Cystic Fibrosis Discovery

Scientists in Belfast have found a potential new mechanism - making antibiotics for treating cystic fibrosis (CF) more effective, in the face of growing resistance.

The Queen's University Belfast researchers have found that fat soluble vitamins, could stop the antibiotics from becoming impeded.

The scientists found fat soluble vitamins can stop

antibiotics from being impeded

The cause of many severe lung infections in those with CF, Burkholderia cenocepacia bacteria have become very resistant to antibiotics.
The team, led by Professor Miguel Valvano from the Wellcome-Wolfson Institute for Experimental Medicine at Queen's, found the problem lay with lipocalins.
These are proteins which latch onto antibiotics, preventing them from destroying the bacteria.
But the scientists found that fat-soluble vitamins, like Vitamin E, can get over this problem, because they stick to the lipocalins more strongly than they do to the antibiotics.
Details of the study are published in the journal mBio.
The team is now examining ways of reformulating antibiotics with vitamins in order to improve their efficacy.
"This is an exciting and potentially life-changing finding, particularly relevant for cystic fibrosis patients who are chronically infected with multi-resistant bacteria," said Professor Valvano.
"Armed with this knowledge, we can focus our efforts on finding alternative solutions to more effectively treat the infection in these patients."

Health Service and Superbugs

Antibiotic resistance is one of the greatest challenges facing health services around the world, numerous reports have told us over the past year.

 

Currently, 700,000 people a year die because their conditions are resistant to the antibiotics traditionally administered to tackle them, and this figure will rise to 10 million within decades unless a solution is found.

 

Studies suggest CPE kills about 40 per cent of those
who become infected, especially older, frail patients.

 

In Ireland, progress has been made in reducing the level of infections caused by organisms that were a significant concern a decade ago. Superbugs such as MRSA haven’t gone away, but the number of patients infected during hospital stays has declined steadily.

However, the ground on which the battle against antibiotic resistance is fought constantly changes, and so new organisms have emerged to create problems in the overcrowded, overstretched Irish health system.

Worryingly, the threat they pose is ever greater, because many of them are resistant to all but the most potent antibiotics and they are difficult, if not impossible, to eradicate.

Of particular concern is the emergence of what is termed carbapenemase-producing Enterobacteriaceae (CPE), which results in some cases of bacteria being resistant to all conventionally-used antibiotics. The carbapenemases are enzymes that work by inactivating antibiotics.

Galway Research on MRSA

Scientists in Galway have discovered that penicillin can be used to make other antibiotics or the body more effective at fighting MRSA.

The finding may open up new avenues for combating antimicrobial resistance, which is claiming an increasing number of lives around the world.
The microbiology team at NUI Galway, working in conjunction with the University of Liverpool, found that while penicillin cannot kill MRSA, it weakens its virulence.
The research, published in the Journal of Infectious Diseases, shows that the penicillin causes the bacteria to switch off its toxin genes and thicken its cell wall.
The body's own immune system and other antibiotics can then exploit this state of change to kill off the infection.

MRSA can be extremely virulent

A recent report from the UK government found that antimicrobial resistance infections, will cause more deaths than cancer by 2050 if not addressed urgently.
Caused by a form of the staphylococcal bacteria, MRSA is resistant to most antibiotics used to treat ordinary infections, and up to a fifth of patients who contract it die from the infection.
The research was funded by the Health Research Board and Medical Research Council.
"Our findings explain the anti-virulence mechanism of penicillin-type antibiotics and support the re-introduction of these drugs as an adjunct therapeutic for MRSA infections.
"MRSA can be extremely virulent, which is part of the challenge in treating it," said Professor James O'Gara from NUI Galway.

Antbiotics - Increased Resistance

Every year, at least 700,000 people die from drug-resistant infections. It is why government scientists have described antibiotic resistance as one of the greatest global threats of the 21st Century.
So what are people doing to try to avert the so-called antibiotics apocalypse? Well, it turns out, quite a lot.

First, there are those who are trying to get us to take fewer antibiotics. That is because the more antibiotics we all take, the more resistant bacteria become.
Jason Doctor, a psychologist at the University of Southern California, has been carrying out experiments to see whether it is possible to get doctors to prescribe fewer pills.
He persuaded more than 200 doctors to sign a letter to their patients, making a commitment to prescribe antibiotics more judiciously. They blew it up into the size of a poster and put it on the walls of their health clinics.

Then they experimented with a ranking system, sending doctors a monthly email telling them how many antibiotics they were prescribing inappropriately compared to their peers.
They set up alerts on doctors' computers, prompting them to question whether they really needed to prescribe antibiotics and they also found ways that doctors could appease persistent patients who demanded the medication.

When they tried all these different approaches together, it dramatically reduced the number of antibiotic prescriptions issued.
Some of these changes are now being implemented across the US and in other countries, but even if people were only given antibiotics when they really needed them, that would not solve the problem. Because while humans are a big market for antibiotics, there is an even bigger one.
In 1950, a chance discovery in a laboratory showed that antibiotics make animals grow faster. Since then, farmers all over the world have pumped them into their animals, even after scientific studies proved that bacterial resistance could pass from animals to humans.



But one country has shown that farmers who were once dependent on antibiotics can wean themselves and their animals off them.

The Netherlands has more animals per square metre than any other country on the planet and for years, those animals were routinely fed antibiotics. A ban on giving growth-promoting antibiotics to their animals had little effect as farmers used the same amount and just labelled them differently.
But after a series of health scares, the government decided to crack down. In 2009, farmers were told they had to reduce the amount of antibiotics they were giving their animals by 20% in two years and 50% in five.

Dik Mevius is an infectious disease specialist and vet who helped farmers draw up a plan to meet those targets.
They set up a database, revealing which farmers were the worst offenders, and stopped farmers from shopping round for antibiotics from different vets. Any vets or farmers who prescribed or used antibiotics unnecessarily were fined or lost their accreditation.
And, surprisingly, Dutch farmers got on board. They stopped using so many antibiotics, which, for many of them, meant they had to change the way they reared their animals.
"It really was a revolution," says Mr Mevius. "We reduced the amount of antibiotics used by 60% in just a couple of years."
But most countries are going in the opposite direction. It is thought that China, Brazil, Russia, India and South Africa will all double their use of antibiotics by 2030, and so resistance will spread. That is why some scientists are scouring the world, looking in the oceans, rainforests and deserts for new sources of antibiotics.

Alarm Raised at Resistant Infection!

US health officials have reported the first case in the country of a patient with an infection resistant to all known antibiotics, and expressed grave concern that the superbug could pose serious danger for routine infections, if it spreads.
"We risk being in a post-antibiotic world," said Thomas Frieden, director of the US Centers for Disease Control and Prevention, referring to the urinary tract infection of a 49-year-old Pennsylvania woman who had not travelled within the prior five months.

The superbug reportedly contains a gene called mcr-1 that confers resistance to colistin

Mr. Frieden, speaking at a National Press Club lunch in Washington, DC, said the infection was not controlled even by colistin, an antibiotic that is reserved for use against "nightmare bacteria."
The infection was reported yesterday in a study appearing in Antimicrobial Agents and Chemotherapy, a publication of the American Society for Microbiology.
It said the superbug itself had first been infected with a tiny piece of DNA called a plasmid, which passed along a gene called mcr-1 that confers resistance to colistin.
"(This) heralds the emergence of truly pan-drug resistant bacteria," said the study, which was conducted by the Walter Reed National Military Medical Center. "To the best of our knowledge, this is the first report of mcr-1 in the USA."
The patient visited a clinic on 26 April 2016 with symptoms of a urinary tract infection, according to the study, which did not describe her current condition.
Authors of the study could not immediately be reached for comment.
The study said continued surveillance to determine the true frequency of the gene in the United States is critical.
"It is dangerous and we would assume it can be spread quickly, even in a hospital environment if it is not well contained," said Dr. Gail Cassell, a microbiologist and senior lecturer at Harvard Medical School.
But she said the potential speed of its spread will not be known until more is learned about how the Pennsylvania patient was infected, and how present the colistin-resistant superbug is in the United States and globally.
In the United States, antibiotic resistance has been blamed for at least 2 million illnesses and 23,000 deaths annually.
The mcr-1 gene was found last year in people and pigs in China, raising alarm.
The potential for the superbug to spread from animals to people is a major concern, Dr. Cassell said.
For now, Dr. Cassell said people can best protect themselves from it and from other bacteria resistant to antibiotics by thoroughly washing their hands, washing fruits and vegetables thoroughly and preparing foods appropriately.
Experts have warned since the 1990s that especially bad superbugs could be on the horizon, but few drug makers have attempted to develop drugs against them.

New Study On Antibiotic Prescribing and Consumption for Urinary Tract Infections

NUI Galway researchers study the culture of antibiotic prescribing and consumption for Urinary Tract Infections and find the need for more dialogue among GPs and Patients

Researchers from NUI Galway’s School of Medicine have carried out a study to explore the culture of antibiotic prescribing and consumption in the community for Urinary Tract Infections (UTIs), from the perspective of the General Practitioners (GPs) and community members. Their results were published in the medical journal BMJ Open.

This research provides insight into the decision-making processes contributing to the continued prescription and consumption of antibiotics for Urinary Tract Infections. An antibiotic is not a satisfactory outcome from every UTI GP consultation.

As a result of this qualitative research, behavioural interventions should focus on:

• Improving the quality of antibiotic prescribing for UTI by encouraging GPs to reflect on their current antibiotic-prescribing practices, including when they prescribe and what antibiotics they choose.
• Supporting a dialogue between the GP and the patient within the consultation about the positive and negative aspects of antibiotic treatment for UTI particularly when symptoms are non-specific.
• Building changes into routine care without elongating the consultation.

As part of the study the NUI Galway researchers carried out in depth interviews with 15 GPs practicing in rural and urban locations in Ireland, and six focus groups were held with community members who had direct or indirect experiences with urinary tract infection.

The study found that decisions made to prescribe or consume an antibiotic for a UTI is a set of complex processes. It includes recognising that you are unwell (need recognition), seeking advice from various sources like the web and family members prior to visiting the GP (information search), and deciding whether to go to the GP (evaluation process). All of these processes are governed by the relationship and interactions between the GP and the patient.

To view the full BMJ Open paper visit:http://bmjopen.bmj.com/content/6/1/e008894.full.pdf+html 

'Game-changing' antibiotic find

The decades-long drought in antibiotic discovery could be over after a breakthrough by US scientists.

Their novel method for growing bacteria has yielded 25 new antibiotics, with one deemed "very promising".

The last new class of antibiotics to make it to clinic was discovered nearly three decades ago.

The study, in the journal Nature, has been described as a "game-changer" and experts believe the antibiotic haul is just the "tip of the iceberg".

The heyday of antibiotic discovery was in the 1950s and 1960s, but nothing found since 1987 has made it into doctor's hands.

Since then microbes have become incredibly resistant. Extensively drug-resistant tuberculosis ignores nearly everything medicine can throw at it.

Back to soil

The researchers, at the Northeastern University in Boston, Massachusetts, turned to the source of nearly all antibiotics - soil.

This is teeming with microbes, but only 1% can be grown in the laboratory.

The team created a "subterranean hotel" for bacteria. One bacterium was placed in each "room" and the whole device was buried in soil.

It allowed the unique chemistry of soil to permeate the room, but kept the bacteria in place for study.

View Article:  A new antibiotic kills pathogens without detectable resistance, 

View link to BBC/News for more information

Patient Safety and Antibiotics - Advice

The Health Service Executive is warning that new bugs are emerging that are multi-resistant. People are being advised to avoid taking antibiotics for a flu or cold, as the HSE says they will get better.
A new website called undertheweather.ie has been set up to give advice on how to treat viral infections.

People are being advised to avoid taking antibiotics for a flu or cold

The HSE says rest, fluid and paracetamol is all people need to get over many of these illnesses.
Dr Philip Crowley, HSE National Director for Quality and Patient Safety, said: "Undertheweather.ie is part of our on-going work to tackle the global threat of overuse of antibiotics, and the fact that antibiotics are becoming less and less effective.

"The common conditions included in the site are almost always caused by a virus, so an antibiotic is useless in dealing with these illnesses, Mr. Crowley said.
"We want to support people to know what to do when they are unwell, and when to get advice from a health professional, but also that antibiotics are almost never the answer when it comes to these common complaints," he added.

www.undertheweather.ie

Queen's University scientists develop new gel to fight superbugs

Researchers at Queen’s University Belfast have synthesised a new hydrogel capable of destroying some of the most potent hospital superbugs.

“Superbugs” is the common name given to bacteria that can resist the action of several antibiotics. “They can attach themselves to medical instruments and implants by growing a biofilm. This is a jelly-like coating which protects them from the action of antibiotics,”explained Dr Garry Laverty, a lecturer in Pharmaceutical Sciences at Queen’sUniversity.

Together with colleagues at Queen’s and Brandeis University (US), he has designed a new type of hydrogel that can kill rapidly common superbugs such as E. Coli, Staphylococcus and Pseudomonas aeruginosa.

Dr Laverty pointed out the gel “is made from peptides, the natural building blocks of proteins. These molecules are smaller than the protective biofilm of the superbugs, and are inherently anti-microbial.”

By breaking down the coating, they are able to kill the bacteria selectively, leaving healthy cells unaffected, he said.

The results of the study are published next month in the journal Biomacromolecules.

Four babies died from pseudomonas at two Northern Ireland hospitals between December 2011 and January 2012.

View full Press release here

Resistance to Antibiotics - WHO

Antibiotic resistance now 'global threat', WHO warns

Resistance to antibiotics poses a "major global threat" to public health, says a new report by the World Health Organization (WHO).

It analysed data from 114 countries and said resistance was happening now "in every region of the world". It described a "post-antibiotic era", where people die from simple infections that have been treatable for decades.There were likely to be "devastating" implications unless "significant" action was taken urgently, it added.

The report focused on seven different bacteria responsible for common serious diseases such as pneumonia, diarrhoea and blood infections. It suggested two key antibiotics no longer work in more than half of people being treated in some countries.

"What we urgently need is a solid global plan of action which provides for the rational use of antibiotics” - Dr Jennifer Cohn Medecins sans Frontiers.  One of them - carbapenem - is a so-called "last-resort" drug used to treat people with life-threatening infections such as pneumonia, bloodstream infections, and infections in newborns, caused by the bacteria K.pneumoniae.

Bacteria naturally mutate to eventually become immune to antibiotics, but the misuse of these drugs - such as doctors over-prescribing them and patients failing to finish courses - means it is happening much faster than expected.

The WHO says more new antibiotics need to be developed, while governments and individuals should take steps to slow this process.

In its report, it said resistance to antibiotics for E.coli urinary tract infections had increased from "virtually zero" in the 1980s to being ineffective in more than half of cases today.
In some countries, it said, resistance to antibiotics used to treat the bacteria "would not work in more than half of people treated".

Dr Keiji Fukuda, assistant director-general at WHO, said: "Without urgent, coordinated action by many stakeholders, the world is headed for a post-antibiotic era, in which common infections and minor injuries which have been treatable for decades can once again kill."

The report also found last-resort treatment for gonorrhoea, a sexually-transmitted infection which can cause infertility, had "failed" in the UK.  It was the same in Austria, Australia, Canada, France, Japan, Norway, South Africa, Slovenia and Sweden, it said.

Dr Jennifer Cohn, medical director of Medecins sans Frontiers' Access Campaign, said: "We see horrendous rates of antibiotic resistance wherever we look in our field operations, including children admitted to nutritional centres in Niger, and people in our surgical and trauma units in Syria.

"Ultimately, WHO's report should be a wake-up call to governments to introduce incentives for industry to develop new, affordable antibiotics that do not rely patents and high prices and are adapted to the needs of developing countries."

She added: "What we urgently need is a solid global plan of action which provides for the rational use of antibiotics so quality-assured antibiotics reach those who need them, but are not overused or priced beyond reach."

View here in BBC/News/Health

'Golden age' of antibiotics 'set to end'

Far fewer pharmaceutical companies are working on new antibiotics than in the past.  Prof Jeremy Farrar, the new head of Britain's biggest medical research charity the Wellcome Trust said it was a "truly global issue".

Prof Farrar said that the golden age of antibiotics could come to an end unless action is taken.
Previous chief medical officers have also warned about the threat from pathogens - bacteria, viruses and parasites.

Multi-drug resistant (MDR) tuberculosis is rising steadily worldwide.  Doctors in London have reported a sharp rise in cases of MDR TB, which can take two years to treat successfully.  Another example is the rise in infections from enterobacteriaceae - bugs that live in the gut like E. coli and Klebsiella.  They are not the commonest cause of hospital acquired infection and some are becoming resistant to carbapenems, a powerful last resort group of antibiotics.

Prof Farrar said we could have used our antibiotics better and we should have invested more in research on infectious diseases.

He said there are just four pharmaceutical companies working on antibiotics now compared to 20 years ago.

And Prof Farrar called for industry to be given incentives to work on antibiotics and greater restrictions placed on access to these medicines

Read full article here on BBC News