This past week, the World Health Organization made a very troubling announcement. We are running out of antibiotics. As much as public health officials have tried to slow the progress of antibiotic resistance, the pace has not slowed and the post-antibiotic era is closer than ever.
The reasons for the rise in antimicrobial resistance have been known for quite some time. The usual suspects are inappropriate prescriptions in medicine and the improper use of antibiotics in agriculture. For years, organizations such as the WHO, the CDC and Public Health Agency of Canada have been attempting to tackle these global issues in the hopes of maintaining our antibiotic supply. Yet, as last week's declaration reveals, there still is much work to be done.
One of the problems associated with the rise in antibiotic resistance is the lack of understanding of how these bacterial species manage to find their way into people to cause infection. Despite the focus on preventative measures such as hygiene, sanitation and infection control practices in health care, antibiotic-resistant bacteria still manage to find their way into individuals. From a purely microbiological perspective, something must be occurring at the microscopic level to allow these bacteria a chance to colonize, survive and thrive. Yet this has continued to be a mystery.
Now that has changed thanks to a group of American researchers. They have provided a glimpse into how these antibiotic-resistant bacteria manage to evade human practices. The results reveal the problem may be far more complicated than we imagined, and resolution may require significant changes in the way we fight these bacterial invaders.
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The team collected information from 234 nursing home residents who took part in a three-year project known as the Targeted Infection Prevention study. The individuals agreed to share three very valuable pieces of information. First, they allowed researchers to determine the types of bacteria living in various parts of their body. They also gave the study permission to log the different types of antibiotics used during their stay. Finally, the study was allowed to log the medical procedures encountered by the individuals, including the use of urinary catheters. These specialized tubes allow people to relieve themselves without having to find a toilet. While they are incredibly helpful, they also are known to be a major risk site for bacterial infection.
The authors of this current study explored the data in the hopes of finding some links between the use of a urinary catheter, the use of antibiotic treatment and the presence of antibiotic resistant bacteria. They had hoped to identify at least one possible path to infection. What they learned was both surprising as well as discouraging.
First, about a third of the 234 residents had at least one antibiotic-resistant species colonizing the groin area. About 40 per cent of them had more than one species living in that area. This alone was disconcerting, as it revealed a high risk for an antibiotic-resistant urinary tract infection.
Taking a closer look at the timing of colonization, the team discovered the presence of one bacterial species actually improved the chances for another species to join the area. This could worsen the situation for an individual rather quickly. This finding also meant health-care workers might need to continually test an individual to determine if any colonization has occurred to prevent the appearance of what the authors described as "bacterial pairs."
The use of antibiotics was leading to more problems, not fewer.
But these revelations were nothing compared to the final one, which left the team realizing the problem was far more complicated than once believed. The use of antibiotics actually helped certain species to colonize. Because they could resist the antibiotics, these invaders could find a home, colonize and then attract other resistant species. In essence, the use of antibiotics was leading to more problems, not fewer.
The results of the study paint a rather gloomy picture involving a trifecta of troubles. While the authors openly admit more needs to be done to confirm their results and also develop new guidelines, these findings need to be taken into account when it comes to using antibiotics in the future. If the use of these drugs ends up increasing the risk for colonization and infection, then changes definitely are needed.
Although the study did focus on nursing home residents, the information can also provide perspective for the rest of the population. As the results suggest, using antibiotics may increase the chances for troubles down the road. The best way to avoid this problem is quite simply to minimize the use of antibiotics. Granted, their use is necessary to resolve certain types of infections. Yet, this decision is best left to a trained health-care professional who can decide whether the benefit is worth the risk.
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