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Clinical Laboratories and Pathology Groups

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Clinical Laboratories and Pathology Groups

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Researchers Find That Antibiotic-Resistant Bacteria Can Persist in the Body for Years

Study results from Switzerland come as clinical laboratory scientists seek new ways to tackle the problem of antimicrobial resistance in hospitals

Microbiologists and clinical laboratory scientists engaged in the fight against antibiotic-resistant (aka, antimicrobial resistant) bacteria will be interested in a recent study conducted at the University of Basel and University Hospital Basel in Switzerland. The epidemiologists involved in the study discovered that some of these so-called “superbugs” can remain in the body for as long as nine years continuing to infect the host and others.

The researchers wanted to see how two species of drug-resistant bacteria—K. pneumoniae and E. coli—changed over time in the body, according to a press release from the university. They analyzed samples of the bacteria collected from patients who were admitted to the hospital over a 10-year period, focusing on older individuals with pre-existing conditions. They found that K. pneumoniae persisted for up to 4.5 years (1,704 days) and E. coli persisted for up to nine years (3,376 days).

“These patients not only repeatedly become ill themselves, but they also act as a source of infection for other people—a reservoir for these pathogens,” said Lisandra Aguilar-Bultet, PhD, the study’s lead author, in the press release.

“This is crucial information for choosing a treatment,” explained Sarah Tschudin Sutter, MD, Head of the Division of Infectious Diseases and Hospital Epidemiology, and of the Division of Hospital Epidemiology, who specializes in hospital-acquired infections and drug-resistant pathogens. Sutter led the Basel University study.

The researchers published their findings in the journal Nature Communications titled, “Within-Host Genetic Diversity of Extended-Spectrum Beta-Lactamase-Producing Enterobacterales in Long-Term Colonized Patients.”

“The issue is that when patients have infections with these drug-resistant bacteria, they can still carry that organism in or on their bodies even after treatment,” said epidemiologist Maroya Spalding Walters, MD (above), who leads the Antimicrobial Resistance Team in the Division of Healthcare Quality Promotion at the federal Centers for Disease Control and Prevention (CDC). “They don’t show any signs or symptoms of illness, but they can get infections again, and they can also transmit the bacteria to other people.” Clinical laboratories working with microbiologists on antibiotic resistance will want to follow the research conducted into these deadly pathogens. (Photo copyright: Centers for Disease Control and Prevention.)

COVID-19 Pandemic Increased Antibiotic Resistance

The Basel researchers looked at 76 K. pneumoniae isolates recovered from 19 patients and 284 E. coli isolates taken from 61 patients, all between 2008 and 2018. The study was limited to patients in which the bacterial strains were detected from at least two consecutive screenings on admission to the hospital.

“DNA analysis indicates that the bacteria initially adapt quite quickly to the conditions in the colonized parts of the body, but undergo few genetic changes thereafter,” the Basel University press release states.

The researchers also discovered that some of the samples, including those from different species, had identical mechanisms of drug resistance, suggesting that the bacteria transmitted mobile genetic elements such as plasmids to each other.

One limitation of the study, the authors acknowledged, was that they could not assess the patients’ exposure to antibiotics.

Meanwhile, recent data from the World Health Organization (WHO) suggests that the COVID-19 pandemic might have exacerbated the challenges of antibiotic resistance. Even though COVID-19 is a viral infection, WHO scientists found that high percentages of patients hospitalized with the disease between 2020 and 2023 received antibiotics.

“While only 8% of hospitalized patients with COVID-19 had bacterial co-infections requiring antibiotics, three out of four or some 75% of patients have been treated with antibiotics ‘just in case’ they help,” the WHO stated in a press release.

WHO uses an antibiotic categorization system known as AWaRe (Access, Watch, Reserve) to classify antibiotics based on risk of resistance. The most frequently prescribed antibiotics were in the “Watch” group, indicating that they are “more prone to be a target of antibiotic resistance and thus prioritized as targets of stewardship programs and monitoring.”

“When a patient requires antibiotics, the benefits often outweigh the risks associated with side effects or antibiotic resistance,” said Silvia Bertagnolio, MD, Unit Head in the Antimicrobial resistance (AMR) Division at the WHO in the press release. “However, when they are unnecessary, they offer no benefit while posing risks, and their use contributes to the emergence and spread of antimicrobial resistance.”

Citing research from the National Institutes of Health (NIH), NPR reported that in the US, hospital-acquired antibiotic-resistant infections increased 32% during the pandemic compared with data from just before the outbreak.

“While that number has dropped, it still hasn’t returned to pre-pandemic levels,” NPR noted.

Search for Better Antimicrobials

In “Drug-Resistant Bacteria Are Killing More and More Humans. We Need New Weapons,” Vox reported that scientists around the world are researching innovative ways to speed development of new antimicrobial treatments.

One such scientist is César de la Fuente, PhD, Presidential Assistant Professor at University of Pennsylvania, whose research team developed an artificial intelligence (AI) system that can look at molecules from the natural world and predict which ones have therapeutic potential.

The UPenn researchers have already developed an antimicrobial treatment derived from guava plants that has proved effective in mice, Vox reported. They’ve also trained an AI model to scan the proteomes of extinct organisms.

“The AI identified peptides from the woolly mammoth and the ancient sea cow, among other ancient animals, as promising candidates,” Vox noted. These, too, showed antimicrobial properties in tests on mice.

These findings can be used by clinical laboratories and microbiologists in their work with hospital infection control teams to better identify patients with antibiotic resistant strains of bacteria who, after discharge, may show up at the hospital months or years later.

—Stephen Beale

Related Information:

Resistant Bacteria Can Remain in The Body for Years

‘Superbugs’ Can Linger in the Body for Years, Potentially Spreading Antibiotic Resistance

Superbug Crisis Threatens to Kill 10 Million Per Year by 2050. Scientists May Have a Solution

Drug-Resistant Bacteria Are Killing More and More Humans. We Need New Weapons.

How the Pandemic Gave Power to Superbugs

WHO Reports Widespread Overuse of Antibiotics in Patients Hospitalized with COVID-19

Precision Healthcare Milestone Reached as Food and Drug Administration Clears New Multi-Marker Medical Laboratory Test to Detect Antibiotic-Resistant Bacteria

FDA issues press release following clearance of a clinical lab test to detect genetic markers that indicate the presence of Carbapenem-resistant Enterobacteriaceae

Clearance by the US Food and Drug Administration (FDA) of a new rapid, multi-marker genetic test designed to identify bacteria that are resistant to Carbapenem antibiotics was considered significant enough that the federal agency issued a press release announcing that the test was cleared and now available for use by physicians and clinical laboratories in the United States.

In the race to develop molecular assays and genetic tests for infectious disease that deliver improved sensitivity and specificity with a faster time-to-answer, this new test offers all three benefits. Results are available in just 48 minutes, for example.

It was on June 29, 2016, that the FDA cleared Cepheid’s Xpert Carba-R rapid-diagnostic test for marketing in the United States. This is the first clinical laboratory test cleared for market by the FDA that detects healthcare-associated infections (AKA, hospital-acquired infections or HAIs) through the use of genetic markers taken directly from clinical samples. The assay tests for genetic markers that indicate the presence of Carbapenem-resistant Enterobacteriaceae (CRE). (more…)

Researchers at Auburn University Collaborate with Clinical Laboratory Team at Keesler Air Force Base to Detect Antibiotic-resistant Bacteria in Just 10 Minutes

This technology could provide medical labs a quick, cost-effective way to diagnose methicillin-resistant Staphylococcus aureus

Even as in vitro diagnostics manufacturers are bringing rapid molecular tests to market that can identify infectious diseases within hours, a research collaboration involving a major university and a medical laboratory at an air force base has demonstrated the ability to identify antibiotic-resistant strains of Staphylococcus in just minutes.

This innovative research is being done by Auburn University’s College of Veterinary Medicine and clinical laboratory professionals at Keesler Air Force Base. Funding is by the U.S. Air Force. This research was of particular interest to the military because the risk for Staph infection increases when individuals are subjected to unhygienic conditions in close quarters. (more…)

Unexpected Discovery of Source of Lethal, Antibiotic-Resistant Strain of E. Coli Could Lead to New Medical Laboratory Tests and Preventative Treatment

Research breakthrough heralded as key insight that can lead to more accurate clinical laboratory tests and more effective antibiotics for treating E. Coli infections

Antibiotic-resistant strains of bacteria are one of healthcare’s biggest threats to patient safety and improved patient outcomes. Now advanced gene sequencing has given researchers a startling new understanding of how Escherichia coli (E. coli) has developed resistance to antibiotics.

This discovery may have a major impact on microbiology labs in hospitals, because they do so much of the medical laboratory testing to detect and identify infections. These new research findings also demonstrate to pathologists how quickly genome analysis can generate new knowledge about diseases and their causes. (more…)

New Tool for Fighting Antibiotic-Resistant Bacteria: Meet Bacteriophage

Microbiologists and hospital infection control teams are intensifying efforts to identify and control infections of antibiotic-resistant strains of bacteria. Now comes news of a new tool that can provide another way to control such infections.

Timothy Lu, a Harvard Medical School student and Massachusetts Institute of Technology Ph.D. recipient, has found a way to use bacteriophage-viruses that infect bacteria cells but not human ones-to boost the effectiveness of antibiotics. This development could prove instrumental to conquering the problem of antibiotic-resistant drugs, such as methacillin-resistant Staphylococus aureas, which causes 94,000 cases of life-threatening infections among hospital patients each year.

Lu has engineered bacteriophage to cut through biofilm-the slick, protective coating that covers bacteria-and to seek out the gene mutations that create antibiotic resistance. The bacteriophage then destroy the resistance mechanisms, enabling antibiotic drugs to perform better. The combination of engineered bacteriophage and antibiotics have the potential to eliminate nearly 30,000 times more bacteria than antibiotics alone.

Lu received the Lemelson-MIT Student Prize of $30,000 for inventing the bacteriophage platform. He is developing a secondary use of the platform that would allow bacteriophage to kill off deadly biofilms that attach themselves to food processing equipment and medical instruments.

The success of Lu’s invention could spell out a much better prognosis for patients who are discovered to have methacillin-resistant Staphylococus aureas (MRSA) based on confirmation by hospital-based laboratory tests. Laboratories always welcome medical advancements that make a positive result from a laboratory test less devastating/life-threatening to patients. Lu’s new technology may have applications in the treatment of numerous other superbugs and antibiotic-resistant bacteria strains.

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