoracic Society’s international conference in San Diego, has found that cigarette smoke increases the resistance of MRSA to being killed by a host’s immune cells. In particular, cigarette smoke induced resistance to antimicrobial peptides – substances produced by human cells, which kill bacteria like antibiotics do. </p>
<p>As the <a href="https://theconversation.com/e-cigs-let-big-tobacco-get-creative-with-advertising-23447">e-cigarette market boomed</a>, I wondered if e-cigarette vapour would have the same effects, so we ran parallel studies on the effects of it on MRSA virulence. We have found over the past few months that both regular cigarette smoke and e-cigarette vapour make drug-resistant bacteria more virulent. We have not yet pinpointed the components of e-cigarette vapour that trigger these effects, but preliminary findings suggest that the nicotine in e-juice (the liquid used in e-cigarettes that is vapourised and inhaled) is a significant contributor. </p>
<p>Regular cigarette smoke has more than 5,000 components and nicotine is a small part of this. E-cigarette vapour has many fewer components, so it could mean that nicotine plays a bigger role in the effect we see on MRSA. E-cigarette users take in two to 20 times the amount of vapour in volume, and thus nicotine, than normal smoke. This is because it is so easy to keep inhaling from an e-cigarette – it can keep going for the equivalent of a whole pack of cigarettes, doesn’t make your clothing or breath smell, and can be vaped indoors. This means that vapers are dramatically increasing their intake of nicotine, and therefore increasing the exposure of their colonising bacteria to this substance.</p>
<p>Like cigarette smoke, e-cigarette vapour exposure also weakens our host defences, making it easier for bacteria to cause invasive infections. This means that the vapour is influencing bacteria to be more aggressive and harder to kill, and suppressing the ability of our own cells to attack and kill bacteria.</p>
<p>MRSA in particular is spreadable to other people via touch. There have been outbreaks on school sports teams for example. It is an aggressive bug, so it can cause disease in healthy people as well as the infirm. It already has antibiotic resistance, so making it even more resistant to antimicrobials and killing by host cells is a dangerous thing. It can be incredibly hard to clear MRSA infections, and we are <a href="http://aac.asm.org/content/56/2/838.short">running out of antibiotics</a> powerful enough to eliminate it.</p>
<p>It is hard to believe that anything could be as bad as cigarette smoke. But we simply don’t know enough about the effects of vapour to be able to say that it is a lesser evil. But as best as we can tell from the data we have, e-cigarette vapour is not benign. In fact, it appears that e-cigarette vapour both makes bacteria tougher to kill and weakens the immune system. Together these early findings suggest that people who vape are at increased risk of developing serious bacterial infections.</p><img src="https://counter.theconversation.com/content/26831/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura E. Crotty Alexander does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>
Smoking weakens the immune system and lowers the ability of human cells to fight infection – research has shown this over and over again. Smoking cigarettes, and breathing in second-hand smoke, puts people…
Laura E. Crotty Alexander, Assistant Professor, University of California, San Diego
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/25843
2014-04-28T05:05:43Z
2014-04-28T05:05:43Z
Households are new source of antibiotic-resistant superbug
<figure><img src="https://images.theconversation.com/files/47078/original/fw2cgp2d-1398536280.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">You can never be too safe.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/government_press_office/6714898189/">government_press_office</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Human skin is a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3535073/">garden of microbes</a> which is home to about <a href="http://news.sciencemag.org/plants-animals/2009/05/your-body-wonderland-...-bacteria">1,000 bacterial species</a>. Most are benign but some invade the skin and cause illness – and of these, antibiotic resistant bacteria are particularly dangerous. </p>
<p>We normally associate these resistant bugs with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670445/">hospitals</a>, but <a href="http://dx.doi.org/10.1073/pnas.1401006111">new research</a> finds that they could be living and spreading in households and within communities, too. For a notorious resistant bug, scientists have also been able to pinpoint where in the world it first began spreading. The hope is that this knowledge will allow better way of controlling infection and stopping epidemics.</p>
<h2>The Staph of nightmares</h2>
<p>About <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC172932/">one in five humans</a> carries the disease causing bacteria <em>Staphylococcus aureus</em>, or Staph, on the skin without any problem. However, breached skin, surgical wounds, or low immunity, as in HIV infection or cancer, may allow <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3372331/">Staph to cause diseases</a> ranging from minor skin ailments to major threats to life. </p>
<p>The emergence of methicillin-resistant Staphylococcus aureus (MRSA) is <a href="https://theconversation.com/a-world-without-antibiotics-would-be-a-dark-place-indeed-20978">well-known</a>. Originally associated with only bacterial infections in hospitals and nursing homes, MRSA is now known to colonise the skin of otherwise healthy individuals – such infections are called “<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3511788/">community-associated</a>” (CA-MRSA). </p>
<p>CA-MRSA spreads by contact with an infected individual. That is why, the spread of CA-MRSA can occur in <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0049900">households</a>, where the spread between house members is difficult to control resulting in high rates of recurrent infection. This is often due to contaminated <a href="http://cid.oxfordjournals.org/content/46/5/752.long">household objects</a> such as shared razors, towels and door knobs. </p>
<h2>Global epidemic</h2>
<p>While the presence of Staph on skin has long been associated with infection, two features make CA-MRSA riskier. It can cause severe disease in <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901661/">previously healthy</a> people – in fact, in about one in every ten cases, CA-MRSA infections leads to deadly pneumonia, severe sepsis, or the dreaded “flesh-eating disease” (a.k.a. ‘necrotizing fasciitis’). It also has the ability to spread rapidly, which has resulted in a global epidemic. </p>
<p>The global epidemic has been attributed to a <a href="http://cid.oxfordjournals.org/content/46/5/752.long">single CA-MRSA microbe</a>, known as USA300. In the US it is responsible for infection outbreaks in 38 states, and it has spread to Canada and several European countries. </p>
<p>Studies of USA300 have found molecular evidence which points to its ability to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2234137/">evolve</a> into more harmful versions. </p>
<p>USA300’s invasion of community households is less well understood. This is what Anne-Catrin Uhlemann at Columbia University Medical Centre and her colleagues wanted to investigate. In a paper in the <a href="http://dx.doi.org/10.1073/pnas.1401006111">Proceedings of the National Academy of Sciences</a> they have successfully used “whole-genome sequencing” on Staph cells from 161 CA-MRSA-infected residents in New York city in order to reconstruct USA300’s evolutionary history.</p>
<p>Whole-genome sequencing takes a snapshot of an organism’s complete genetic make-up, known as the genome, and determines the DNA sequence of all genetic material. Uhlemann used genomic sequencing and health statistics to gain insights into USA300’s spread during a period covering 2009-2011.</p>
<p>They looked for small changes in the genome, which often give clues as to how the cell evolved. After investigating more than 12,000 small changes in the USA300 genome, the authors reconstructed the genetic history. This helped them determine that USA300 first arose around 1993. The molecular signatures allowed them to also home in on the geographic location where this happened, which they determined to be in northern Manhattan.</p>
<h2>Sneaky bug</h2>
<p>Detailed study of USA300’s genome showed it acquired antibiotic resistant genes from <a href="http://dx.doi.org/10.1016/j.meegid.2013.04.022">viruses that infect bacteria</a>. This allowed the genetic adjustments necessary for USA300 to become harmful. The authors also discovered a smaller subgroup of USA300 resistant to another antibiotic-class, fluoroquinolones, which appeared to emerge around the time when fluoroquinolone prescription rates had soared in the US.</p>
<p>All this information put together shows that USA300 evolved and spread in households and communities in New York city. The occurrence of different antibiotic-resistant bugs highlights the effects of overuse of antibiotics. But working out how CA-MRSA spread within households and inside communities may help devise an infection control strategy to break the pattern of spread and reduce the possibility of another large-scale outbreak.</p><img src="https://counter.theconversation.com/content/25843/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>All viewpoints expressed in the article are those of Kausik, and do not necessarily represent official positions of the Johns Hopkins Medical Institutions and the Johns Hopkins University.</span></em></p>
Human skin is a garden of microbes which is home to about 1,000 bacterial species. Most are benign but some invade the skin and cause illness – and of these, antibiotic resistant bacteria are particularly…
Kausik Datta, Post-doctoral Fellow, Johns Hopkins University
Licensed as Creative Commons – attribution, no derivatives.
tag:theconversation.com,2011:article/18160
2013-09-12T12:14:14Z
2013-09-12T12:14:14Z
Superbugs move faster than governments can act
<figure><img src="https://images.theconversation.com/files/31238/original/khyk2pqy-1378980083.jpg?ixlib=rb-1.1.0&rect=0%2C9%2C2112%2C1587&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Time to shelve our overuse of antibiotics.</span> <span class="attribution"><span class="source">Elsamu</span></span></figcaption></figure><p>Infections and deaths caused by superbugs are increasing every year. So the government’s five-year strategy to tackle the problem, if a little tardy, is a welcome step. </p>
<p>In January, Chief Medical Officer Sally Davies said antimicrobial resistance posed <a href="http://www.theguardian.com/society/2013/jan/23/antibiotic-resistant-diseases-apocalyptic-threat">such a catastrophic threat</a> that within 20 years we could return to a pre-antibiotic era where people die from routine infections because we have nothing to treat them with.</p>
<h2>Production stalled</h2>
<p>Many existing antibiotics are no longer effective and their production has stopped. The number of antibiotics available for use by doctors has <a href="http://www.manchester.ac.uk/escholar/uk-ac-man-scw:78144">reduced by nearly 25%</a> and in life-threatening situations where MDR organisms cause infections in the critically ill, old antibiotics (which are often toxic) are used in an attempt to save their life.</p>
<p>The development of new antibiotics is at an all-time low and many pharmaceutical companies have changed the focus of their research and development programmes to meet the treatment needs for lifestyle illnesses such as diabetes and obesity. </p>
<p>The speed and cost of developing a single antibiotic, estimated at £300-£550m, can be prohibitive. The associated scientific and regulatory challenges make <a href="http://www.telegraph.co.uk/finance/newsbysector/pharmaceuticalsandchemicals/9010738/The-battle-to-discover-new-antibiotics.html">this type of project riskier</a> than other drug-related research. </p>
<p>Totally <a href="https://theconversation.com/marine-compound-first-new-natural-antibiotic-in-decades-16433">new discoveries are rare</a> but the <a href="http://www.who.int/bulletin/volumes/89/2/11-030211/en/">potential to find new bacteria</a> to culture is there.</p>
<h2>Better late than never</h2>
<p><a href="https://www.gov.uk/government/publications/uk-5-year-antimicrobial-resistance-strategy-2013-to-2018">The government’s strategy</a> has three major aims in slowing the development and spread of antimicrobial resistance: improve knowledge and understanding; conserve and steward the effectiveness of existing treatments; and stimulate the development of new antibiotics, diagnostics and novel therapies.</p>
<p>It has promised major investment in areas including improving infection control in people and animals through better hygiene, surveillance and monitoring; improving farming practises; education and training in health-care on appropriate use and also importantly, collecting better data on resistant bugs so we can track them more effectively, find the most resistant bacteria and step in earlier.</p>
<p>In addition the strategy sets out to encourage further development of new antibiotics, rapid diagnostic methods and alternative treatment strategies and provide £4m in funding to set up a new research unit to focus on antimicrobial resistance and health-care associated infections.</p>
<p>Demand on the National Health Service is probably greater than ever before. Medical advancements are exciting and we now expect to survive conditions we’d previously have died from. However, it is the introduction of some of these advancements and the lack of understanding of the interaction with the microbial community that has helped create the problems we are now facing. </p>
<h2>Adapting fast</h2>
<p>The threat posed to our health is palpable. Common organisms that are capable of causing disease, such as <em>Staphylococcus aureus</em>, have acquired pieces of DNA (genes) that have allowed them to survive in the presence of antibiotics. These organisms have continued to acquire more genes and are now resistant to the majority of antibiotics and are known as multiply drug resistant (MDR). </p>
<p>Multiple drug resistance is also found in organisms that cause tuberculosis, and infections in the skin, chest, blood stream and gastrointestinal system to name a few.</p>
<p>Bacteria, viruses and fungi are all adapting to their environment and in hospitals and other health-care facilities where antibiotics are frequently used (sometimes inappropriately), this has occurred with alarming speed. </p>
<p>The first case of methicillin-resistant Staphylococcus aureus (MRSA) occurred a few years after the introduction of the antibiotic in 1961, but it wasn’t until the late 1980s and early 1990s that the numbers of cases rapidly increased. It is now a global problem and frequently causes health-care associated infection. </p>
<p>Although major investment has been made to minimise the spread, for example through infection control, a “wash your hands” campaign and alcohol hand gels, it’s now unlikely to disappear from hospital altogether. </p>
<p>We are now seeing this organism in the community too. Worryingly, other common organisms found in hospital areas are also becoming multiply drug resistant and are found contaminating some of the medical equipment used in critical care.</p>
<p>We must conserve the antibiotics we have left by using them effectively. And the process of developing new antimicrobials and getting them to market safely must be accelerated. We also need to further develop a rapid diagnosis of MDR infections to allow more targeted treatment rather than using antibiotics with a shot gun approach.</p>
<p>We all - doctors, patients, the public and <a href="http://www.theecologist.org/News/news_analysis/897405/overuse_of_drugs_in_animal_farming_linked_to_growing_antibioticresistance_in_humans.html">farmers and animal keepers</a> who use antibiotics - need to understand the value and importance of antibiotics and the dangers of inappropriate use. I</p>
<p>The interaction between man, microbe, environment and the drugs that we develop needs to be fully understood. The new strategy is a great step, but as resistance grows we need to move much faster and keep up the momentum. Let’s hope it isn’t a little too late.</p><img src="https://counter.theconversation.com/content/18160/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Val Edwards-Jones is a Consultant Microbiologist for Embarrassing Bodies on Channel 4. She is also Professor of Microbial Proteomics at Northwick Park Institute of Medical Research and Managing Director of EssentialMicrobiology Ltd</span></em></p>
Infections and deaths caused by superbugs are increasing every year. So the government’s five-year strategy to tackle the problem, if a little tardy, is a welcome step. In January, Chief Medical Officer…
Val Edwards-Jones, Professor of Medical Microbiology, Manchester Metropolitan University
Licensed as Creative Commons – attribution, no derivatives.