tag:theconversation.com,2011:/fr/topics/resistant-superbugs-6211/articlesResistant superbugs – The Conversation2024-01-05T14:54:09Ztag:theconversation.com,2011:article/2205642024-01-05T14:54:09Z2024-01-05T14:54:09ZNew antibiotic zosurabalpin shows promise against drug-resistant bacteria – an expert explains how it works<figure><img src="https://images.theconversation.com/files/567989/original/file-20240105-24-a6i28q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5120%2C2880&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Carbapenem-resistant Acinetobacter baumannii is classified as a priority 1 critical pathogen by the World Health Organization</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/medical-science-laboratory-portrait-beautiful-black-1922200124">Gorodenkoff/Shutterstock</a></span></figcaption></figure><p>Researchers have <a href="https://www.nature.com/articles/s41586-023-06799-7">identified</a> an entirely new class of antibiotic that can kill bacteria that are resistant to most current drugs. </p>
<p>Zosurabalpin is highly effective against the bacterium carbapenem-resistant <em>Acinetobacter baumannii</em> (Crab), which is <a href="https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed">classified</a> as a “priority 1” pathogen by the World Health Organization due to its growing presence in hospitals.</p>
<p>Crab <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9137960/">can kill</a> up to 60% of people infected with it. It commonly causes infections of the urinary tract, respiratory tract and blood stream, potentially leading to sepsis. It is responsible for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913636/">around 20%</a> of infections in places like hospitals, care homes or other similar healthcare settings.</p>
<p>Antibiotics commonly work by crossing the cell wall that surrounds infectious bacteria to reach the vital machinery inside. Once inside the cell, antibiotics block that machinery in such a way as to either stop the bacteria from growing or to cause cell death. </p>
<p>Crab is a clinical challenge as it has a double-layered cell wall, a feature that microbiologists describe as “<a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/gram-negative-bacteria">gram negative</a>”. This means that antibiotics need to cross both layers to reach the vital machinery inside the bacteria to kill them and treat the infection. </p>
<p>An exception to this rule is penicillin-based antibiotics, where the target is in the cell wall itself. These antibiotics, known as <a href="https://www.bmj.com/content/344/bmj.e3236">carbapenems</a>, were derived from penicillin some 48 years after it was first discovered and still work in the same way. However, they have undergone clever chemical modification to prevent bacteria successfully evolving to resist them. This makes them a vital part of treating infections like those caused by <em>Acinetobacter baumannii</em>. </p>
<p>But Crab, the superbug version of this infection, has developed the ability to break down carbapenems, giving it an evolutionary upper hand, which has led to its rise to supremacy in hospitals. </p>
<h2>Zosurabalpin</h2>
<p>This new class of antibiotic, zosurabalpin, is shown to be highly effective against Crab both in the laboratory and in infected animals. Researchers tested zosurabalpin against more than 100 Crab samples from patients suffering from the infection. The research team, <a href="https://www.nature.com/articles/s41586-023-06799-7">found</a> that zosurabalpin was able to kill all of these bacterial strains. It could also kill the bacteria in the bloodstream of mice infected with Crab, preventing them from developing sepsis. </p>
<p>Crab has the ability to make a toxin called <a href="https://www.sciencedirect.com/topics/neuroscience/lipopolysaccharide">lipopolysaccharide</a> that it uses as part of its weaponry for infecting people and which it normally embeds into its outer cell wall. </p>
<p>Zosurabalpin works by blocking a molecular machine called <a href="https://www.nature.com/articles/s41586-023-06873-0">LptB2FGC</a> that transports the lipopolysaccharide toxin from the inside barrier to the outside one. This makes the toxin build up inside the bacteria, causing the Crab cells to die. Essentially, the bacteria pull the pin out of their own grenade but zosurabalpin stops them from being able to throw it. </p>
<p>This LptB2FGC mechanism is pretty unique to Crab, which has some advantages and disadvantages. The bad news is that zosurabalpin will only kill Crab infections and not those caused by other types of bacteria. This means doctors would need to accurately diagnose patients with this infection to decide if zosurabalpin would be the right drug. </p>
<p>But a major advantage is that the chance of antibiotic resistance emerging is reduced, as this resistance could only emerge from Crab and not other types of bacteria. Hopefully, this could extend the shelf life of this drug. </p>
<p>The researchers say they have already seen some mutations in the drug target, LptB2FGC. However, these only seem to reduce the effectiveness of zosurabalpin, rather than stopping it working entirely. The great news is that this is the first time an antibiotic has been reported to work in this way. It gives microbiologists a new avenue to explore ways to kill our bacterial enemies before they kill us. </p>
<figure class="align-center ">
<img alt="Close up of microscope with lab glassware." src="https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568021/original/file-20240105-25-qzeyh5.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">
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<span class="caption">Zosurabalpin is effective against the bacteria, Crab, which can kill up to 60% of people infected with it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/microscope-lab-glassware-science-laboratory-research-530971462">totojang1977/Shutterstock</a></span>
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</figure>
<p>Zosurabalpin is now in phase 1 clinical trial for use in patients infected with Crab. This early testing in humans will help the company developing the drug, Roche, to work out any side effects of the drugs as well as potential toxicity. Most importantly, they need to check that the drug works just as well in humans as it did in mice, and look to see if any antibiotic resistance emerges in the trial patients. </p>
<p>It’s early days and the failure rate for new antibiotic development is high, but scientists are rising to the challenge. This discovery offers significant opportunities to the scientific field as a whole and a vital lifeline in the fight against antibiotic-resistant infections.</p><img src="https://counter.theconversation.com/content/220564/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonathan Cox receives research funding from UKRI, charities and industry.
He is Co-Director of the Antibiotic Discovery Accelerator (ABX) Network </span></em></p>Zosurabalpin is highly effective against dangerous bacterium Crab, which can kill up to 60% of people infected with it.Jonathan Cox, Senior Lecturer in Microbiology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139812023-11-20T19:00:17Z2023-11-20T19:00:17ZNo, antibiotics aren’t always needed. Here’s how GPs can avoid overprescribing<figure><img src="https://images.theconversation.com/files/559257/original/file-20231114-26-vqpic.jpg?ixlib=rb-1.1.0&rect=718%2C370%2C6543%2C4463&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-photo/candid-shot-black-female-doctor-explaining-2281209513">Shutterstock</a></span></figcaption></figure><p><em>Antimicrobial resistance is <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">one of the biggest global threats</a> to health, food security and development. This month, The Conversation’s experts <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">explore how we got here and the potential solutions</a>.</em></p>
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<p>The growth in antibiotic resistance threatens to return the world to the pre-antibiotic era – with deaths from now-treatable infections, and some elective surgery being restricted because of the risks of infection. </p>
<p>Antibiotic resistance is a major problem worldwide and should be the concern of everyone, including you. </p>
<p>We need to develop new antibiotics that can fight the resistant bacteria or antibiotics that bacteria would not be quickly resistant to. This is like finding new weapons to help the immune system fight the bacteria.</p>
<p>More importantly, we need to use our current antibiotics – our existing weapons against the bacteria – more wisely.</p>
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<p>
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Read more:
<a href="https://theconversation.com/could-new-antibiotic-clovibactin-beat-superbugs-or-will-it-join-the-long-list-of-failed-drugs-212774">Could new antibiotic clovibactin beat superbugs? Or will it join the long list of failed drugs?</a>
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<h2>Giving GPs the tools to say no</h2>
<p>In 2022, more than <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/aura-2023-fifth-australian-report-antimicrobial-use-and-resistance-human-health">one-third of Australians</a> had least one antibiotic prescription, with <a href="https://www.safetyandquality.gov.au/publications-and-resources/resource-library/analysis-2015-2022-pbs-and-rpbs-antimicrobial-dispensing-data">88%</a> of antibiotics prescribed by GPs.</p>
<p>Many people <a href="https://pubmed.ncbi.nlm.nih.gov/28289114/">mistakenly think</a> antibiotics are necessary for treating any infection and that infections won’t improve unless treated with antibiotics. This misconception is found in studies involving patients with various conditions, including respiratory infections and conjunctivitis. </p>
<p>In reality, not all infections require antibiotics, and this belief drives patients requesting antibiotics from GPs. </p>
<p>Other times, GPs give antibiotics because they think patients want them, even when they might not be necessary. Although, in reality they are <a href="https://pubmed.ncbi.nlm.nih.gov/17148626/">after symptom relief</a>. </p>
<p>For GPs, there are ways to target antibiotics for only when they are clearly needed, even with short appointments with patients perceived to want antibiotics. This includes:</p>
<ul>
<li><p>using <a href="https://pubmed.ncbi.nlm.nih.gov/32357226/">decision guides</a> or tests to decide if antibiotics are really necessary</p></li>
<li><p>giving <a href="https://www.safetyandquality.gov.au/our-work/partnering-consumers/shared-decision-making/decision-support-tools-specific-conditions">patients information sheets</a> when antibiotics aren’t needed</p></li>
<li><p>giving a “<a href="https://pubmed.ncbi.nlm.nih.gov/33910882/">delayed prescription</a>” – only to be used after the patient waits to see if they get better on their own. </p></li>
</ul>
<p>All these strategies need some <a href="https://www.nps.org.au/assets/NPS/pdf/NPS-MedicineWise-Economic-evaluation-report-Reducing-Antibiotic-Resistance-2012-17.pdf">training</a> and practice, but they can help GPs prescribe antibiotics more responsibly. GPs can also learn from each other and use tools like <a href="https://pubmed.ncbi.nlm.nih.gov/24474434/">posters</a> as reminders.</p>
<p>To help with patients’ expectations, public campaigns have been run periodically to educate people about antibiotics. These campaigns <a href="https://pubmed.ncbi.nlm.nih.gov/35098267/">explain why</a> using antibiotics too much can be harmful and when it’s essential to take them.</p>
<h2>Giving doctors feedback on their prescribing</h2>
<p>National programs and interventions can help GPs use antibiotics more wisely </p>
<p>One successful way they do this is by <a href="https://pubmed.ncbi.nlm.nih.gov/34356788/">giving GPs feedback</a> about how they prescribe antibiotics. This works better when it’s provided by organisations that GPs trust, it happens more than once and clear goals are set for improvement. </p>
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<img alt="GP types on laptop" src="https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559258/original/file-20231114-21-ou0m9a.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">
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<span class="caption">GPs tend to act on feedback about their antibiotic prescribing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/doctor-entering-patient-notes-on-laptop-1033147024">Shutterstock</a></span>
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<p>The NPS (formerly National Prescribing Service) MedicineWise program, for example, had been giving feedback to GPs on how their antibiotic prescriptions compared to others. This reduced the number of antibiotics prescribed. </p>
<p>However, <a href="https://australianprescriber.tg.org.au/articles/the-end-of-nps-medicinewise.html">NPS no longer exists</a>. </p>
<p>In 2017, the Australian health department did something similar by sending <a href="https://behaviouraleconomics.pmc.gov.au/projects/nudge-vs-superbugs-behavioural-economics-trial-reduce-overprescribing-antibiotics">feedback letters</a>, randomly using different formats, to the GPs who prescribed the most antibiotics, showing them how they were prescribing compared to others. </p>
<p>The most effective letter, which used pictures to show this comparison, reduced the number of antibiotics GPs prescribed by <a href="https://behaviouraleconomics.pmc.gov.au/sites/default/files/projects/nudge-vs-superbugs-12-months-on-report.pdf">9% in a year</a>.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
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</p>
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<h2>Clearer rules and regulations</h2>
<p>Rules and regulations are crucial in the fight against antibiotic resistance. </p>
<p>Before April 2020, many GPs’ computer systems made it easy to get multiple repeat prescriptions for the same condition, which could encourage their overuse. </p>
<p>However, in April 2020, the Pharmaceutical Benefits Scheme (PBS) <a href="https://www.pbs.gov.au/pbs/industry/listing/elements/pbac-meetings/psd/2019-08/antibiotic-repeats-on-the-pharmaceutical-benefits-scheme">changed the rules</a> to ensure GPs had to think more carefully about whether patients actually needed repeat antibiotics. This meant the amount of medicine prescribed better matched the days it was needed for. </p>
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<img alt="Pharmacist looks at antibiotics" src="https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=377&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=377&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=377&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559259/original/file-20231114-27-txxbfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Simple changes can make a difference to antibiotic prescribing and dispensing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmacist-holding-medicine-box-capsule-pack-704036482">Shutterstock</a></span>
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<p>Other regulations or policy targets could include: </p>
<ul>
<li><p>ensuring all GPs have access to antibiotic prescribing guidelines, such as <a href="https://www.tg.org.au/">Therapeutic Guidelines</a>, which is well accepted and widely available in Australia</p></li>
<li><p>ensuring GPs are only prescribing antibiotics when needed. Many of the conditions antibiotics are currently prescribed for (such as sore throat, cough and middle ear infections) are self-limiting, meaning they will get better without antibiotics </p></li>
<li><p>encouraging GP working with antibiotics manufacturers to align pack sizes to the recommended treatment duration. The recommended first-line treatments for uncomplicated urinary tract infections in non-pregnant women, for example, are either three days of trimethoprim 300 mg per night or five days of nitrofurantoin 100 mg every six hours. However, the packs contain enough for seven days. This can mean patients take it for longer or use leftovers later. </p></li>
</ul>
<h2>Australia lags behind Sweden</h2>
<p>Australia has some good strategies for antibiotic prescribing, but we have not had a sustained long-term plan to ensure wise use. </p>
<p>Although Australian GPs have been doing well in <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/aura-2021">reducing antibiotic prescribing</a> since 2015, <a href="https://pubmed.ncbi.nlm.nih.gov/35098269/">more</a> could be done. </p>
<p>In the 1990s, Sweden’s antibiotic use was similar to Australia’s, but is now less than half. For more than two decades, Sweden has had a national strategy that reduces antibiotic use by about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677604/">7% annually</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-can-reverse-antibiotic-resistance-in-australia-heres-how-sweden-is-doing-it-123081">We can reverse antibiotic resistance in Australia. Here's how Sweden is doing it</a>
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<p>It is vital Australia invests in a similar long-term national strategy – to have a centrally funded program, but with regional groups working on the implementation. This could be funded directly by the Commonwealth Department of Health and Ageing, or with earmarked funds via another body such as the Australian Centre for Disease Control. </p>
<p>In the meantime, individual GPs can do their part to prescribe antibiotics better, and patients can join the national effort to combat antibiotic resistance by asking their GP: “what would happen if I don’t take an antibiotic?”. </p>
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<p><em>Read the other articles in The Conversation’s series on the dangers of antibiotic resistance <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">here</a>. Listen to the podcast <a href="https://theconversation.com/antibiotic-resistance-microbiologists-turn-to-new-technologies-in-the-hunt-for-solutions-podcast-217615">here</a>.</em></p><img src="https://counter.theconversation.com/content/213981/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mina Bakhit received funding from Therapeutic Guidelines Ltd (TGL) / Royal Australian College of General Practitioners (RACGP) Foundation Research Grant. </span></em></p><p class="fine-print"><em><span>Paul Glasziou receives funding from an National Health and Medical Research Council (NHMCR) Investigator grant.</span></em></p>Developing new antibiotics is important in the fight against antibiotic resistance. But we also need to use the antibiotics we already have much more wisely – GPs play a major role in this.Mina Bakhit, Assistant Professor of Public Health, Bond UniversityPaul Glasziou, Professor of Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2070252023-11-15T19:04:23Z2023-11-15T19:04:23Z‘Phage therapy’ could treat some drug-resistant superbug infections, but comes with unique challenges<figure><img src="https://images.theconversation.com/files/557066/original/file-20231101-25-9niwf.jpg?ixlib=rb-1.1.0&rect=136%2C528%2C5208%2C3029&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-photo/pharmacist-nurse-stethoscope-analyzing-healthcare-treatment-2052272615">Shutterstock</a></span></figcaption></figure><p><em>Antimicrobial resistance is <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">one of the biggest global threats</a> to health, food security and development. This month, The Conversation’s experts <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">explore how we got here and the potential solutions</a>.</em></p>
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<p>As bacteria become resistant to antibiotics, more people will become infected and die of untreatable bacterial infections. By 2050, drug-resistant infections are predicted to kill <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">ten million people a year</a>.</p>
<p>So researchers are desperately seeking viable alternatives. One promising therapy uses specialised viruses called bacteriophages to invade and kill bacteria. They’re called “phages” for short.</p>
<p>This “phage therapy” has been <a href="https://www.bbc.com/news/health-48199915">used</a> to <a href="https://www.bbc.com/news/stories-50221375">treat</a> antibiotic-resistant <a href="https://www.abc.net.au/news/2021-01-15/antibiotic-resistant-superbug-bacteriophage-therapy/12213010">infections</a> in small numbers of people who would have died without another way to kill the bacteria causing their infections.</p>
<p>But phage therapy is complicated, more complicated than prescribing antibiotics and picking up a script from the pharmacy. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-rise-and-fall-of-antibiotics-what-would-a-post-antibiotic-world-look-like-213450">The rise and fall of antibiotics. What would a post-antibiotic world look like?</a>
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<h2>What is phage therapy?</h2>
<p>In the wake of COVID, we’re all familiar with viruses that infect human cells. There are also viruses that infect bacteria, known as phages. </p>
<p>Just as viruses that infect humans only affect certain types of human cells, phages prefer to infect certain types of bacteria. MS2 phage, for example, can infect <em>Escherichia coli</em> (<em>E. coli</em>) and some related bacteria – but not all of them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557068/original/file-20231101-23-aqs9xd.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">Phages (shown in red) are viruses that attack and infect bacteria (shown in green).</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/bacteriophages-viruses-that-attack-infect-bacteria-1391256956">Shutterstock</a></span>
</figcaption>
</figure>
<p>Often, phages infect bacteria and just remain there, existing within the bacterium. </p>
<p>Sometimes, phages infect bacteria with lethal consequences for the infected bacterium. This is what can be harnessed and turned into phage therapy.</p>
<p>If the right phage can be found, it can be delivered to the infection site (either intravenously, topically to the skin or by aerosol inhalation), where it will find, infect and kill the bacteria causing the patient’s infection. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/viruses-are-both-the-villains-and-heroes-of-life-as-we-know-it-169131">Viruses are both the villains and heroes of life as we know it</a>
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</em>
</p>
<hr>
<p>Since phages don’t infect and cause disease in humans, phage therapy selectively targets and kills the bacteria in the patient, and not the patient. An added bonus is phages leave other beneficial bacteria unaffected, unlike antibiotics.</p>
<h2>So how is phage therapy prepared?</h2>
<p>Before use, the right phage – capable of infecting the bacteria causing the infection – must be matched to target the infecting bacteria. This involves developing comprehensive <a href="https://pubmed.ncbi.nlm.nih.gov/33581425/">phage libraries</a> by isolating and selecting phages with the <a href="https://www.mdpi.com/2079-6382/8/3/126">desired</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9323186/">properties</a>. </p>
<p>Fortunately, phages are everywhere – in soil, water, plants, animals and us. Finding and characterising them is straightforward, but takes time.</p>
<p>Successfully matching phage to the specific bacteria causing the patient’s infection requires lab technicians to isolate the bacteria first. This takes one to three days. </p>
<figure class="align-center ">
<img alt="Scientist looks through microscope" src="https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557069/original/file-20231101-25-fwb4ej.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">First, lab technicians must isolate the bacteria causing the patient’s infection.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/health-care-researchers-working-life-science-2340899525">Shutterstock</a></span>
</figcaption>
</figure>
<p>Then, the isolated bacterium is tested against hundreds of phages from the phage library to find one that can infect and kill that bacterium. The methods are slow, labour-intensive and take another few days. </p>
<p>Finally, when a phage that can kill the bacterium is identified, that specific phage, or a cocktail of multiple lethal phages, must be manufactured and administered to the patient. </p>
<p>Ironically, the unique advantages that make phage therapy a viable treatment for antibiotic-resistant infections bring challenges for treating lots of patients. </p>
<h2>Testing for clinical efficacy is still under way</h2>
<p>Before phage therapy can be approved for widespread use, it must meet the stringent safety and efficacy <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2018.00376/full">requirements</a>. Efforts to achieve this for specific infections are currently underway in academic and commercial research settings.</p>
<p>In the meantime, phage therapy is available in the <a href="https://www.fda.gov/drugs/investigational-new-drug-ind-application/physicians-how-request-single-patient-expanded-access-compassionate-use">United States</a> on an <a href="https://link.springer.com/content/pdf/10.1007/978-3-319-41986-2_52.pdf">ad hoc basis</a> for “compassionate use”. In Australia, a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9743374/">special access scheme</a>” provides limited access, with efforts to <a href="https://www.phageaustralia.org/">expand access underway</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-think-you-have-a-penicillin-allergy-you-might-be-wrong-212874">Do you think you have a penicillin allergy? You might be wrong</a>
</strong>
</em>
</p>
<hr>
<p>Individual instances of phage therapy have <a href="https://www.contagionlive.com/view/from-a-harrowing-experience-comes-a-professional-calling">saved the lives</a> of those who would otherwise have died. But while there is a growing body of research supporting the efficacy of phage therapy, <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2018.00376/full">well-designed clinical trials</a> are needed to establish its effectiveness.</p>
<h2>Manufacturing presents a number of challenges</h2>
<p>Phages are biological products that require careful production and quality-control processes. Propagating phages in the lab is one thing, but preparing them to a standard that can be applied, ingested, instilled or even injected into patients is another. </p>
<p>Developing scalable and standardised methods for phage production, purification and formulation is essential to meet the demand for widespread use. </p>
<p>Phages are made up of DNA or RNA, protein, and sometimes fats (known as lipids), all of which can be compromised if exposed to unfavourable conditions. </p>
<p>Pharmaceutical preparations of phage need to be transported, stored and dispensed in ways that preserve their biological activity, which can vary tremendously.</p>
<figure class="align-center ">
<img alt="petri dish with bacterial culture with phage" src="https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/557071/original/file-20231101-29-bn23t6.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">Phages can infect the bacteria that cause drug-resistant infections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/petri-dish-bacterial-culture-phace-activity-1658404837">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Bacteria can become phage-resistant</h2>
<p>Similar to antibiotics, bacteria can develop resistance to phages over time. This can occur through various mechanisms, such as the modification of bacterial surface receptors targeted by phages to gain entry to the bacteria. </p>
<p>Ways to <a href="https://doi.org/10.1146/annurev-virology-012423-110530">minimise or overcome the development of resistance</a> need to be explored to ensure long-term effectiveness. This includes using phage cocktails, staggered administration of single phages or combining phage therapy with other treatments.</p>
<h2>Commercial viability</h2>
<p>Antibiotics aren’t “one size fits all” for bacterial infections, but one antibiotic covers many infections and many different bacteria. Prescribing antibiotics takes moments, treatment can start right away, and they have a large and established industrial, commercial and regulatory framework surrounding them.</p>
<p>In contrast, the customisation involved in delivering phage therapy takes a lot of time, labour and resources. This could make phage therapy relatively expensive.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/could-new-antibiotic-clovibactin-beat-superbugs-or-will-it-join-the-long-list-of-failed-drugs-212774">Could new antibiotic clovibactin beat superbugs? Or will it join the long list of failed drugs?</a>
</strong>
</em>
</p>
<hr>
<p>To prepare bespoke phage preparations on demand, there must be a commercially viable and sustainable pathway to set up and maintain the infrastructure needed.</p>
<p>Much of the technology already exists to modernise, standardise and massively scale the phage therapy pipeline. With continued dedication, collaboration and investment, we have the potential to harness phage therapy as a tool in the fight against drug-resistant infections.</p>
<hr>
<p><em>Read the other articles in The Conversation’s series on the dangers of antibiotic resistance <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">here</a>.</em></p><img src="https://counter.theconversation.com/content/207025/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christine Carson receives funding from the WA Future Health Research and Innovation Fund, and the CUREator program, a national biotechnology incubator delivered by Brandon BioCatalyst. She has a commercial interest in companies developing diagnostic tests, and preventing viral infections.</span></em></p><p class="fine-print"><em><span>Lucy Furfaro receives funding from the National Health and Medical Research Council (NHMRC) and is associated with Phage Australia.</span></em></p>Researchers are desperately seeking viable alternatives to antibiotics. So what is phage therapy? And how could it help?Christine Carson, Senior Research Fellow, School of Medicine, The University of Western AustraliaLucy Furfaro, NHMRC Emerging Leadership Fellow, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2127742023-11-13T19:46:25Z2023-11-13T19:46:25ZCould new antibiotic clovibactin beat superbugs? Or will it join the long list of failed drugs?<figure><img src="https://images.theconversation.com/files/556012/original/file-20231026-27-9p25k9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5000%2C3315&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-photo/injured-hand-arm-girl-tied-by-1614690262">Shutterstock</a></span></figcaption></figure><p><em>Antimicrobial resistance is <a href="https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance">one of the biggest global threats</a> to health, food security and development. This month, The Conversation’s experts <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">explore how we got here and the potential solutions</a>.</em></p>
<hr>
<p>Imagine a world where simple infections could become life-threatening, where a small cut could spell disaster, and where doctors couldn’t treat diseases effectively anymore. This isn’t the plot of a science fiction movie – it’s a real concern. </p>
<p>For decades, antibiotics have been used successfully to fight a wide range of bacterial infections. However, overuse of these medicines has led to the development of antibiotic-resistant bacteria, known as “superbugs”. </p>
<p>Scientists are now in a race against time to discover new antibiotics that can defeat these bacteria. While this has been a difficult task, the recently discovered antibiotic <a href="https://www.cell.com/cell/fulltext/S0092-8674(23)00853-X">clovibactin</a> has renewed hope that we can fight our way out of this antibiotic resistance crisis. </p>
<p>So is clovibactin the saviour we’ve been hoping for? Or is it another in a long list of antibiotics that will remain only useful for research? The results so far are mixed.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-rise-and-fall-of-antibiotics-what-would-a-post-antibiotic-world-look-like-213450">The rise and fall of antibiotics. What would a post-antibiotic world look like?</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, how do antibiotics work?</h2>
<p>Antibiotics work by either directly killing bacteria or preventing them from growing and dividing. They do this by targeting parts of the bacterial cell that are not present in human cells. </p>
<p>Bacteria are surrounded by a cell wall. It might be helpful to imagine the cell walls around bacteria as the walls of a fortress, which helps them survive in the environment. </p>
<p>Antibiotics are like a group of knights trying to breach the walls and take down the enemy inside. Traditional antibiotics, like penicillin, act to weaken these walls. They kill the bacteria and make it easier for our immune system to finish the job. </p>
<p>However, bacteria have evolved to resist these attacks, meaning that antibiotics in some cases no longer have any effect. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-do-bacteria-actually-become-resistant-to-antibiotics-213451">How do bacteria actually become resistant to antibiotics?</a>
</strong>
</em>
</p>
<hr>
<h2>What about clovibactin?</h2>
<p>Clovibactin works differently. It targets bacteria from the inside out, taking away the bricks that are used to build the wall in the first place. </p>
<p>Bacteria have very limited options when choosing bricks to build their walls, so this approach means that resistance is much less likely to develop. </p>
<p>This mechanism of action is unique and offers hope that we can use clovibactin as a model to develop other antibiotics that act in a similar way. </p>
<p>But significant challenges still lie ahead. </p>
<h2>Why do most antibiotics fail?</h2>
<p>The field of antibiotic discovery is littered with drugs that have failed to progress beyond the early stages of research. </p>
<p>Antibiotic testing usually progresses from the laboratory bench to animal trials and, eventually, to human trials. While some antibiotics are very effective at killing bacteria in the lab, they are not always used to treat patients. </p>
<figure class="align-center ">
<img alt="Female scientist looks in microscope" src="https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556747/original/file-20231030-27-7gs26l.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">Some antibiotics are effective in the lab but this doesn’t always translate to humans in the real world.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/female-scientist-in-white-lab-coat-using-a-microscope-4032060/">Edward Jenner/Pexels</a></span>
</figcaption>
</figure>
<p>There are many reasons why this happens that cannot be predicted when an antibiotic is first discovered. An unfortunate, yet common, example is that antibiotics that appear safe in animals may turn out to be toxic at the higher doses required to treat humans. </p>
<p>Such unforeseen complications during the development phase are one part of the reason why <a href="https://wellcome.org/news/its-time-fix-antibiotic-market">more than 98.5%</a> of newly discovered antibiotics never make it out of the lab. </p>
<p>Even for those with a perfect development pathway, the average time to market is nine years at a <a href="https://wellcome.org/news/its-time-fix-antibiotic-market">cost</a> of greater than US$1 billion. </p>
<p>For clovibactin, the early signs look promising. No toxicity in human cells was detected and it successfully <a href="https://www.cell.com/cell/fulltext/S0092-8674(23)00853-X">cured mice infected with golden staph</a>. </p>
<p>However, there are still risks and market forces that may also be against clovibactin. </p>
<h2>Pharmaceutical companies want a return on their investment</h2>
<p>Antibiotics are not particularly profitable drugs and for a drug company to recoup their investment, an antibiotic must kill as many different bacteria as possible. </p>
<p>Health bodies such as the <a href="https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed">World Health Organization</a> and the United States <a href="https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf">Centers for Disease Control</a> have compiled lists of bacteria that pose the greatest threat to humans and for which we have limited treatments. Although clovibactin can kill <em>some</em> of the drug-resistant bacteria on these lists, it is not effective against the most troublesome and damaging bacteria. </p>
<p>Even for those it can kill, it does not appear to be superior to already available drugs, such as vancomycin. </p>
<p>Such shortcomings may prevent clovibactin from gaining future United States Food and Drug Administration (FDA) approval.</p>
<p>Although, scientists may be able to overcome these issues by chemically “tweaking” clovibactin to give it the desired traits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/will-we-still-have-antibiotics-in-50-years-we-asked-7-global-experts-214950">Will we still have antibiotics in 50 years? We asked 7 global experts</a>
</strong>
</em>
</p>
<hr>
<h2>Even if it works, we’ll still need other antibiotics</h2>
<p>Although clovibactin offers hope, one new compound alone cannot solve our current antibiotic resistance crisis. In fact, even the <a href="https://www.bio.org/sites/default/files/2022-02/The-State-of-Innovation-in-Antibacterial-Therapeutics.pdf">64 antibiotics</a> currently in clinical trials will be insufficient, particularly as 80% of these will likely hit <a href="https://wellcome.org/news/its-time-fix-antibiotic-market">development hurdles</a>. </p>
<figure class="align-center ">
<img alt="Man looks at medicine bottle in front of cabinet" src="https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/556752/original/file-20231031-25-fcceqd.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">Antibiotics need to be effective, safe and ideally, deliver a return on pharma company investment.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-hold-medication-bottle-reading-instruction-2262340167">Shutterstock</a></span>
</figcaption>
</figure>
<p>The good news is that more than one-third of these 64 antibiotics <a href="https://www.bio.org/sites/default/files/2022-02/The-State-of-Innovation-in-Antibacterial-Therapeutics.pdf">target</a> infections for which we desperately need new treatments, including tuberculosis and gut infections caused by <em>Clostridium difficile</em>.</p>
<p>As we eagerly await the day new antibiotics become part of our standard medical treatments, it’s crucial for all of us as individuals to continue practising good hygiene and following prescribed antibiotic regimens. </p>
<p>Continuing support for research to combat antibiotic resistance is also needed, not just from governments and non-profits, but also through policies that incentivise private sector investment. </p>
<p>In doing so, we can maintain these effective weapons in the fight against bacterial infections for as long as possible.</p>
<hr>
<p><em>Read the other articles in The Conversation’s series on the dangers of antibiotic resistance <a href="https://theconversation.com/au/topics/the-dangers-of-antibiotic-resistance-146983">here</a>.</em></p><img src="https://counter.theconversation.com/content/212774/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sacha Pidot receives funding from the National Health and Medical Research Council and the Australian Research Council for research on antibiotics.</span></em></p>Scientists are racing to discover new antibiotics that can defeat these drug-resistant superbugs. So how is the newly developed antibiotic clovibactin different?Sacha Pidot, Molecular microbiologist; laboratory head, The Peter Doherty Institute for Infection and ImmunityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1673542021-09-08T02:38:21Z2021-09-08T02:38:21ZThe 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">
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<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>
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<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>
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<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">
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<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>
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<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>
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<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>
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<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>
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<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>
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<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>
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<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>
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<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 RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1200952019-07-15T00:12:23Z2019-07-15T00:12:23Z1 in 10 patients are infected in hospital, and it’s not always with what you think<figure><img src="https://images.theconversation.com/files/283457/original/file-20190710-44472-1mqt2eb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drips and other medical devices were potential sources of infection. But no-one expected to find hospital-acquired pneumonia and urinary tract infections.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/anesthesiologist-nurse-open-intravenous-fluid-225255157?src=oS27Q0yT7trUvePFlYlWwg-1-43&studio=1">from www.shutterstock.com</a></span></figcaption></figure><p>Most people expect hospital treatment to make them better. But for some, a stay in hospital can actually make them sicker. Their wound might get infected after an operation or they might get a blood infection as a result of a medical procedure.</p>
<p>Our study, published today in the international journal <a href="https://aricjournal.biomedcentral.com/articles/10.1186/s13756-019-0570-y">Antimicrobial Resistance and Infection Control</a>, found one in ten adult patients in hospital with an acute (short-term) condition had a health care associated infection.</p>
<p>In the first study of its kind in Australia for over 30 years, we also uncovered unexpected infections, like pneumonia and urinary tract infections, as well as high numbers of patients with multi-drug resistant organisms (superbugs).</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/infections-complications-and-safety-breaches-why-patients-need-better-data-on-how-hospitals-compare-86748">Infections, complications and safety breaches: why patients need better data on how hospitals compare</a>
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<h2>Why do we need to keep track of infections?</h2>
<p>Most of these infections can be prevented. So it is important to know what type of infections they are, how common they are and which patients get them. Once we have this information, we can work out a way to prevent them. </p>
<p>Left unchecked, these infections can make already sick patients sicker, can divert hospital resources unnecessarily, and can kill.</p>
<p>Most hospitals in Australia have ongoing surveillance for specific infections, such as wound and bloodstream infections. </p>
<p>Some states have well coordinated programs like the Victorian program <a href="https://www.vicniss.org.au">VICNISS</a>, leading to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25782895">detailed data</a> on health care associated infections. This data is then used to inform hospital strategies on how to prevent infections. However, this type of surveillance method requires extensive resources and does not capture all infections that occur in a hospital.</p>
<p>Instead, we conducted a “point prevalence” survey, which takes a snapshot of the current situation on any given day. This is less resource intensive than ongoing surveillance and it provides valuable information on the distribution and occurrence of <em>all</em> infections in a hospital.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/some-private-hospitals-are-safer-than-others-but-we-dont-know-which-77096">Some private hospitals are safer than others, but we don't know which</a>
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<p>In Europe, the <a href="https://ecdc.europa.eu/en/healthcare-associated-infections-acute-care-hospitals/facts/about">European Centre for Disease Prevention and Control</a> co-ordinates national point prevalence studies every four years. These have provided valuable insight into the burden of health care associated infections. They have also been used to track the emergence of multi-drug resistant organisms in Europe. The US, Singapore and many other countries also run them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284013/original/file-20190715-173366-dg76d4.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">Most hospital infections can be prevented.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/633363035?src=jhlWisgjKa449M1gf5-h5A-1-101&studio=1&size=huge_jpg">Santypan/Shutterstock</a></span>
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<p>Unlike <a href="https://www.cdc.gov/nhsn/index.html">most OECD countries</a>, Australia does not have a national health care associated infection surveillance program and does not undertake national point prevalence studies. </p>
<p>The only national data routinely collected relates to <a href="https://www.myhospitals.gov.au/our-reports/healthcare-staphylococcus-aureus-bloodstream/february-2019/overview">bloodstream infections</a> caused by the microorganism <em>Staphylococcus aureus</em>. These infections are serious but rare and only represent a tiny fraction of all infections in hospitals.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/golden-staph-the-deadly-bug-that-wreaks-havoc-in-hospitals-39790">Golden staph: the deadly bug that wreaks havoc in hospitals</a>
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</em>
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<p>To improve our understanding of health care associated infections across Australia, we used the same study method as the Europeans. Over a four month period in 2018, we visited 19 large hospitals across Australia and collected information on all infections in adult acute inpatients. Four of the hospitals were regional, the others major city hospitals.</p>
<h2>What infections did we find?</h2>
<p>Of the 2,767 patients we surveyed, we found 363 infections in 273 patients, meaning some patients had more than one infection. The most common infections were wound infections after surgery (surgical site infections), pneumonia and urinary tract infections. These accounted for 64% of all the infections we found. </p>
<p>This is important as most hospitals do not normally look for pneumonia or urinary tract infections and there is no routine statewide or national surveillance for these. </p>
<p>Our findings mean these infections are commonly occurring but undetected. A potential source of information on these types of infections is hospital <a href="https://www.ihpa.gov.au/what-we-do/ar-drg-classification-system">administrative coding data</a>. However, these codes were mainly designed for billing purposes and have been shown to be <a href="https://www.ncbi.nlm.nih.gov/pubmed/24218103">unreliable</a> when it comes to identifying <a href="https://www.ncbi.nlm.nih.gov/pubmed/26316651">infections</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-know-why-bacteria-become-resistant-to-antibiotics-but-how-does-this-actually-happen-59891">We know _why_ bacteria become resistant to antibiotics, but _how_ does this actually happen?</a>
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<p>We also found patients with a medical device, such as a <a href="https://www.cdc.gov/hai/bsi/catheter_faqs.html">large intravenous drip</a>, or <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/urinary-catheterisation">urinary catheter</a> (a flexible tube inserted into the bladder to empty it of urine), were more likely to have an infection than those who did not. </p>
<p>Intensive care units treat patients who are gravely unwell and at greater risk of infection. So it was unsurprising to find that 25% of patients in intensive care units had a health care associated infection.</p>
<p>The emergence of multi-drug resistant organisms (<a href="https://theconversation.com/explainer-what-are-superbugs-and-how-can-we-control-them-44364">superbugs</a>) is a concern worldwide. Previously unknown, our study revealed that 10% of the adult acute inpatients in our study had a multi-drug resistant organism.</p>
<h2>What have other studies found?</h2>
<p>For the first time in 34 years we have a glimpse of how common health care associated infections are in Australian hospitals. Although the only other <a href="https://www.ncbi.nlm.nih.gov/pubmed/3143900">previous study</a> was larger, a major strength of our study is that we used the same two trained data collectors to collect the data from all hospitals. </p>
<p>This reduced the potential inconsistency in finding infections that might occur if hospital staff collected their own data. It also minimised the use of hospital resources to undertake the survey.</p>
<p>Importantly though, we did not survey all types of hospitals. It is possible that if the same survey was extended to include children, babies and cancer hospitals, higher rates of infection may be found given the vulnerability of these patients.</p>
<h2>What can we do better?</h2>
<p>As one of the authors has <a href="https://theconversation.com/heres-how-many-people-get-infections-in-australian-hospitals-every-year-82309">previously noted</a>, a major gap in Australia’s effort to combat health care associated infections, and the emergence of multi-drug resistance organisms, is the lack of robust national data.</p>
<p>This means we cannot measure the effect of national policy or <a href="https://www.nhmrc.gov.au/health-advice/public-health/preventing-infection">guidelines</a> despite significant investment.</p>
<p>In the absence of a national surveillance program, we recommend that large-scale point prevalence surveys, including smaller hospitals, specialist hospitals and the private sector be undertaken regularly. Data generated from these studies could then be used to inform and drive national infection prevention initiatives.</p><img src="https://counter.theconversation.com/content/120095/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Philip Russo receives funding from a National Health and Medical Research Council Early Career Fellowship, and is also President Elect of the Australasian College for Infection Prevention and Control. He was a member of the NHMRC Infection Control Guideline Advisory Committee, and a former member of the Healthcare Infection Advisory Committee of the Australian Commission for Safety and Quality in Health Care.
This project was wholly funded by a grant from the Rosemary Norman Foundation, a philanthropic nursing charity. None of the researchers receive any income from the funding or have any role with the charity. The Foundation was not involved in the design nor the conduct of the study, and will not benefit in any form from the results of the study. In-kind support was provided by the Centre for Quality and Patient Safety Research, Deakin University, Monash University and Avondale College of Higher Education.</span></em></p><p class="fine-print"><em><span>Brett Mitchell has received funding from the HCF Foundation and the NHMRC. Brett is the Editor-in-Chief of Infection, Disease and Health. This project was wholly funded by a grant from the Rosemary Norman Foundation, a philanthropic nursing charity. None of the researchers receive any income from the funding or have any role with the charity. The Foundation was not involved in the design nor the conduct of the study, and will not benefit in any form from the results of the study. In-kind support was provided by the Centre for Quality and Patient Safety Research, Deakin University, Monash University and Avondale College of Higher Education.</span></em></p>A surprising number of people are catching pneumonia or urinary tract infections in hospital, a new Australian study shows for the first time.Philip Russo, Associate Professor, Director Cabrini Monash University Department of Nursing Research, Monash UniversityBrett Mitchell, Professor of Nursing, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1106362019-01-29T15:38:50Z2019-01-29T15:38:50ZAntibiotic resistant ‘superbug’ genes found in the High Arctic<figure><img src="https://images.theconversation.com/files/256068/original/file-20190129-108370-1xc04k7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Svalbard archipelago, Norway.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/winter-mountain-nature-svalbard-longyearbyen-norway-605660774?src=TPaZTXEkIiiP-TKor-UxyQ-1-2">Ginger_polina_bublik/Shutterstock</a></span></figcaption></figure><p>Antibiotic resistance in bacteria is spreading rapidly worldwide and has even been called a global threat to humans <a href="https://edition.cnn.com/2019/01/24/health/antibiotic-resistance-climate-change-gbr-scli-intl/index.html">as serious as climate change</a>. Excessive and imprudent use of antibiotics is usually blamed, but the rate and extent of the spread can’t be explained by overuse alone.</p>
<p>Antibiotic resistance has now been found in remote parts of the world where humans and antibiotics are scarce or absent. Recently we published a study in <a href="https://www.sciencedirect.com/science/article/pii/S016041201832587X?via%253Dihub">Environment International</a> that reported antibiotic resistant genes in Svalbard in the High Arctic.</p>
<p><a href="https://theconversation.com/bacterias-secret-weapons-in-defeating-antibiotics-discovered-87272">Antibiotic resistance itself is natural</a>, but continued human exposure to antibiotics has selected for progressively stronger bacteria. These bacteria often acquire antibiotic resistance genes that allow them to make powerful defence proteins. As more antibiotics are used new forms of resistance evolve, including multiple drug resistance in pathogens, <a href="https://www.cdc.gov/antibiotic-use/community/about/antibiotic-resistance-faqs.html">creating a health crisis</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=342&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=342&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=342&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=430&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=430&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256106/original/file-20190129-127151-1qzx71x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=430&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sampling locations for soil bacteria in Svalbard, Norway.</span>
<span class="attribution"><span class="source">David Graham</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>For our research, we extracted bacterial DNA from 40 soil cores at eight locations along Kongsfjorden on the west coast of Spitsbergen on the Arctic Ocean, 300km from the North Pole. This location is fairly unusual in the Arctic for its vibrant wildlife populations and neighbouring fjord which does not freeze. We screened the Arctic soil DNA and quantified 131 antibiotic resistance genes associated with nine major antibiotic classes. These include aminoglycosides, carbapenem, macrolides and β-lactams – many of which are used to treat human and veterinary infections. </p>
<p>Some of the detected genes, some of which are almost certainly not “local” to the Arctic, can confer resistance to multiple drugs. These “foreign” genes were found in highest concentrations near fresh water sources – areas where wildlife tend to congregate.</p>
<p>One antibiotic resistance gene we found is called “blaNDM-1”. This gene confers resistance in bacteria to carbapenem antibiotics, one of our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3195018/">last resort remedies</a> to infectious disease. We found this gene in soils near a small Arctic lake in 2013, but it was first detected in a hospital patient in India in 2007, and was later <a href="https://www.ncbi.nlm.nih.gov/pubmed/21478057">found in surface waters in urban India in 2010</a>.</p>
<p>Although not explicitly from India, BlaNDM-1 was first identified on one side of the world and migrated to the other in less than three years, ending up in a place where few humans reside and where antibiotics are scarce. How did it get there?</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256104/original/file-20190129-108370-frcsx2.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">Bacteria with ‘foreign’ antibiotic resistant genes were most abundant near fresh water.</span>
<span class="attribution"><span class="source">David Graham</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>A migrating resistance</h2>
<p>Places with inadequate sanitation often have <a href="https://pubs.acs.org/doi/abs/10.1021/es405348h">higher levels of resistance genes and bacteria</a> in the surrounding water and soil. Local overpopulation, poorly controlled antibiotic use and incomplete wastewater treatment means <a href="https://www.sciencedirect.com/science/article/pii/S0160412018301016">resistance is more readily selected</a> in these places.</p>
<p>Local water and food supplies become contaminated with faecal matter, providing a pathway for resistance genes and their bacterial hosts to be ingested by humans and wildlife – hitching a ride from one region of the world to another. It’s unclear whether it’s a single migration via a bird or a human, or a chain reaction of exposures. By whatever pathway, resistance genes are moving fast and to places where antibiotics are not present.</p>
<p>As antibiotic resistance migrates, it also changes as it passes through animals and the wider environment. This complicates tracing these genes from their origins to where they end up. In the case of blaNDM-1, it was initially detected as a single gene in a few places, but there are now numerous variants which have been <a href="https://www.ncbi.nlm.nih.gov/pubmed/28449650">found in tens of countries</a>, now including the Arctic.</p>
<p>If resistance genes migrate via humans or wildlife to other locations, especially places with inadequate local sanitation, such genes and bacterial hosts might be selected in subsequent human and wildlife populations. This is what we think is happening worldwide. These genes move around the world with people and other animals, seeding new places with resistance potential.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256109/original/file-20190129-108370-13kv3bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Overuse of antibiotics drives resistance in bacteria, but addressing this alone will not be enough.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pharmaceuticals-antibiotics-pills-medicine-colorful-antibacterials-1061962868?src=Q5t6gv78WbIvBowBAinMxA-1-0">Nokwalai/Shutterstock</a></span>
</figcaption>
</figure>
<p>Reducing antibiotic use is critical to tackling bacterial resistance. In the UK, this is outlined in the <a href="https://www.bbc.co.uk/news/health-46973641">five-year action plan</a> announced by the health secretary, Matt Hancock. However, reducing local antibiotic use may have a limited effect on global resistance unless <a href="https://www.theguardian.com/society/2019/jan/28/genes-linked-to-antibiotic-resistant-superbugs-found-in-arctic">environmental pathways are not given greater consideration</a>. Improving sanitation and water quality worldwide must be part of the fight against antibiotic resistance.</p>
<p>There is one positive note from our High Arctic study, however. Although we detected genes like blaNDM-1, we also found other interesting and unexpected antibiotic resistance genes. We found one gene that codes for multiple drug resistance in Tuberculosis bacteria in almost all of our soil cores. This gene was not explicitly related to faecal matter, which means it is almost certainly natural to this remote environment.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-the-age-of-the-antibiotic-revolution-not-apocalypse-73476">It’s the age of the antibiotic revolution, not apocalypse</a>
</strong>
</em>
</p>
<hr>
<p>This might sound like bad news, but it suggests where this specific resistance gene might have originated. Understanding more about the origins of this gene might help us better understand <a href="https://www.wsj.com/articles/superbug-from-india-spread-far-and-fast-study-finds-11548633600">resistance in tuberculosis</a>.</p>
<p>That said, focusing efforts on developing new arsenals of antibiotic drugs may not be enough. It additionally would be wise for wealthier countries to help poorer ones improve water quality and sanitation, even if it is only providing toilets to reduce open defecation. Smarter use of antibiotics in agriculture and medicine is a necessary step for tackling resistance, but only a comprehensive approach will reduce the evolution and spread of antibiotic resistance.</p><img src="https://counter.theconversation.com/content/110636/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David W Graham receives funding from UK Natural Environment Research Council and the UK Engineering and Physical Sciences Research Council. </span></em></p>Antibiotic resistance is common in bacteria where there’s a large human population and poor sanitation. For the first time however, it’s been found in the remote Arctic.David W Graham, Professor of Ecosystems Engineering, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/632362016-08-03T10:21:24Z2016-08-03T10:21:24ZFrom nostrils to crocodile blood – ten surprising places to look for antibiotics<figure><img src="https://images.theconversation.com/files/132944/original/image-20160803-12192-7yoffz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Amazing things lurk up there...</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=1fv5ar9W19RQWl3YDDvBkw-1-8&id=361162187&size=medium_jpg">Shutterstock</a></span></figcaption></figure><p>One in ten people’s noses contain bacteria that could be the source of a powerful new antibiotic, <a href="http://www.bbc.co.uk/news/health-36910766">German scientists say</a>. Even resistant superbugs, such as MRSA and vancomycin-resistant enterococci, died when exposed to this new compound, <a href="http://www.nature.com/nature/journal/v535/n7613/full/nature18634.html">lugdunin</a>. </p>
<p>Antimicrobial resistance is a major global threat, with Europe facing “<a href="http://www.news-medical.net/news/20150424/Leading-scientists-warn-of-Antibiotic-Armageddon-in-Britain-and-Europe-by-2025.aspx">Antimicrobial Armageddon</a>” by 2025. Leading scientists predict a million deaths from untreatable infections if more new antibiotics aren’t found. </p>
<p>So academics hunting for new drugs in unusual places such as human “snot” are on the right track. Here are ten more surprising places scientists are looking for antibiotics, from ants and cow stomachs to medieval libraries and snake blood.</p>
<h2>1. Ants</h2>
<p>The microbes living in and on tropical ants are studied for antibacterial and antifungal drugs by scientists across the world. Matt Hutchings from the University of East Anglia leads a <a href="https://www.uea.ac.uk/leafcutter-ants/home">major British study</a>, prospecting bioactive compounds from <a href="http://www.biomedcentral.com/1741-7007/8/109">fungus-farming attine and arboreal ants</a>. </p>
<p>Attine (leaf cutter) ants from the Americas rely on antibiotics produced by actinomycete bacteria carried on their cuticles to protect their fungal garden from infestations. Tree-living, sap-drinking African slender ants and American Allomerus ants are thought to protect their host trees by cultivating mostly <a href="https://en.wikipedia.org/wiki/Gram-negative_bacteria">Gram-negative bacteria</a>. These produce antibiotics and other compounds, which affect plant pathogens and deter herbivores from destroying their host plants. <a href="https://www.uea.ac.uk/about/media-room/press-release-archive/-/asset_publisher/a2jEGMiFHPhv/content/ants-found-to-use-multiple-antibiotics-as-weed-killers">Hutchings said</a>: </p>
<blockquote>
<p>It’s very exciting that ants not only evolved agriculture before humans but also combination therapy with natural antibiotics. Humans are just starting to realise that this is one way to slow down the rise of drug resistant bacteria – the so called superbugs.</p>
</blockquote>
<h2>2. Crocodile blood</h2>
<p>Crocodiles not only have the strongest bite, their immune system is also very potent. It allows them to recover quickly from injuries that would kill other animals. <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiN9IGLgaTOAhXoDMAKHQ1QBkUQFggcMAA&url=http%3A%2F%2Fwww.cardiffmet.ac.uk%2Fhealth%2Fstaff%2FPages%2FDr%2520Sarah%2520Maddocks.aspx&usg=AFQjCNFinItsEbPSw7mymMLy5GlnVWIF0g&sig2=qM0ncmbyenpiv2v5zi3Hrg&bvm=bv.128617741,d.d24">Scientists from Cardiff Metropolitan University</a> gave an update at <a href="http://www2.warwick.ac.uk/fac/sci/wcibb/meetings/chemistryandbiologysymposium/">a recent international symposium</a> on the blood of Thai crocodiles as an antibacterial source. Crocodile blood haemoglobin could kill highly-resistant superbugs, such as <em>Klebsiella pneumoniae</em> and <em>Pseudomonas aeruginosa</em>. These can cause urinary tract infections and pneumonia in already sick patients or those with cystic fibrosis.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132945/original/image-20160803-12234-2wy38f.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">Test us … if you dare.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-404912527/stock-photo-siamese-freshwater-crocodile.html?src=HMrxOzGzaMfkUjF7QaEXUQ-1-4">Shutterstock</a></span>
</figcaption>
</figure>
<h2>3. Cow stomachs</h2>
<p>If you thought that cows just turn grass into milk, beef and manure, then think again. The stomachs of the cow harbour billions of microbes that help digest the grass, while competing with each other for their own food. Sharon Huws’ team from Aberystwyth University has identified over 100 <a href="https://www.aber.ac.uk/en/ibers/research/biologythatdelivers/healthy_plants/">novel antimicrobial candidates</a> from <a href="http://animalsmart.org/species/sheep/what's-a-rumen-">rumen</a> microorganisms. The most promising compounds from pre-clinical tests are currently undergoing further trials. </p>
<h2>4. Dirt, deserts and 10 Downing Street</h2>
<p>Around two-thirds of currently prescribed antibiotics come from soil bacteria. Swansea University Medical School is leading studies digging for antibiotics directly from dirt and very dry habitats. <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&uact=8&ved=0ahUKEwiRt6uPgqTOAhVpK8AKHZltDYkQFggvMAc&url=http%3A%2F%2Fwww.swansea.ac.uk%2Fstaff%2Fmedicine%2Flearningandteaching%2Fvankeuleng%2F&usg=AFQjCNEPkpSognf0IVeboBuqs2Cm2j-2kw&sig2=eJ-KWJSzpGZV01LSdidbtA&bvm=bv.128617741,d.d24">I reported</a> on a <a href="http://npronet.com/funding/funded-poc-1/">dirt study</a> and we are now working with industry to engineer a commercially viable route to novel antibiotics from dirt.</p>
<p>Paul Dyson’s team at Swansea is isolating microbes from <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwiY5pffhKTOAhVnAcAKHXqKDS0QFgguMAE&url=http%3A%2F%2Fwww.bbsrc.ac.uk%2Fdocuments%2Fchina-previous-awards-pdf%2F&usg=AFQjCNHf3tkDHxd9VM72dsJw_c0bubz7Pg&sig2=GjYmGFOZ3dkK4tQinMEygQ&bvm=bv.128617741,d.bGg">extreme environments</a> such as the Gobi and Arabian deserts and high-altitude Tibetan soils that hardly sustain life. These microbes are now producing antibiotic leads in the laboratory.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=415&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=415&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=415&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=522&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=522&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132946/original/image-20160803-12223-rmy0qu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=522&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Source of a cure?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-183630518/stock-photo-london-uk-april-10-2009-downing-streets-sign-in-westminster-downing-st-has-housed-government-leaders-for-over-three-hundred-years.html?src=C2Yhrcezi7prHP_8jnCnSQ-1-2">Shutterstock</a></span>
</figcaption>
</figure>
<p>And anyone can help. The garden of <a href="http://www.microbiologysociety.org/news/society-news.cfm/number-10-joins-the-hunt-for-new-antibiotics-in-soil">10 Downing Street</a> was dug up recently as part of a project to crowdsource samples for the <a href="http://www.smallworldinitiative.org/">Small World Initiative</a>. SWI’s Nicole Broderick <a href="http://www.microbiologysociety.org/events/annual-conferences/index.cfm/annual-conference-2016">said of the progress</a> made by thousands of students across the globe: “The grand goal is to find new antibiotics, while getting young people interested in science.” </p>
<h2>5. Frog skin and foam</h2>
<p>Frogs have been known to make deadly compounds for centuries – the skin of poison dart frogs contains alkaloid toxins that can kill humans quickly. Recently, many other species of <a href="http://www.bbc.co.uk/news/health-11101278">frogs have been tested for antimicrobials</a> and antibiotic-delivery systems. The tiny Caribbean <a href="http://www.bbc.co.uk/news/health-35869662">Tungaran frog produces a foam</a> with its hindlegs that protects its eggs from infection and predation. This foam slowly releases antimicrobials, which scientists at the University of Strathclyde are now testing as novel drug delivery systems for wound care. Paul Hoskisson said: “I’d say we are about half way there to making a stable foam. Once we do that, we would then need to test it in patients, but that will take a few years yet.”</p>
<h2>6. Honey</h2>
<p>Honey is not only spread on toast, it’s been used to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831240/">treat patients’ wounds</a> for centuries. Honey made from the nectar of the Mānuka tree is particularly potent for wound infections. Microbiologists from Cardiff Metropolitan University have discovered that combinations of <a href="http://www.bbc.co.uk/news/health-13047332">Mānuka honey</a> and regular antibiotics can make MRSA more sensitive. Rose Cooper, professor of microbiology, said:</p>
<blockquote>
<p>This indicates that existing antibiotics may be more effective against drug-resistant infections if used <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0045600">in combination with Mānuka honey</a>.</p>
</blockquote>
<h2>7. Maggots and cockroaches</h2>
<p>Other creepy crawlies are also a proven success. Maggot secretions, cockroach brains, and the humid brood cells of beewolf wasps all contain antimicrobials. Patients suffering from chronic open wounds, or resistant superbug infections, are often reluctant to undergo <a href="http://biomonde.com/en/">maggot therapy</a>, but Yamni Nigam from Swansea University has launched the innovative <a href="https://twitter.com/search?q=%23loveamaggot&src=typd">#loveamaggot</a> campaign. Nigam claims that “maggot therapy is a quick and highly effective way to treat infected and festering wounds. Limbs, and even lives, of chronically ill patients have been saved”.</p>
<h2>8. Medieval libraries</h2>
<p>The <a href="http://mbio.asm.org/content/6/4/e01129-15">interdisciplinary</a> <a href="https://www.nottingham.ac.uk/news/pressreleases/2015/march/ancientbiotics---a-medieval-remedy-for-modern-day-superbugs.aspx">AncientBiotics consortium</a> is hunting for recipes to treat infections in ancient books. One of the recipes found in Bald’s Leechbook, an <a href="http://www.bbc.co.uk/news/uk-england-nottinghamshire-32117815">Anglo-Saxon manuscript</a> held in the British Library, proved particularly powerful against superbugs. Consortium founding member Freya Harrison said the team thought the eye salve might show a “small amount of antibiotic activity … But we were absolutely blown away by just how effective the combination of ingredients was”.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=541&fit=crop&dpr=1 754w, https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=541&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/132947/original/image-20160803-12186-26phdc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=541&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Old books could contain new drugs.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/dl2_lim.mhtml?src=pd-photo-32742700-2&id=92050808&size=medium_jpg">Shutterstock</a></span>
</figcaption>
</figure>
<h2>9. Sharks</h2>
<p>The immune system of sharks is naturally powerful to protect them against bacterial and viral infections. This led investigators from the Georgetown University Medical Center to search for <a href="http://www.bbc.co.uk/news/health-14974605">shark compounds</a> with therapeutical potential. They discovered that the steroid compound squalamine from dogfish sharks is <a href="http://dx.doi.org/10.1128%2FAAC.00421-15">effective against human pathogenic bacteria</a> – for example <em>Pseudomonas aeruginosa</em> – and <a href="https://doi.org/10.1073/pnas.1108558108">human viruses</a> such as dengue and hepatitis. </p>
<h2>10. Snakes</h2>
<p>Scientists from the Aga Khan University in Pakistan tested whether animals eating germ-infested rodents harboured powerful antimicrobials. They discovered that the blood and other organs such as lungs and gallbladder from <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4083174/">black cobra snakes</a> showed activity against human pathogenic bacteria, fungi and amoeba.</p>
<p>Our current range of antibiotics is under severe threat by superbugs with fast evolving resistance. Scientists must keep looking for new antibiotics, even in unusual places such as the human nose. It’s a search that could save millions of lives.</p><img src="https://counter.theconversation.com/content/63236/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Geertje van Keulen currently receives funding from NERC, BBSRC, and the CDE. She is affiliated with the Microbiology Society, the Society for Applied Microbiology and the Royal Society for Chemistry.</span></em></p>In the battle against superbugs, you’d be amazed where we might find the cures of the future.Geertje van Keulen, Associate Professor, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/457262015-08-13T04:57:58Z2015-08-13T04:57:58ZStop bugging the bugs: the world as we know it would fall apart without them<figure><img src="https://images.theconversation.com/files/91637/original/image-20150812-18104-1boqbn.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Insects are key to holding the food chain together. Without them, much of what we eat today won't exist.</span> <span class="attribution"><span class="source">Pia Addison</span></span></figcaption></figure><p>Just under one million insect species have been <a href="http://www.amnh.org/ology/features/askascientist/question21.php">identified</a> on the planet. Global insect species diversity makes up more than half of all other species diversity on earth. Estimates of actual species richness range from a realistic four to six million to an extravagant 80 million species. But insects are continuously evolving, so we will never really know. </p>
<p>Insects are characterised by having three pairs of legs, two pairs of wings – which are sometimes reduced or absent – and three body segments: the head, thorax and abdomen. And they change their appearance during development in a process known as <a href="http://dictionary.reference.com/browse/metamorphosis">metamorphosis</a>.</p>
<p>If all the insects on the planet were put together they would weigh more than humans put together. It is estimated that total insect biomass is 300 times greater than total human <a href="http://www.si.edu/encyclopedia_si/nmnh/buginfo/bugnos.htm">biomass</a>. Ants and termites alone are estimated to weigh <a href="http://mic.com/articles/84681/this-is-exactly-how-much-weight-humans-take-up-on-earth-compared-to-other-animals">more</a> than humans. These are estimates – insect biomass measures can be contentious because solid data are scarce.</p>
<p>There are many things that humans take for granted that would be affected if there were no insects. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=567&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=567&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=567&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=713&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=713&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91638/original/image-20150812-11849-1in7mtm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=713&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ants and termites play a key role in the world we live in.</span>
<span class="attribution"><span class="source">Pia Addison</span></span>
</figcaption>
</figure>
<h2>Bugs hold the food chain together</h2>
<p>Our total food supply would be severely restricted without insects. We would suffer from a variety of deficiencies as we would have very little fresh fruit and vegetables to eat. Insects are pollinators and many crop yields would suffer if they didn’t exist. Certain products like silk and honey would simply not <a href="http://insected.arizona.edu/manduca/Insects.html">exist</a>.</p>
<p>The food chain would <a href="http://indianapublicmedia.org/amomentofscience/a-world-without-insects/">diminish</a>. There would be no birds, or any other animals that rely on insects as food.</p>
<p>The world would be littered with decomposing organic material. The consequence would be complete degradation of our soils. All remaining life would subsequently disappear.</p>
<p>If that was not enough and if we were still alive, creativity would suffer. Insects are an inspiration for artists, for movies and documentaries. They are studied by engineers and scientists to find out how we can be more sustainable and efficient in our everyday lives. </p>
<h2>Survival mechanisms</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/91635/original/image-20150812-13700-1jcu935.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">Parasitic wasp sitting on a codling moth egg (which measures about 1mm across).</span>
<span class="attribution"><span class="source">Nadine Wahner</span></span>
</figcaption>
</figure>
<p>The smallest insect is a <a href="http://www.termite-control-glendale.com/blog/pest-control-worlds-smallest-insect-tanzanian-parasitic-wasp/418/">parasitic wasp</a>, measuring in at a staggering 139 micrometres. Like so many insects it is not visible to the naked eye. Insects can be found in seeds, grasses, flowering plants or soil, or they could be parasitising the insects that feed on the plants. You would then find other insects parasitising the insects that parasitise the plant eaters.</p>
<p>Insects are highly adaptable to environmental change and have well-structured <a href="http://www.biology-resources.com/insect-structure.html">sensory systems</a>, comparable to vertebrates. Due to their short life cycles vinegar flies, aphids and mosquitoes can complete their entire life cycle, from egg to adult, in less than seven days. They are able to respond to change much <a href="http://www.bbc.com/news/science-environment-24078179">faster</a> than animals with longer life stages. </p>
<p>That is why insects can become resistant to insecticides so quickly. The housefly developed <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1744-7348.1950.tb01050.x/pdf">resistance</a> to the insecticide DDT in 1947 eight years after it was developed for the first time. </p>
<p>Today, insecticide resistance is developing much faster due to the large variety of chemistry that insects are exposed to providing increasing selection pressures.</p>
<h2>The cleverest trick of them all</h2>
<p>Insects are well known for having intricate relationships with plants and with other insects. As the plants change, so do they. This co-evolution has been going on for about 360 million years when the first insects <a href="http://www.els.net/WileyCDA/ElsArticle/refId-a0001762.html">evolved</a>. This is considerably longer than the first humans Homo erectus evolved, some <a href="https://en.wikipedia.org/wiki/Human_evolution">two million years ago</a>. </p>
<p>That many insects can fly is a major asset. They can disperse quicker, get out of danger faster and reach food sources more efficiently. The fastest wing beat in an insect – a midge – has been recorded at <a href="http://entnemdept.ifas.ufl.edu/walker/ufbir/chapters/chapter_09.shtml">1046 beats persecond</a>, attributed to asynchronous muscle contractions. </p>
<p>In comparison, the fastest wing beat of a bird (the hummingbird) is <a href="http://ask.metafilter.com/205631/Whats-faster-than-a-hummingbirds-wings">55 beats per second</a>. The fastest flier is a <a href="https://top5ofanything.com/list/928c1786/Fastest-Flying-Insects-on-Earth">horsefly</a>, clocking 145km/hour.</p>
<p>Insects have external not internal skeletons. Their hard armour serves as a point for muscle attachment, protects them from drying out and from <a href="http://www.cals.ncsu.edu/course/ent425/tutorial/integ.html">toxins</a> getting into their systems. For heavily sclerotised insects – like beetles, which are among the most <a href="http://bioteaching.com/beetles-the-most-successful-animals/">successful</a> insects – the external skeleton also protects them from predation. </p>
<p>Beetles exhibit probably the highest diversity of all insects, the reason for which still remains a riddle. Spines and other strange designs offer defence mechanisms and camouflage. </p>
<p>Lastly insects are able to drastically change their appearance during their development. Immature stages of butterflies look like worms. They then become a pupae, while the adult is winged. Adult butterflies and moths rarely feed, often only taking in small amounts of water or nectar.</p>
<p>Many adult insects do not possess <a href="http://www.livescience.com/21933-moth-week-facts.html">mouth</a> parts at all. The evolutionary advantage of this is that adults do not compete with their offspring for food and therefore exploit different habitats, providing a reproductive advantage.</p><img src="https://counter.theconversation.com/content/45726/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pia Addison receives funding from the National Research Foundation (NRF), fruit industry partners, including HortGro Science, Citrus Research International, Winetech, SASRI and SATI.</span></em></p>Without insects the food chain would diminish and we would have very little fruit and vegetables to eat.Pia Addison, Senior Lecturer in Insect Diversity, Stellenbosch UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/433892015-06-17T06:15:47Z2015-06-17T06:15:47ZExplainer: what is KPC and should I be worried about these superbugs?<figure><img src="https://images.theconversation.com/files/85343/original/image-20150617-23259-axi2vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">New antibiotics are desperately needed to treat these infections. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-157681805/stock-photo-woman-lying-down-in-hospital-bed.html?src=mCMExOTXOnVDqrAEYkstyA-1-15">wandee007/Shutterstock</a></span></figcaption></figure><p>Superbugs are <a href="http://www.heraldsun.com.au/news/victoria/deadly-superbug-cre-kills-two-in-melbourne-spreads-across-victoria-infecting-60/story-fni0fit3-1227400507088">back</a> in the <a href="http://www.skynews.com.au/news/national/2015/06/16/superbug-found-in-vic-hospitals.html">news</a> – and <a href="http://www.theage.com.au/victoria/deadly-superbug-found-spreading-in-victorian-hospitals-20150616-ghp9x2.html">everybody</a> loves a good germ panic <a href="http://www.abc.net.au/news/2015-06-16/hospitals-warned-over-new-antibiotic-resistant-bacteria-kpc/6550398">story</a>. The bugs raising alarm are called KPC (<em>Klebsiella pneumoniae</em> carbapenemase) or CRE (carbapenem-resistant Enterobacteriaceae).</p>
<p>The <a href="https://en.wikipedia.org/wiki/Enterobacteriaceae">Enterobacteriaceae</a> (pronounced enter-oh-bact-ear-ee-ay-cee-ee) are a large family of bacteria, which largely live as a normal part of people’s healthy gut bacteria. It includes <em>E. coli</em> as well as some more nasty bugs such as <em>Salmonella</em> and <em>Shigella</em>, which cause gastroenteritis. </p>
<p>A member of the family that doesn’t get as much press is <em><a href="https://en.wikipedia.org/wiki/Klebsiella">Klebsiella</a></em>. It’s a fairly common cause of infections in hospitals, such as urinary tract infections and pneumonia. Different species also live widely in the environment.</p>
<p>The C refers to a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1932750/">carbapenemase</a>, which is an enzyme the bacteria produces that can <a href="https://theconversation.com/the-last-stand-the-strongest-of-the-superbugs-and-their-antibiotic-nemesis-10727">break down</a> the class of antibiotics called carbapenems. <a href="https://en.wikipedia.org/wiki/Carbapenem">Carbapenems</a> are the hospital’s “big guns”, used for patients who are critically ill, or where there is resistance to other antibiotics. </p>
<p>The problem is that carbapenems share a common structure with penicillins and cephalosporins. Together, this family of antibiotics account for <a href="http://www.safetyandquality.gov.au/publications/antimicrobial-prescribing-practice-in-australia-results-of-the-2013-national-antimicrobial-prescribing-survey-november-2014/">the majority</a> of antibiotic use in hospital. </p>
<p>These bugs sometimes carry extra resistance genes which stop other commonly used antibiotics from working. This often leaves <a href="https://theconversation.com/back-to-the-future-breathing-new-life-into-old-antibiotics-to-fight-superbugs-1421">antibiotics</a> which we no longer commonly use (often because they have significant side-effects) as the only treatment option. There have been <a href="http://www.ncbi.nlm.nih.gov/pubmed/19527172">reports</a> of bacteria <a href="http://jmidonline.org/upload/sayi/18/JMID-00780.pdf">resistant</a> to all available antibiotics, and trials on the best way to treat these bugs are underway.</p>
<p>The first isolates of these bacteria seem to have been imported from <a href="http://www.ncbi.nlm.nih.gov/pubmed/21258100">travellers from overseas</a> or Australians returning home. But these bugs may spread between people relatively easily, especially in health-care facilities. <a href="http://www.abc.net.au/am/content/2015/s4256463.htm">Reports suggest</a> this has occurred in Victoria.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=491&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=491&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85345/original/image-20150617-23256-1ddpwe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=491&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The bacteria seems to have been imported from travellers.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-248584702/stock-photo-girl-in-the-airport.html?src=MsELYNi8-thH6MqDToSx4A-1-56">Capricorn Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Although these infections may be easily transmitted, becoming sick from them is rare. As the bugs that carry the resistance are similar to normal gut bacteria, they can live there quite happily without causing you any bother. We call this being “colonised” by the bacterium. When they get into places they shouldn’t be (such as your lungs or into your blood) the bacteria can then cause infection. This is more likely in patients who are very unwell, such as people in intensive care units. </p>
<p>Most people who have tested positive for CRE are carrying the bacterium, but are not sick from it. Media reports are therefore <a href="http://www.skynews.com.au/news/national/2015/06/16/superbug-found-in-vic-hospitals.html">carefully phrased</a> with lines such as “have died with a … superbug in their systems”, which means the patient was colonised rather than infected. </p>
<p>When actual infection does occur, the outcomes are often poor. Intensive care units in Europe <a href="http://www.ncbi.nlm.nih.gov/pubmed/25017796">have reported</a> death rates up to 50%. This is generally because patients who acquire CRE are very sick before their infection, but <a href="http://www.ncbi.nlm.nih.gov/pubmed/25017796">outcomes</a> are certainly worse for very resistant infections than for more sensitive ones. </p>
<p>Resistance also <a href="http://www.ncbi.nlm.nih.gov/pubmed/16355321">increases</a> the cost of care and hospital length of stay, impacting everybody in the health-care system.</p>
<p>New antibiotics are desperately needed to treat these infections. The United States government has announced the <a href="http://www.idsociety.org/10x20/">10x20 initiative</a> – ten new antibiotics by 2020. Australian <a href="http://cooper.imb.uq.edu.au/">researchers</a> are <a href="http://www.deakin.edu.au/research/mmr/our-research/infection-and-immunity-theme">also</a> active in this <a href="http://www.uqccr.uq.edu.au/research/infection-and-immunity.aspx">area</a>. But antibiotic <a href="https://theconversation.com/new-antibiotics-whats-in-the-pipeline-10724">development</a> is a slow process, so in the meantime, a holding strategy is needed.</p>
<p>There are two ways to hold the bugs back – prevent people from acquiring them in the first place, and slow the development of antibiotic resistance. </p>
<p><a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">Infection control</a> is a critical, but often under-appreciated part of our hospitals. And the most important part of infection control is <a href="http://www.hha.org.au/home.aspx">hand hygiene</a>. The hands of health-care workers are critical to the transmission of bacteria between patients. Patients with resistant organisms are often kept isolated, but at least some of the benefit of this isolation comes from prompting health-care workers to clean their hands before and after patient care. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85344/original/image-20150617-23223-zsvuax.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 most important part of infection control is hand washing.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-206779540/stock-photo-surgeon-washing-hands-before-operation.html?src=jbLvMXccCsFAtGYiWjJ2wg-1-2">nata-lunata/Shutterstock</a></span>
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<p>Australia has <a href="http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cd33_exec_summary.pdf">national guidelines</a> for infection control generally, and <a href="http://www.safetyandquality.gov.au/wp-content/uploads/2013/12/MRGN-Guide-Enterobacteriaceae-PDF-1.89MB.pdf">specific guidelines</a> for CRE. </p>
<p>The second key intervention is <a href="https://theconversation.com/we-can-beat-superbugs-with-better-stewardship-of-antibiotics-9492">antimicrobial stewardship</a>. Exposing bacteria to antibiotics is the way resistance comes about, and by reducing the use of antibiotics, we can delay resistance. Reducing the use of carbapenem is an important target of stewardship programs, which are now a mandatory requirement for hospitals to be <a href="http://www.achs.org.au/publications-resources/equipnational/">accredited</a>.</p>
<p>The last two years have been a time of rapid development in the fight against antimicrobial resistance. The <a href="http://www.who.int/mediacentre/news/releases/2015/antibiotic-resistance-lacking/en/">World Health Organisation</a> has increased its focus on resistance, and the Australian government has released its own <a href="http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-amr.htm">national strategy</a>.</p>
<p>Outbreaks such as this highlight the need for government, academia and industry to work together to help take these plans beyond the summits and discussion papers and into our hospitals. Understanding by and involvement of the public is also crucial. </p>
<p>Only with a united front can we hope to slow the “<a href="https://www.mja.com.au/journal/2013/198/5/gram-negative-resistance-can-we-combat-coming-new-red-plague">red tide</a>” of resistance.</p><img src="https://counter.theconversation.com/content/43389/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Trent has no financial disclosures relevant to this article, but has participated as an investigator in (industry-funded) clinical trials on new antimicrobial agents. He is a member of the Australian Society for Infectious Diseases, the Australian College of Infection Prevention and Control, and the Public Health Association of Australia. These views are his own, and not those of his employer or professional associations.</span></em></p>Superbugs are back in the news – and everybody loves a good germ panic story.Trent Yarwood, Infectious Diseases Physician, Senior Lecturer, James Cook University and, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/413912015-05-07T15:58:25Z2015-05-07T15:58:25ZThe answer to tackling superbugs could be … more superbugs<figure><img src="https://images.theconversation.com/files/80833/original/image-20150507-1245-vsimbg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Antibiotic-resistant bacteria are a leading cause of hospital infections.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>Hard-to-kill bacteria or “superbugs” have become a major problem for hospitals. Between 5% and 12% of hospital patients in the EU are thought to acquire an infection <a href="http://ec.europa.eu/health/antimicrobial_resistance/policy/index_en.htm">during their stay</a>, with many caused by bacteria such as <em>Clostridium difficile</em> (<em>C. diff</em>) that are resistant to antibiotics.</p>
<p>In the US, <em>C. diff</em> is the <a href="http://www.ncbi.nlm.nih.gov/pubmed/25714160">leading cause</a> of hospital-acquired infections and, in the UK – although it is declining – it remains a major healthcare problem implicated in <a href="https://www.gov.uk/government/statistics/clostridium-difficile-infection-annual-data">thousands of deaths</a> every year. But a group of researchers believe they may have found <a href="http://www.bbc.co.uk/news/health-32551873%20http://jama.jamanetwork.com/article.aspx?articleid=2281703">a surprising answer</a> to treating <em>C. diff</em>: giving patients another dose of the bacterium.</p>
<p>The effects of <em>C. diff</em> range from mild diarrhoea to more serious and life-threatening conditions such as pseudomembraneous colitis (inflammation of the intestines) and toxic megacolon, which often require surgery to remove the affected tissue and can be fatal.</p>
<p>Despite being a major human pathogen, <em>C. diff</em> is actually part of the normal group of microorganisms found in the gut (<a href="http://www.ncbi.nlm.nih.gov/pubmed/25595843">in 3% of healthy adults</a>). But sometimes it takes advantage of disruptions in our bacterial flora to cause disease. These changes are typically caused when antibiotics are used to treat an unrelated condition, killing off the protective microorganisms of our gut and allowing <em>C. diff</em> to flourish.</p>
<p>Paradoxically, more antibiotics are typically used in an attempt to kill off the <em>C. diff</em> as well. However, this can create the same problem again, leading to a <a href="http://www.ncbi.nlm.nih.gov/pubmed/25714160">recurrence of the infection</a> in approximately 30% of cases. And once the infection has recurred once, it recurs again in 60% of cases. This has led doctors to consider many alternative strategies.</p>
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<p>Giving patients bacteria thought to promote a healthy digestive system (probiotics) has been tried as a way of replacing the normal gut flora killed by antibiotics, but with <a href="http://www.ncbi.nlm.nih.gov/pubmed/25922397">little evidence</a> of success.</p>
<p>More recently, <a href="http://www.ncbi.nlm.nih.gov/pubmed/23967542">trials have begun</a> with the more controversial “faecal transplants”. Both selected bacteria from the faeces of a healthy donor and entire samples faecal matter have been implanted in a patient’s colon to test the idea. There is a growing <a href="http://www.ncbi.nlm.nih.gov/pubmed/23967542">body of evidence</a> to suggest this can provide both resolution and protection from recurrence. </p>
<p>Researchers from Loyola University Health System in Illinois have now <a href="http://jama.jamanetwork.com/article.aspx?articleid=2281703">published a trial</a> of a technique that could be described as a more refined and specific version of probiotic treatment or faecal transplant. Rather than replacing the entire gut-flora of an individual, the researchers introduced a different, harmless strain of <em>C. diff</em> that doesn’t produce any toxins.</p>
<p>Having already conducted an initial trial, the researchers expected that the non-toxic bacteria would outcompete the toxic strain and prevent the progression and recurrence of infection. The latest trial demonstrated the safety of the treatment and presented further evidence for its efficacy. The most effective dose of bacteria reduced the rate of recurrence to 5%, compared to 30% in a placebo group.</p>
<p>This is an extremely encouraging result. The next stage in the translation of this into the clinic is a phase III trial which will determine the efficacy and safety over many thousands of diverse patients. If successful this could lead to an incredible, cost-effective and widely applicable treatment. Further work is needed to understand why and how this non-toxic strain outcompetes the toxic strains in the gut.</p>
<p>There is a cautionary note, however. <em>C. diff</em> <a href="http://www.ncbi.nlm.nih.gov/pubmed/24131955">has been shown</a> to transfer its DNA (containing the toxin genes) from toxic strains to non-toxic strains in the laboratory. If the non-toxin strain is inherently more fit in the human gut than the toxic ones, and if it could readily acquire the toxin genes and become a fitter toxic strain, we may head straight back to square one. This would add yet another, even more dangerous superbug to the ever-growing list.</p><img src="https://counter.theconversation.com/content/41391/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Adam Roberts has received funding from the European Community’s
Seventh Framework Programme and the Medical Research Council. This article represents the author's own opinions not those of any organisation or funding body.</span></em></p><p class="fine-print"><em><span>Ruth Massey 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>New research shows the best way to treat hospital infections caused by C. difficile may be with more of the bacteria.Ruth Massey, Senior lecturer, department of biology & biochemistry, University of BathAdam Roberts, Senior lecturer, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/397902015-04-08T20:06:24Z2015-04-08T20:06:24ZGolden 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>
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<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">
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<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>
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<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>
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<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>
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<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 HealthLicensed as Creative Commons – attribution, no derivatives.