What is an Example of Patients Needing to be Isolated?
Methicillin-resistant Staphylococcus aureus (MRSA) diagnosis is an indication for Centers for Disease Control and Prevention (CDC)-recommended isolation. This is because MRSA tends to hang out on skin. If you handle a MRSA-positive patient, then your skin can be colonized and potentially transmitted to the next patient.
In addition, we found similar results with vancomycin-resistant gonococcus.
We performed mock physical exams on patients and analyzed what was transferred to the gloves and gowns. We found that two thirds of the time you could transfer organisms picked up on the gloves and gowns to an agar plate. Conversely, we found that using an alcohol cleanser eliminated the transfer of organisms from the patient to the gloves and gowns entirely.
What About the Current State and Trajectory of Multidrug-Resistant (MDR) Bacteria?
Fortunately, there are relatively low numbers of MDR bacteria in the United States, but the current data indicate that there has been some increase, particularly in gram-negative bacteria. One piece of good news is that MRSA rates have actually gone down. In hospital settings, we attribute this to more stronger focus on hand hygiene.
Are You Thinking About Microbiome Approaches to These Problems?
No, we are not really looking at this in the laboratory, but we do have a program for fecal transplants at the hospital and it does work. The real frontier in this field will be to the figure out the minimal cocktail of bugs needed so we will no longer need to do a fecal transfer; however, currently the big concern is to figure out if there is something out there that a donor has in his or her system that they could pass on to the patient. While they do screen donors, there is still a concern for adverse events. There is also some interesting suggestive data from animal models, which will be published, showing that fecal transplants in these models reduced antibiotic bacteria. Therefore, perhaps someday similar approaches can be used in the clinic. This supports the notion the perhaps some day we will be able to use microbiome based therapies to address issues of antibiotic resistance through competition.
It Seems Like the Whole Idea of Changing the Bacterial Ecosystem, Instead of Focusing on an Enzyme is Such a New Idea Historically Speaking. What Are Your Thoughts?
Yes, it is at such a new stage where we know so little that the theoretical potential is not yet limited by our experiential knowledge yet. And so, there is great excitement, but I am sure that there are some things that will not pan out. We just need to figure out the key components that drive dysbiosis.
Feature Image Source: Harvard Public Affairs & Communications [Stephanie Mitchell/Harvard Staff Photographer]
W. Todd Penberthy, PhD is a medical writer with over 4 years of experience based in Orlando, Florida. Prior to that Todd was a professor directing biomedical research using zebrafish models of human disease with expertise in orthomolecular niacin-related science for 10 years.
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