Antibiotic Resistance
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1 Preparing for the Battle Antibiotic Resistance Joy Jiao Systems Biology, Harvard University
2 World Health Organization Global Report on Antibiotic Resistance, 01: resistance to common bacteria has reached alarming levels few, if any, of the available treatments options remain effective for common infections
3 Battle Plan 1 Understand the enemy Attack and counterattack Intelligence from the frontlines Join the fight
4 Battle Plan Understand the enemy Meet your microbes Attack and counterattack Intelligence from the frontlines Join the fight
5 Bacteria are very small
6 They outnumber us 1 >10:1 on our bodies 1. Berg, R. Trends in Microbiology, 1996
7 1 They can be helpful S. epidermidis inhibits S. aureus 1 colonization Skin Cells Iwase et al, Nature 010
8 1 They can be helpful Bacteria in the large intestine help us digest food, and produce useful compounds such as vitamins Intestinal Cell
9 1 They can be helpful Bacteria in the gut are important for training the immune system Immune Cell
10 1 1 Not all bacteria are good CLOSTRIDIUM DIFFICILE 50,000 Infections/ year ENTEROBACTERIACEAE 9,000 Infections/year Graphics and data adapted from CDC Report on Antibiotic Resistance, 01 NEISSERIA GONORRHOEAE 6,000 Infections/year
11 Not all bacteria are good 1 Each year, antibiotic resistant microbes cause at least,09, illnesses,000 deaths Graphics and data adapted from CDC Report on Antibiotic Resistance, 01
12 Battle Plan 1 Understanding the enemy Attack and counterattack History of antibiotics How antibiotics work What causes antibiotic resistance? Intelligence from the frontlines Join the fight
13 1 Antibiotics revolutionized medicine Photo: Plate image adapted from: Alexander Flemming discovered Penicillin in 198
14 Antibiotics target critical processes in the cell
15 Antibiotics target critical processes in the cell DNA Replication Fluoroquinolones Adapted from
16 Antibiotics target critical processes in the cell Rifamycin RNA Transcription Adapted from
17 Antibiotics target critical processes in the cell Tetracycline Protein Synthesis Adapted from
18 Antibiotics target critical processes in the cell Penicillin Cell Wall Synthesis Adapted from
19
20 Our antibiotics are losing effectiveness against Neisseria Gonorrhoeae CDC Report on antibiotic resistance, 01
21 How did this happen? Adapted from Clatworthy et al, Nature ChemBio, 007
22 How did this happen? EVOLUTION Adapted from Clatworthy et al, Nature ChemBio, 007
23 Replication errors create diversity within a population
24 Replication errors create diversity within a population Resistant mutant
25 1 Bacteria share genes via horizontal gene transfer Many important genes for antibiotic resistance can be found on PLASMIDS mobile DNA elements that can easily jump between species
26 Antibiotics kill off the sensitive cells, allowing resistant cells to take over Initial sensitive population with rare resistant cell
27 Antibiotics kill off the sensitive cells, allowing resistant cells to take over Initial sensitive population with rare resistant cell Antibiotics kill sensitive cells, but not resistant cells
28 Antibiotics kill off the sensitive cells, allowing resistant cells to take over Initial sensitive population with rare resistant cell Antibiotics kill sensitive cells, but not resistant cells Resistant cells take over the population
29 Questions? CDC Report on antibiotic resistance, 01
30 Battle Plan 1 Understanding the enemy Attack and counterattack Intelligence from the frontlines Better Stewardship New antibiotics Diagnostics Join the fight
31 Conserve what we have left: better Stewardship ~90% of antibiotics used in the US are for agricultural production 1 Antibiotics used as growth promoters in livestock production: Bambermycin Lasalocid Monensin Salinomycin Virginiamycin Bacitracin 1. Union of Concerned Scientists Reinhardt, Merck Veterinary Manual, 01
32 Conserve what we have left: better Stewardship Antibiotic use in agriculture has been shown to generate resistant bacteria which can then spread to humans In 01, the FDA imposed voluntary guidelines for phasing out certain antibiotics in livestock feed Wegener, Curr Opinion in Microbiol. 00 Knox, npr.org, 01 Carlet, Antimicrobial Resistance and Infectino Control, 01
33 Conserve what we have left: better Stewardship As much as 50% of antibiotics prescriptions are unnecessary or misused Hospitals are working to: Make sure to culture bacteria for identification before starting antibiotic treatment Give clear dosage and duration instructions Reassess effectiveness in - days CDC Report on antibiotic resistance, 01
34 Battle Plan 1 Understanding the enemy Attack and counterattack Intelligence from the frontlines Better Stewardship New antibiotics Diagnostics Join the fight
35 We are discovering fewer and fewer antibiotics Graphics and data adapted from CDC Report on Antibiotic Resistance, 01
36 Sorting through dirt for new antibiotics Through millenia of microbial warfare, soil bacteria have developed the majority of antibiotics Many microbes need support from the soil community to grow and are difficult to grow in the laboratory The ichip, introduced in 010, can grow previously uncultured bacteria Teixobactin, 015 Nichols et al, ACM, 010 Ling et al, Nature, 015
37 1 New diagnostics for fast detection Many pathogens grow very slowly in the lab Knowing what antibiotics they are resistant to is time-sensitive Don t waste time using the wrong antibiotics Don t allow further resistance to develop New methods for fast diagnosis based on detection of microbial DNA can significantly speed up this process
38 Battle Plan 1 Understanding the enemy Attack and counterattack Intelligence from the frontlines Join the fight
39 The CDC recommends: Tactic #1 Prevent infections by practicing good hand hygiene
40 The CDC recommends: Tactic # DO NOT ask for antibiotics when your doctor thinks you do not need them (ex. viral infections)
41 Antibiotics cannot kill viruses Bacteria: complex cell with DNA replication, transcription, translation Virus: a packet of DNA
42 The CDC recommends: Tactic # Always use antibiotics for full duration prescribed
43 What doesn t kill you makes you more resistant Initial sensitive population with rare resistant cell
44 What doesn t kill you makes you more resistant Initial sensitive population with rare resistant cell Antibiotics kill sensitive cells quickly, and slightly resistant cells slowly. Therapy eventually eradicates all cells.
45 What doesn t kill you makes you more resistant Premature end of antibiotics therapy allow slightly resistant cells to take over, and possibly gain increased resistance Initial sensitive population with rare resistant cell
46 Battle Plan 1 Understand the enemy Attack and counterattack Intelligence from the frontlines Join the fight 90% 50% Livestock Incorrect 1. DO Wash your hands. DON T take antibiotics for viral infections. DON T skip prescribed antibiotics
47 Thank you! SITN would like to acknowledge the following organizations for their generous support of this event.
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