Tag Archives: antibiotic resistance

Antibiotic resistance is at a crisis point – but new drugs could help defeat superbugs

Credit: Pxhere.

Antibiotic resistance poses one of the most important health challenges of the 21st century. And time has already run out to stop its dire consequences.

The rise of multidrug-resistant bacteria has already led to a significant increase in human disease and death. The U.S. Centers for Disease Control and Prevention estimates that approximately 2.8 million people worldwide are infected with antibiotic-resistant bacteria, accounting for 35,000 deaths each year in the U.S. and 700,000 deaths around the globe.

A 2019 joint report by the United Nations, World Health Organization and World Organization for Animal Health states that drug-resistant diseases could cause 10 million deaths each year by 2050 and force up to 24 million people into extreme poverty by 2030 if no action is taken. Superbugs are already able to evade all existing treatments – a 70-year-old woman from Nevada died in 2016 from a bacterial infection resistant to every available antibiotic in the U.S.

I am a biochemist and microbiologist who has been researching and teaching about antibiotic development and resistance over the past 20 years. I believe that solving this crisis requires more than just proper antibiotic use by doctors and patients. It also requires mutual investment and collaboration across industries and the government.

Antibiotics revolutionized modern medicine. But improper usage of antibiotics and lack of research funding have led to a growing crisis of antibiotic-resistant bacteria.

How do bacteria become resistant to drugs?

In order to survive, bacteria naturally evolve to become resistant to the drugs that kill them. They do this via two methods: genetic mutation and horizontal gene transfer.

Genetic mutation occurs when the bacteria’s DNA, or genetic material, randomly changes. If these changes let the bacteria evade an antibiotic that would have otherwise killed it, it will be able to survive and pass on this resistance when it reproduces. Over time, the proportion of resistant bacteria will increase as nonresistant bacteria are killed by the antibiotic. Eventually, the drug will no longer work on these bacteria because they all have the mutation for resistance.

The other method bacteria use is horizontal gene transfer. Here, one bacterium acquires resistance genes from another source, either through their environment or directly from another bacterium or bacterial virus.

Bacteria can gain resistance via infection from a virus (transduction), picking it up from the environment (transformation) or direct transfer from other bacteria (conjugation). 2013MMG320B/Wikimedia Commons

But the antibiotic resistance crisis is largely anthropogenic, or human-made. Factors include the overuse and abuse of antibiotics, as well as a lack of regulations and enforcement pertaining to proper use. For example, doctors prescribing antibiotics for nonbacterial infections and patients not completing their prescribed course of treatment give bacteria the chance to evolve resistance.

There are also no regulations on antibiotic use in animal agriculture, including controlling leakage into the surrounding environment. Only recently has there been a push for more antibiotic oversight in agriculture in the U.S. As an October 2021 report by the National Academies of Sciences, Engineering and Medicine noted, antibiotic resistance is an issue that connects human, environmental and animal health. Effectively addressing one facet requires addressing the others.

The antibiotic discovery void

One of the major reasons for the resistance crisis is the stalling of antibiotic development over the past 34 years. Scientists call this the antibiotic discovery void.

Researchers discovered the last class of highly effective antibiotics in 1987. Since then, no new antibiotics have made it out of the lab. This is partly because there was no financial incentive for the pharmaceutical industry to invest in further research and development. Antibiotics at the time were also effective at what they did. Unlike chronic diseases like hypertension and diabetes, bacterial infections don’t typically require ongoing treatment, and so have a lower return on investment.

Reversing this trend requires investment not just in drug development, but also in the basic research that allows scientists to understand how antibiotics and bacteria work in the first place.

Basic research focuses on advancing knowledge rather than developing interventions to solve a specific problem. It gives scientists the opportunity to ask new questions and think long-term about the natural world. A better understanding of the driving forces behind antibiotic resistance can lead to innovations in drug development and techniques to combat multidrug-resistant bacteria.

Basic science also provides opportunities to mentor the next generation of researchers tasked with solving problems like antibiotic resistance. By teaching students about the fundamental principles of science, basic scientists can train and inspire the future workforce with the passion, aptitude and competency to address problems that require scientific understanding to solve.

Collaboration by triangulation

Many scientists agree that addressing antibiotic resistance requires more than just responsible use by individuals. The federal government, academia and pharmaceutical companies need to partner together in order to effectively tackle this crisis – what I call collaboration by triangulation.

[The Conversation’s science, health and technology editors pick their favorite stories. Weekly on Wednesdays.]

Collaboration between basic scientists in academia and pharmaceutical companies is one pillar of this effort. While basic science research provides the knowledge foundation to discover new drugs, pharmaceutical companies have the infrastructure to produce them at a scale typically unavailable in academic settings.

The remaining two pillars involve financial and legislative support from the federal government. This includes enhancing research funding for academics and changing current policies and practices that impede, rather than offer, incentives for pharmaceutical company investment in antibiotic development.

To that end, a bipartisan bill proposed in June 2021, the Pioneering Antimicrobial Subscriptions to End Upsurging Resistance (PASTEUR) Act, aims to fill the discovery void. If passed into law, the bill would pay developers contractually agreed-upon amounts to research and develop antimicrobial drugs for a time period that ranges from five years up to the end of the patent.

I believe the passage of this act would be an important step in the right direction to address antibiotic resistance and the threat it poses to human health in the U.S. and around the globe. A monetary incentive to take up basic research around new ways to kill dangerous bacteria seems to me like the world’s best available option for emerging from the antibiotic resistance crisis.The Conversation

Andre Hudson, Professor and Head of the Thomas H. Gosnell School of Life Sciences, Rochester Institute of Technology

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Trained bacteriophages could help us with our drug resistance issues

Antibiotic-resistant bacteria are giving our medicine an increasingly-harder time. Bacteriophages however, viruses that prey on bacteria, could help us regain the upper hand.

A bacteriophage model made out of digital Lego blocks. Image credits Pascal / Flickr.

We’re quite spoiled in this modern day and age. Things as minor as cutting a finger are dealt with a wash, bandage, and an antibiotic at most — but they could be very deadly for our ancestors even 100 years ago. But as time passes, bacteria adapt to the drugs they’re exposed to, developing resistance.

It’s estimated that by 2050, antibiotic-resistant bacteria will claim over 10 million lives, as our existing therapies lose effectiveness and patients are left vulnerable.

Bacteria eaters

“Antibiotic resistance is inherently an evolutionary problem, so this paper describes a possible new solution as we run out of antibiotic drug options,” says Joshua Borin, lead author of the study. “Using bacterial viruses that can adapt and evolve to the host bacteria that we want them to infect and kill is an old idea that is being revived. It’s the idea of the enemy of our enemy is our friend.”

Bacteriophages, or phages for short, are viruses that specialize in infecting and reproducing using bacteria. They’re quite like the viruses that make us sick, only with a different ‘meal’ preference.

A new project led by researchers at the University of California San Diego, Biological Sciences department, have shown that phages can be trained, so to speak, to make them better able to attack and destroy bacteria. These pre-trained phages could help delay the onset of antibiotic resistance in groups of bacteria by physically destroying them (rather than chemically, as drugs do), and the team showcases this potential in their experiments. The study also included researchers at the University of Haifa in Israel and the University of Texas at Austin

The experiment was carried out in a series of unassuming laboratory flasks. Boiled down, it involved training specialized phages to recognize and attack certain bacterial strains, in preparation for a final ‘target’. The secret here is that the phages are given an opportunity to better adapt to their prey while kept in the flasks (through natural evolutionary processes). Phages that were ‘trained’ for 28 days, the team explains, were 1,000 times more efficient at suppressing the bacterial colony than untrained ones, and for between three to eight times as long.

“The trained phage had already experienced ways that the bacteria would try to dodge it,” said Associate Professor Justin Meyer, the study’s corresponding author. “It had ‘learned’ in a genetic sense. It had already evolved mutations to help it counteract those moves that the bacteria were taking. We are using phage’s own improvement algorithm, evolution by natural selection, to regain its therapeutic potential and solve the problem of bacteria evolving resistance to yet another therapy.”

While the findings are encouraging, they’re still quite preliminary — more of a proof of concept, if you will. Moving forward, the team wants to test their approach on strains of bacteria important in clinical settings, such as E. coli. Its viability as a treatment option will also be checked using animal models.

The paper “Coevolutionary phage training leads to greater bacterial suppression and delays the evolution of phage resistance” has been published in the journal PNAS.

Silver nanoparticles change shape and get ‘consumed’ when destroying bacteria

New research is looking into the interaction between silver nanoparticles and E. coli bacteria as a possible solution to the growing levels of antibiotic resistance seen in pathogens. Although the antibacterial effect of silver has been known for some time now, we didn’t understand why it had this effect.

Silver bars. Image via Pixabay.

Silver has seen growing use for pathogen control in the last few years, in things such as antimicrobial coatings, for example. So far, it definitely seems to be good at the job of killing these tiny threats. Still, a better understanding of how and why it can protect from microbes could help us better apply silver to the task.

In order to glean this information, a team of researchers monitored the interactions between silver nanoparticles and a culture of E. coli bacteria. According to the results, silver nanoparticles undergo several dramatic changes in properties such as size and shape while interacting with bacteria.

Silver for monsters

Concerning the issue of antibiotic resistance, silver poses a very exciting prospect in that it physically kills bacteria, not chemically, as our drugs do. In other words, pathogens don’t have any way of defending themselves against silver.

An international team of researchers with members from Italy, the United States, and Singapore report that silver nanoparticles go through “several dramatic” changes when interacting with E. coli bacteria. This goes against the current prevailing wisdom that the metal remains unaltered during such interactions.

These changes seem to originate in electrostatic interactions between the silver and the bacteria. This causes some of the nanoparticles to dissolve and spread as ions in the environment, eventually making their way into the bacterial cells. Their shape changes as they dissolve, getting smaller and more rounded (they start out as triangular shapes).

After observing these mechanisms, the team treated their E. coli colony with a substance that increased the permeability of the bacteria’s membranes, and then tested them again. In this case, the effects on the silver were more pronounced, they explain.

“It seems from this study that silver is ‘consumed’ from the interaction,” said Guglielmo Lanzani, one of the authors on the paper and director of the Center for Nano Science and Technology of IIT-Istituto di Tecnologia.

“We think this does not affect the efficiency of the biocidal process and, due to the tiny exchange of mass, the lifetime is essentially unlimited,” said Giuseppe Paternò, a researcher at IIT and co-author of the study. “The structural modifications, however, affect the optical properties of the metal nanostructures.”

Although the findings help us better understand the interactions between bacteria and silver nanoparticles, they’re likely not the entire story, the authors note. Laboratories are highly controlled environments, and as such cannot begin to capture everything that’s going on in the wild. These factors that are left out might have an important hand to play in shaping the final interaction between bacteria and silver.

Even so, the team will continue to explore this topic, with a particular interest in studying the chemical machinery (‘chemical pathways’) inside the bacteria that cause these structural changes in silver. They also want to understand why silver is a more powerful antibacterial agent than other materials, and why bacterial membranes seem to be so vulnerable to it while our cells are almost unaffected.

The paper “The impact of bacteria exposure on the plasmonic response of silver nanostructured surfaces” has been published in the journal Chemical Physics Reviews.

Gut bacteria resistance to antibiotics doubles in the last 20 years

Researchers have uncovered a worrisome trend in which harmful bacteria known to cause dangerous stomach diseases are becoming increasingly resistant to even some of the most powerful antibiotics at our disposal. According to a new study, resistance to commonly-used antibiotics has doubled in the past 20 years.

Credit: Wikimedia Commons.

For their study, the team led by Francis Megraud, Professor of Bacteriology at the University of Bordeaux in France and the founder of the European Helicobacter & Microbiota Study Group, studied the antibiotic response of 1,232 patients from 18 countries who were infected with Helicobacter pylori (H. pylori).

If left untreated, this bacterial infection may cause gastric ulcers, lymphoma, and even gastric cancer.

For years, doctors have been prescribing clarithromycin to ward off H. pylori, but since 1998, resistance to the antibiotic has surged from 9.9% to 21.6% as of last year. The researchers found similar jumps in resistance for levofloxacin and metronidazole.

H. pylori infection is already a complex condition to treat, requiring a combination of medications. With resistance rates to commonly used antibiotics such as clarithromycin increasing at an alarming rate of nearly 1% per year, treatment options for H. pylori will become progressively limited and ineffective if novel treatment strategies remain undeveloped. The reduced efficacy of current therapies could maintain the high incidence rates of gastric cancer and other conditions such as peptic ulcer disease, if drug resistance continues to increase at this pace,” Megraud said in a statement.

The study found that the highest rates of clarithromycin resistance in H. pylori were in Southern Italy (39.9%), Croatia (34.6) and Greece (30%). It’s no wonder that these countries are also known for overconsumption of antibiotics in inappropriate situations, including for conditions like cold and flu (for which antibiotics are useless since they’re caused by viral infections). These countries also have poor antibiotic resistance containment strategies.

Antibiotic resistance occurs when an antibiotic is no longer effective at controlling or killing bacterial growth. Bacteria that are ‘resistant’ can multiply in the presence of various therapeutic levels of an antibiotic. Sometimes, increasing the dose of an antibiotic can help tackle a more severe infection but in some instances — and these are becoming more and more frequent — no dose seems to control bacterial growth. Each year, 25,000 patients from the EU and 63,000 patients from the USA die because of hospital-acquired bacterial infections which are resistant to multidrug-action. 

According to a 2013 CDC report titled “Antibiotic Resistance Threats in the United States, antibiotic resistance is responsible for $20 billion in direct health-care costs in the United States. Without urgent action, the number of infections could rise dramatically.

H. pylori is believed to be present in about one half of the world’s population, but most never get sick. Some, however, aren’t so lucky and the bacteria can cause some uncomfortable complications like inflammation of the stomach lining (gastritis) and peptic ulcers.

For some time, H. pylori antibiotic resistance has been considered as a severe threat to public health, with the World Health Organization (WHO) calling clarithromycin-resistant H. pylori a high priority for antibiotic research and development. According to an OECD report, superbug infections could cost the lives of around 2.4 million people in Europe, North America and Australia over the next 30 years. The good news is three out of four deaths could be averted by spending just 2 USD per person a year on measures like handwashing and more prudent prescription of antibiotics.

“The findings of this study are certainly concerning, as H. pylori is the main cause of peptic disease and gastric cancer,” commented Mário Dinis-Ribeiro, President of the European Society of Gastrointestinal Endoscopy. “The increasing resistance of H. pylori to a number of commonly-used antibiotics may jeopardize prevention strategies.”

The findings appeared in the journal UEG Journal and were presented today at UEG Week Barcelona 2019.

Global antibiotic resistance in food animals has become a major issue

A new report concludes that growing antibiotic resistance in animals threatens not only animal and human health — but even food security.

A simple explanation of how antibiotic resistance works. Image credits: NIAID.

In recent years, antibiotic resistance has emerged as one of the biggest threats to human health, with the World Health Organization (WHO) and the Center for Disease Control (CDC) both considering it tremendously dangerous. The world is not ready to deal with antibiotic resistance, and the prospect of having newly-untreatable pathogens running around is horrifying. Thankfully, many parts of the world are starting to take action, acknowledging the urgency and the scale of the problem.

But it’s not just humans that take antibiotics. Antibiotic-resistant bacteria are on the rise globally, and much of that comes from farm animals. Animals consume three times as many antibiotics as humans and meat consumption is growing globally (particularly in low-income or developing countries).

To be able to meet the growing demand for animal protein, most meat production systems routinely use antibiotics, not just for disease prevention, but also for growth promotion. In most parts of the world, veterinary antibiotic sales are unregulated, and people stock their animals up with antibiotics because, frankly, it’s simpler and more financially lucrative.

However, although this can be beneficial in the short-term, overconsumption of antibiotics can produce untreatable infections not only for animals, but also for the humans that consume the meat. This is understudied as most research is focused on antibiotic resistance in humans, and there are very few monitoring mechanisms for this issue in developing countries.

The proportion of microbial compounds with resistance higher than 50%, confidence interval 95%. Credits: Van Boeckel et al, Science.

To address this issue, researchers mapped developed a geospatial model starting from the reported rates of antibiotic resistance in animals and animal-based food products. They used 901 surveys carried out between 2000 and 2018, focusing on foodborne pathogens such as Escherichia coli, Campylobacter spp., non-typhoidal Salmonella, and Staphylococcus aureus. The results are concerning.

Antibiotic resistance has increased by more than 50% overall in the time interval. The highest rates of resistance were identified in antibiotics commonly used in food production, including tetracyclines, sulfonamides, and penicillins.

When looking at a map of the antibiotic resistance, researchers also found a few hotspots of multidrug-resistance: north-eastern India, north-eastern China, northern Pakistan, Iran, eastern Turkey, the south coast of Brazil, the Nile River delta, the Red River delta in Vietnam and the areas surrounding Mexico City and Johannesburg in South Africa seem to be the worst affected. While there is some uncertainty due to lack of data in some areas (particularly in rural areas), the data paints a compelling picture: antibiotic resistance in animals is on the rise, and it’s rising particularly fast in areas which are starting to eat more meat.

“Animal production is increasing worldwide and the consequences of intensive use of antibiotics on resistance in animals is amply clear from our analysis. We have a small window of opportunity to help low- and middle-income countries transition to more sustainable farming practices. High-income countries -where antimicrobials have been used since the 1950s- should support that transition,” said study author Ramanan Laxminarayan, director of CDDEP and senior research scholar at Princeton University.

This means that if current trends continue, antibiotic usage will become less and less effective, which is especially dangerous for the people and animals who are actually sick and need the antibiotics — but at a larger scale, it’s dangerous for all society.

Researchers also point out that although the hotspots are in developing parts of the world, developed countries have their fair share of the blame, and should contribute to solving this issue. This is a global issue that requires global action and if we don’t act, we will all suffer in the end.

“It is of particular concern that antibiotic resistance is rising in low- and middle-income countries because this is where meat consumption is growing the fastest while access to veterinary antimicrobials remains largely unregulated. Antibiotic resistance is a global problem, and there is little point of making considerable efforts to reduce resistance on one side of the world if it is increasing dramatically on the other side,” concludes study author Thomas Van Boeckel at ETH Zurich.

The study titled, “Global Trends in Antimicrobial Resistance in Animals in Low- and Middle-Income Countries,” has been published in Science.

New bacteria strain.

Irish dirt might cure the world of (most) multi-drug-resistant bacteria

Irish soil might win us the fight against drug-resistant superbugs. Literally!

New bacteria strain.

Growth of the newly discovered Streptomyces sp. myrophorea. Although superficially resembling fungi, Streptomyces are true bacteria and are the source of two-thirds of the various frontline antibiotics used in medicine.
Image credits G Quinn / Swansea University

An international team of researchers based at the Swansea University Medical School, UK, reports finding a new strain of bacteria that can murder pathogens that our antibiotics increasingly cannot. The bacteria has been found in soil samples recovered from an area of Fermanagh, Northern Ireland.

Bad bugs get grounded

“This new strain of bacteria is effective against 4 of the top 6 pathogens that are resistant to antibiotics, including MRSA. Our discovery is an important step forward in the fight against antibiotic resistance,” says Professor Paul Dyson of Swansea University Medical School, paper co-author.

The finding is far from inconsequential. The World Health Organisation (WHO) describes rising antibiotic resistance as “one of the biggest threats to global health, food security, and development today”. Further research also estimated that antibiotic-resistant ‘superbugs’ could lead up to 1.3 million deaths in Europe alone by 2050.

The team named their discovery Streptomyces sp. myrophorea. It was discovered in the Boho Highlands, County Fermanagh, Northern Ireland, hiding in the soil. The researchers investigated the soils there as Dr. Gerry Quinn, a previous resident of the area, became curious to investigate local healing traditions.

Those traditions called for a small amount of soil to be wrapped up in cotton cloth and applied to cure ailments varying from toothaches to throat or neck infections. The team notes that the area has been inhabited for at least 4,000 years — first by Neolithic tribes and later druidic tribes — who may have started this tradition.

Lab tests later revealed the presence of the strain in local soils, and clued the team in on their impressive antibacterial properties. This bacteria inhibited the growth of four of the top six multi-resistant pathogens (those listed by the WHO as being responsible for healthcare-associated infections): Vancomycin-resistant Enterococcus faecium (VRE), methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumonia, and Carbenepenem-resistant Acinetobacter baumanii. It was also successful in inhibiting both gram positive and gram negative bacteria, which differ in the structure of their cell wall. Gram-negative bacteria are, generally speaking, more resistant to antibiotics.

It is not yet clear exactly how the bacteria do this, but the team is hard at work finding out.

New bacteria strain.

Zone of inhibition (light brown) produced by Streptomyces sp myrophorea (brown spot) on a lawn of MRSA.
Image credits G Quinn / Swansea University.

The active compounds secreted by Streptomyces sp.myrophorea could help create a new class of treatment against multi-drug resistant bacteria, the study reports. These pathogens are one of the most pressing threats to public health currently, as doctors are often left powerless to treat them. They’re especially dangerous in hospitals, where the large density of patients (often with weakened or compromised immune systems) means easy pickings for such pathogens.

“Our results show that folklore and traditional medicines are worth investigating in the search for new antibiotics,” Professor Dyson says. “Scientists, historians, and archaeologists can all have something to contribute to this task. It seems that part of the answer to this very modern problem might lie in the wisdom of the past.”

“We will now concentrate on the purification and identification of these antibiotics. We have also discovered additional antibacterial organisms from the same soil cure which may cover a broader spectrum of multi-resistant pathogens.”

The paper “A Novel Alkaliphilic Streptomyces Inhibits ESKAPE Pathogens” has been published in the journal Frontiers in Microbiology.

Probiotics and breastfeeding help fight antibiotic resistance in children, study suggests

A targeted probiotic supplementation, in conjunction with breastfeeding, could help reduce the potential for antibiotic resistance, a new study suggests.

Image credits: Andrés Nieto Porras.

Probiotics (live bacteria and yeasts that are allegedly good for your health and digestive system) remain a controversial topic — their benefits are often oversold and rarely backed up by actual science. But in recent years, studies have shown that, in some specific scenarios, probiotics do offer significant advantages.

In a new study, researchers found that breastfed infants who were given a specific probiotic strain of B. infantis had, on average, 87.5% less antibiotic resistance genes in their gut microbiome compared to infants who were breastfed without that probiotics.

Antibiotic resistance is not something many people think about while raising their children, but perhaps we should start paying more attention to it: recently, the World Health Organisation announced antibiotic resistance as one of the biggest threats to global health, and this is definitely a growing concern for the younger generations. Having a simple way to reduce antibiotic resistance could make a big difference in the long run.

[panel style=”panel-default” title=”Antibiotic resistance” footer=””]Because many members of the public take antibiotics when they are not required to, many pathogens have started developing an immunity to common treatments — even the strong treatments. This has become a great concern, especially as some infections have started going beyond the limit of what we can currently treat.

Misuse of antibiotics in both humans and animals is accentuating this problem, and researchers are looking for ways to combat it.[/panel]

Dr. Giorgio Casaburi, lead author of the research, comments:

“These results demonstrate that targeted bacterial supplementation is capable of remodelling the ecology of the infant gut microbiome and therefore reduce antibiotic gene reservoirs in children. We found that supplementation with the infant gut symbiont significantly diminished both the abundance and diversity of antibiotic resistance genes”.

Casaburi and his colleagues administered the probiotic supplement for 21 days. They chose a probiotic uniquely adapted to thrive in the infant’s gastrointestinal system. The probiotic bacteria colonize the infant’s gut. Without it, the gut is colonized by other bacteria which enable the evolution, persistence and dissemination of antibiotic resistance genes.

While this is a fairly small trial, it still showcases an important potential for dealing with antibiotic resistance in a safe way that doesn’t have any unwanted side effects.

“The supplementation offers a novel approach towards providing an alternative, safe and non-invasive method to decrease the number of genes that resist antibiotics in infants” added Dr Casaburi. “This is the first demonstration of significant remodelling of the infant gut microbiome. This modulation could help to reduce the burden and diversity of antibiotic resistance genes in current and future generations”.

The results have not yet been peer-reviewed and will be presented at European Society for Paediatric Gastroenterology Hepatology and Nutrition.

Neisseria gonorrhoeae

World-first case of antibiotic-resistant gonorrhea, identified in the UK

Public Health England released the first global report of antibiotic-resistant gonorrhea.

Neisseria gonorrhoeae

Colourised scanning electron micrograph of Neisseria gonorrhoeae bacteria.
image via National Institute of Allergy and Infectious Diseases / Flickr

A UK man is the first on record to contract a strand of gonorrhea that can shrug off our main antibiotic treatment against the disease. The report, issued by Public Health England (PHE), notes that while he had a regular partner in the UK, the man contracted the infection following a sexual encounter with a woman in south-east Asia.

He first visited a health clinic for treatment in early 2018. However, although doctors placed him on the recommended treatment for the disease — a cocktail of antibiotics azithromycin and ceftriaxone — the infection persists, according to The Guardian.

“We are investigating a case who has gonorrhoea which was acquired abroad and is very resistant to the recommended first line treatment,” said Dr Gwenda Hughes, the head of PHE’s STI section.

“This is the first time a case has displayed such high-level resistance to both of these drugs and to most other commonly used antibiotics.”

The man is currently receiving an intravenous treatment course of ertapenem, an antibiotic used as a last line of defense against multidrug-resistant bacteria. So far, it seems to be effective — lab tests scheduled for April will tell whether or not this is the case. The man’s partner tested negative for infection. However, authorities have traced the man’s sexual partners to ensure that the strain didn’t spread.

“We are following up this case to ensure that the infection was effectively treated with other options and the risk of any onward transmission is minimized,” Hughes adds.

Symptoms of gonorrhea include inflammation, a burning sensation when urinating, and unusual discharge from the sexual organ. Left untreated, the infection can cause other serious health problems, including long-term abdominal pain and pelvic inflammatory disease. But what makes the prospect of antibiotic-resistant strains really menacing is that these complications often lead to infertility.

The WHO estimates that some 78 million people worldwide contract gonorrhea each year. In the US, CDC estimates place the number of new infections at around 820,000 countrywide per year. Worse still, gonorrhea has shown a worrying trend of successive adaptation to our antibiotic treatments over the last few years. That’s why Hughes stressed the importance of practicing safe sex:

“It is better to avoid getting or passing on gonorrhoea in the first place and everyone can significantly reduce their risk by using condoms consistently and correctly with all new and casual partners,” she said in a statement.

Still, the report is a confirmation of healthcare authorities’ greatest fear: drug-resistant gonorrhea is spreading around the globe. Massive research efforts have led to an effective vaccine against the disease — but at the time of writing this, we’re still very far away from a fail-proof vaccine; currently, it only reduces the disease’s incidence by 31%, one in every three cases.

British surfers are more prone to be antibiotic resistant bacteria carriers

A new study shows that surfers are three times more likely to harbor very resistant types of E.coli.

Surfers swallow almost ten times more seawater than the average swimmer, researchers at the University of Exeter report. Since many sewage collections drain into the sea, they sometimes bring along various types of Antibiotic-Resistant Bacteria (ARB). Researchers suspected that surfers ingest a worrying amount of such bacteria.

Source: Pixabay/andyperdana69

Dr Anne Leonard, lead author of the paper said: “This research is the first of its kind to identify an association between surfing and gut colonisation by antibiotic resistant bacteria.”

Unfit antibiotic treatments for viral infections and not respecting the full length and dosage of such treatments, are catalysts for bacterial resistance, a problem which is becoming more and more worrisome.

Bacteria are living organisms and the laws of evolution apply to them just like other creatures. When you take a treatment that kills most but not all bacteria, you’re accelerating their evolution. The survivors will be super trained to resist treatment. In a way, antibiotic resistance is their only way of surviving and adapting.

Via Pixabay/geralt

Surfing with the bugs

Scientists isolated many genes responsible for allowing Enterobacteriae (the family which includes E. coli) to survive antibiotics. One group, the blaCTX-M genes, confers resistance to multiple beta-lactam antibiotics.

Researchers analyzed 97 bathing water samples from England and Wales, noting the proportion of E. coli harboring blaCTX-M.They discovered that 11 out of the 97 bathing water samples were contaminated with the super-bug.

After they identified surfers as being at risk of exposure to ARB, scientists compared surfers and non-surfers to see whether there was an association between surfing and gut colonization by blaCTX-M- bearing E. coli.

The scientists discovered that 9 out of 143 (6.3%) surfers were colonized by blaCTX-M-bearing E. coli, as compared with 2 out of 130 (1.5%) of non-surfers.

Professor Colin Garner, founder and manager of Antibiotic Research UK — the only charity in the world set-up to tackle antibiotic resistance — said this was a “pioneering finding”.

He said that antibiotics enter the environment from farms or sewage. Environmental samples “have higher antibiotic concentrations than patients being administered antibiotics”.

“Research into new medicines to replace our archaic antibiotics has stagnated and unless new treatments are found, this could be potentially devastating for human health,” Professor Garners added.

“We know very little about the spread of antibiotic resistant bacteria and resistance genes between our environment, farm animals, wild animals and humans.”

Source: Pixabay/n4pgw

“This research helps us understand better the movement of resistant bacteria in surfers,” he said, but the next step should be testing if surfers and those in close contact with them are at greater risk of serious infection.

Bacteriophages (green) attacking a bacterium (orange). Credit: Graham Beards.

Patient saved from antibiotic-resistant infection with novel bacteriophage treatment

An experimental therapy using bacteriophages (viruses of bacteria) successfully cured a patient of a multi-drug resistant bacterial infection. No antibiotic, no matter how strong, could help the patient who had been in a coma for two years. The findings suggest that personalized phage therapy can be very successful and will likely propel more research groups to devote more resources for such life-saving initiatives. The World Health Organization estimates that by 2050, 50 million people will die because of antibiotic-resistant infections. No new class of antibiotics has been discovered in the last three decades.

When bacteria resist

In late 2015, Tom Petterson,  a 69-year-old professor in the Department of Psychiatry at UC San Diego School of Medicine, was vacationing with his wife in Egypt when he suddenly became ill. Local doctors quickly diagnosed him with pancreatitis, an inflammation of the pancreas, and when standard care failed he was urgently flown to Frankfurt, Germany. There, doctors found he had been infected with a multidrug-resistant strain of Acinetobacter baumannii. 

The German doctors also discovered a pancreatic pseudocyst which causes fluid to build up around the pancreas. Antibiotics seemed to fail. The only thing that worked was a drug of last resort — a mix of meropenem, tigecycline, and colistin, which is known to cause kidney damage among its many side effects. The situation warranted this extreme measure, though, and once his condition became stable enough, Patterson was flown to the Thornton Hospital at UC San Diego Health. Here disaster waited. The doctors found that upon arrival the bacteria had become resistant to all antibiotics.

To make matters worse, as Patterson was prepared for transfer to a long-term acute care facility, an internal drain slipped, spilling bacteria into his abdomen and bloodstream. The patient immediately entered in septic shock and soon after fell into a coma. He would stay in a coma for the next two months. His days were numbered but family and colleagues at the university didn’t stay idle.

“There came a point when he was getting weaker and weaker, and I didn’t want to lose him. I wasn’t ready to let him go and so I held his hand and said, ‘Honey, they’re doing everything they can and there’s nothing that can kill this bug, so if you want to fight, you need to fight. Do you want me to find some alternative therapies? We can leave no stone unturned,'” the patient’s wife, Steffanie Strathdee, recalled. Strathdee is the chief of the Division of Global Public Health in the Department of Medicine at UC San Diego and no stranger to crippling diseases.

Two can play this game: infecting bacteria

Bacteriophages (green) attacking a bacterium (orange). Credit: Graham Beards.

Bacteriophages (green) attacking a bacterium (orange). Credit: Graham Beards.

Strathdee read everything she got her hands on. While researching, she was informed about a case from Tblisi, Georgia where a patient suffering from a ‘difficult’ infection was ‘miraculously cured’ after undergoing phage therapy.

Bacteriophages are viruses, and the most numerous kind to boot. By some estimates, there are 1031 bacteriophages on the planet or more than every other organism on Earth combined. That includes bacteria. If bacteria infects humans, bacteriophages infect the bacteria. These phages cause a trillion trillion successful infections per second and destroy up to 40 percent of all bacterial cells in the ocean every day.

Bacteriophages were formally discovered in the mid to late teens of the 20th century, with the first publication coming out in 1915. In the 1920s and the 1930s, phage therapy was commonly used to treat various bacterial infections but as antibiotics became more widespread and easy to use, phage therapy turned into a simple mention in medical textbooks. Some parts of Eastern Europe and the Soviet Union were still involved with phage therapy research, it’s worth adding.

More than a hundred years since phage therapy was described, the joke’s on us. Countless strains of bacteria are becoming resistant to antibiotics. Common STDs like gonorrhea will become untreatable in the next decade by some accounts, and mortality because of multi-drug bacterial infections will become widespread. Already, hundreds of thousands of people around the world die from hospital-acquired multi-drug resistant bacteria and the World Health Organization estimates antimicrobial resistance will kill at least 50 million people per year by 2050.

Though obscure, Strathdee managed to come across people who were working with phage therapy. They found three team with phages that could target Patterson’s specific infection: the Biological Defense Research Directorate of the NMRC in Frederick, MD; the Center for Phage Technology at Texas A&M University; and AmpliPhi, a San Diego-based biotech company specializing in bacteriophage-based therapies. All three agreed to help and the phage samples were sent to San Diego State University where they were purified. Meanwhile, emergency approval for the samples’ use was given by the Food and Drug Administration.

Against all odds

Patterson was given the phages through catheters into his abdominal cavity and intravenously so the therapy acted more broadly. Patterson’s condition began to improve and within three days since the first IV phage therapy, he had emerged from his long coma.

“As a treating doctor, it was a challenge,” said Chip Schooley, one of Strathdee’s colleagues. “Usually you know what the dosage should be, how often to treat. Improving vital signs is a good way to know that you’re progressing, but when you’re doing it for the first time, you don’t have anything to compare it to.

“A lot was really worked out as we went along, combining previous literature, our own intuition about how these phages would circulate and work and advice from people who had been thinking about this for a long time.”

Patterson described the experience as miraculous, though his body had been severely weakened after losing 100 pounds in coma, mostly muscle.

“The phage therapy has really been a miracle for me, and for what it might mean that millions of people who may be cured from multidrug-resistant infections in the future. It’s been sort of a privilege,” Patterson confessed.

Though the sample size of the study only measures one person, Patterson’s case study gives hope that personalized therapy with bacteriophages can undo possibly any infection where antibiotics don’t work. Most people around the world won’t have Patterson’s privilege of having friends and family who are among the best doctors in the world. It will be an immense challenge to translate this sort of therapy into something that’s as easy and cheap as antibiotics are today. Well, cheap and easy for now at least.