Fight the good fight: the race between man and microbes
4th May 2017 - 0 comments
Hearing the words ‘antibiotic resistance’ is enough to instil a little panic in all of us. Reports of doctors struggling to find effective medicines are increasing, and awareness of hospital-acquired infections induces fear about going to hospital. ‘I don’t want to come home with more than I went in with’ moaned an elderly neighbour of mine who was due to undergo a minor hospital procedure.
I remember lecturers ranting on about the perils of antibiotic misuse in the 1970s. Now 2017 has been flagged as a ‘tipping point’ for antibiotic resistance as the situation becomes critical – videos of evolving bacteria highlight the point.
It has taken many years for this message to come across which reinforces the need for clear communications on such serious issues.
The discovery in 1928 of an antimicrobial compound which could kill bacteria by disrupting their cell walls revolutionised medicine and veterinary science. As bacteria evolved mechanisms to survive this onslaught, genes conferring antibiotic resistance were swapped around between the same and different bacterial species. This led to the development of generations of antibiotics in the fight to keep up.
Outbreaks of resistance in skin colonisers, such as Staphylococcus species, were followed by those residing in the bacteria of the gut. This has been more difficult to contain and now many drug resistant bacteria exist not only in man and animals but also in the environment. Overuse and misuse of antibiotics has hastened this process and even commensals and probiotic bacteria can become potential killers, acting as a reservoir for antibiotic resistance genes.
We tend to think of antibiotic resistance as a recent problem, it has, in fact, been going on for thousands of years. An interesting development has isolated functional resistance genes from 5000-year-old DNA in the Beringian permafrost. Antibiotic resistance genes have also been found in the gut bacteria of 1000-year-old mummies from the Inca Empire, resistant to drugs only discovered in the last 100 years including penicillin, vancomycin and tetracycline. This knowledge of the past could be helpful in predictions about the future of antibiotic resistance.
So, are we about to enter a pre-antibiotic era where even the tiniest scratch could develop into an untreatable and potentially fatal infection? A woman from Nevada died last year from a strain of Klebsiella that was to resistant to 26 antibiotics, and the World Health Organisation recently published a list of bacteria for which new antibiotics are urgently needed.
Several strategies to tackle this include the search for new drugs, reinstating old ones and treatments with novel drug combinations. Improved vaccination schedules, the use of bacteria- killing viruses and devising ways to attack multiple targets of bacterial structure and metabolism are also part of the armoury. Even the use of 3D printing is helping in vaccine design. Platforms are also available for clinicians to rapidly obtain resistance profiles of bacteria prior to prescribing.
Alexander Fleming modestly declared ‘Nature makes penicillin; I just found it’ but in 1945 he also stated ‘The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.’
Increased communications about the worldwide threat to health from antibiotic resistance has at last spurred a call to action. The fight between man and the microbes is on.
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Written by Sarah Warnes – Scientific Writer, PhD