The Unexpected Way Hospitals Could Fight Antibiotic Resistance

Hospital wastewater may contain a solution.

It's human nature to find blame when the situation turns dire. As antibiotic resistance continues to rise and the post-antibiotic era looms closer, the fingers are pointed squarely at two major suspects. The first is agriculture, which continues to misuse these drugs to maintain profitable gains. The other is the medical community for their unbridled use of these lifesaving treatments.

In the case of the latter, the most common place of concern is the hospital. It's known as one of the most important hotspots for antibiotic resistance. The accusation is not without merit, as many of the resistant bacteria circulating today in the community come at one point or another from a health-care institution.

Upon closer inspection of the hospital, the path to resistance spread is not through the doors of the building. Rather, research has shown the most common route happens to be through the sewers. The collection of different waters sent down the drain ― known as wastewater ― has been known for decades to be as being a significant source for antibiotic-resistant bacteria. These bacteria are given the freedom to travel into the normal wastewater distribution system and eventually into the environment.

Not surprisingly, research on wastewater has been aimed at reducing the levels of these resistant organisms. Several options have been developed over the years such as chemicals, filters, and even electricity. Many have proven themselves in both laboratory and field trials, suggesting we may have the means to reduce the spread of resistant bacteria coming out of these institutions.

The information gained also offers some hope in the fight against antibiotic resistance.

But there could be a reason to see some good in this rather troubling story. It comes thanks to a group of Iranian researchers. Whereas most people consider hospital wastewater to be a problem, these individuals saw it as an opportunity to identify a new route to treat antibiotic-resistant bacterial infections. Their results suggest we may want to give this water a second look in order to help stave off the post-antibiotic era.

The group took samples of hospital wastewater and examined it for signs of a different kind of microbial life. They were in search of viruses known as bacteriophages or phages for short. These small microscopic organisms are found all over the world, including inside of each of us. As to their function, for our interest, they have only one job. They kill bacteria.

The hope of the study was to find one or more different types of bacteriophages possessing the ability to kill antibiotic-resistant bacteria. If they could identify any possible candidates, then they would be stored and examined for use as replacements for antibiotics, a practice known as phage therapy.

The experiments were straightforward. The team collected water samples from hospitals as well as from other sources such as the Caspian Sea and the Persian Gulf, and then tried to find any phages with an appetite for bacteria. But instead of looking at a variety of different bacterial food items, they chose only one.

It's known as Acinetobacter baumannii and it is one of the most troubling concerns to human health. It can cause pneumonia, urinary tract infections and the life-threatening condition known as sepsis. But what makes it such a killer is the ability of many strains to resist one or more antibiotics. The situation with this bacterium has gotten so bad that several strains are resistant to all available antibiotics.

For the researchers, finding viruses capable of killing this antibiotic-resistant public enemy was of great importance. But it also came with some risk. Although phages to this bacterium had been found before, they came primarily from environmental sources. There was no guarantee they would find a phage in the hospital's discharge.

When the tests were run, the effort was rewarded. The team found two phages capable of killing several strains with incredible effectiveness. At concentrations over 100 million per millilitre, the bacteria were eliminated within an hour.

Upon further examination of the phages, the group was surprised to find they were not related. Instead, they appeared to belong to two separate families. This suggested the baumannii bacteria could be attacked by a variety of viruses rather than just one type.

The results of this study open the door to more explorations of hospital wastewater in search of other phages capable of killing antibiotic-resistant bacteria. The information gained also offers some hope in the fight against antibiotic resistance. While there is much more research to be done on these isolated phages and any other found in the future, we can rest a little more comfortably knowing we may be able to harness nature to help us deal with the looming post-antibiotic era and avoid what might be considered a health apocalypse.

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