Bacteria

Recent FDA rulings prompt important questions

About a month ago, the Food and Drug Administration (FDA) ruled that antibiotics should not be used in livestock for the purpose of promoting growth. As with most FDA rulings, they do not garner a lot of weight as their decisions are non-binding. In a surprise however, many livestock farmers who were polled about the ruling have stated that they would comply with the ruling. For years, we have seen the outcome of use of antibiotics in livestock as the numbers of antibiotic resistant bacteria types and associated infections rise. Now that the FDA has taken this intervening step, we now have to consider finding a balance in this process. Antibiotics still have a place in the raising of livestock as a means to insure that one sick animal does not infect an entire herd. As a preemptive action, antibiotics should still be used and used judiciously to reduce the potentially devastating economic effects of the loss of livestock due to illness.

A few days after the antibiotics ruling, the FDA also asked manufacturers of antibacterial products to conduct additional research to prove that an active ingredient, triclosan is safe for long-term use. Triclosan has been shown in lab testing to have deleterious effects, especially on children. In lab rats, triclosan has been shown to decrease thyroid hormone, affect metabolism and reproduction. These companies have to prove that triclosan, in it’s current formulation will not have these long term effects or will, if not shown have to reformulate their products without triclosan. It is interesting to note, the FDA first ruled on the use of triclosan in 1978, when it was in limited use. As the use of this chemical has expanded. the FDA felt it was in the interest of consumers to call for this review in advance of a potential new ruling on triclosan’s use in 2016.

FDA rulings have very little teeth as far as compliance and enforcement are concerned. I have been saying for a few years now that the role of the FDA needs to be drastically changed in order to better serve the needs of consumers and to insure that rulings truly have the force of law behind them. Without any major changes on the horizon, it will appear that the only way that proper regulation is in place will be via the legislative branch through the passing of new laws that will reduce antibiotic use and if triclosan is shown to be problematic in long-term use, that the chemical be regulated more closely or outright banned for use. Before that, we need to have alternatives, safe alternatives to triclosan so that our antimicrobial products still have usefulness in this era of unprecedented antimicrobial resistance.

Additional reading: FDA antimicrobial resistance strategy
Press release on safety of antimicrobial soaps

Media Misfire on Bacteria in Water Fountains

Part of teaching microbiology to my students who look to become the health care practitioners of tomorrow is also educating the public at large about the risk of microbes. I take this very seriously and I read as much of the latest research as possible in order to do this. Even a short presentation to an academic audience requires a lot of preparation to provide as much useful and timely information as possible. I am a bit distressed however when I see news reports that distort or twist information in such a way that could cause panic among the general population. Case in point, I was watching the Fox DC morning news yesterday morning when a report came on about drinking fountains and bacteria. As I watched this report, there were some points discussed that I took major issue with. In summation, the research took place in Tampa, Fla along the Pinellas Trail where water fountains are placed for those that traverse the area. Of the ten tested water fountains, water from three contained bacteria commonly found on toilets, cell phones and purse bottoms.  First, the sample size of ten cannot be applied to the population of water fountains as a whole. This research (as first reported by the The Suncoast News) states that the Pinellas trail water fountains and others in various sites around the area were being tested for harmful bacteria and to alert county officials of any findings. At no point in this article were any of the researchers making any claims that these findings could be common nationwide. So why was this report delivered in such a way that these and other facts listed in the article were not discussed?

Watch the report:
http://www.myfoxdc.com/videoautoStart=true&topVideoCatNo=default&clipId=9049990

Many factors were ignored in this report in addition to the small sample size. The environment where the water fountains are and the activities that occur at these water fountains. Researchers observed walkers allowing dogs to drink directly from the fountain, so that could account for this area but not all water fountains have this source of bacteria as a problem. Also, if the infrastructure providing the water is intact, how much of a role could the animals in this environment contribute to the increased bacterial numbers? Fox DC in my opinion could create a mini stir among the general population with this report by nit-picking out the major details and focusing on the pieces that made this a “story.” When talking to an audience that wants news and needs to hear as much as the facts as possible, this story does a disservice to all. Explaining scientific concepts or more importantly public health interest research requires that ALL of the facts be laid out and explained in a way that minimizes fear and panic and places emphasis on informing and offering common sense solutions as the research can support. This was a very disappointing job of presenting interesting information for the sake of ratings and sensationalism.

Medical Travel and Disease

The New York Times reports this week that a new mutation has emerged which makes bacteria resistant to all antibiotics. The mutation has been discovered in India and Pakistan and is reported to be found in patients from the UK and the US who travel to this region to receive medical treatment. The mutation labeled NDM-1 according to the article has microbiologists and physicians worried that this could be the mother of all mutations. However, it is too early to tell if this is the case. How does a mutation come about and why is this mutation of concern?

Bacterial cells reproduce via cell division. A single bacterial cell creates a carbon of itself in multiplicative fashion. If a bacteria has basic characteristics (whether it causes disease or not), it will pass on those characteristics to it’s carbon copy. Bacterial cells obtain additional characteristics, such as antibiotic resistance through the uptake of a plasmid. A plasmid is a smaller, circular form of DNA which can give bacterial cells a variety of new characteristics and codes for ways by which the new characteristics can be expressed. Antibacterial resistance can be coded in bacteria in ways such as giving the bacteria the ability to synthesize enzymes to affect the antibiotics action or the bacteria can create structures called porins which shuffle antibiotics out of the cell. Plasmids, like the DNA that is innately in the bacterial cell is constantly undergoing evolutionary change and new characteristics can be created.

In a previous post, I discussed factors which have increased the spread of disease globally. Travel across the globe is one of the major ways by which disease can be introduced into susceptible populations. Medical travel to obtain treatments for a variety of aliments has been ongoing for many years. In this day and age, more and more people have used medical travel in the wake of loss of insurance, being denied claims or lower cost for certain medical treatments. Travelers returning from the India/Pakistan region to their home countries potentially could harbor this resistant bacteria. Only then and with time will we know if this is the super resistant bacteria that we have been fearing it’s arrival.

Bacteria: Friend, Foe or all of the above?

Remember the episode of the Cosby Show, when Rudy catches a cold and Cliff has to take care of her? Cliff’s characterization of what made Rudy sick is probably a common experience and is most likely the first lesson we received about “germs” and their effects. Bacteria have and continue to get a bad rap as only a cause of disease. But did you know that bacteria have positive effects on the lives of humans and other higher organisms? I always begin my beneficial effects of bacteria lecture by posing that question to my students. The most common reaction to my question is disbelief, as if I had just shattered everything they ever learned. The look on their faces says it all: “Bacteria can be useful?” And I commence to explain how this is possible. I think that the reaction that I receive on a consistent basis from students and even from the public at large, that bacteria are all bad, period. I am not saying that the perception is all wrong but the majority of people have it half right and only focus on the ill-effects of bacteria. What are the benefits of bacteria and how do these benefits impact human life?

The relationship between humans and bacteria when beneficial is characterized as commensal or a relationship where neither human nor bacteria is harmed. Bacteria found in and on humans grow and survive with no problems and begin to engage in biological activities which assist human life. One of the most important activities bacteria engage in is protection and immunity from disease. Human skin is the largest and most important body organ. Skin protects muscle, bone and tissue from damage due to everyday movement, sunlight and disease. In addition to the oils naturally secreted by the skin and sweat which contains an enzyme that assists in killing pathogenic or disease causing bacteria, bacterial cells occupy the skin in large numbers. Although bacteria have no problem growing and surviving on the skin, skin is a very poor growth medium because it has a very low pH and is very dry. A large number of bacterial species occupy the skin and maintain a protective barrier against disease causing bacteria. This is only the first line of defense, a disease causing bacteria that enters the skin will trigger an immune reaction which begins a vigorous, second line of defense in fighting off a potential infection.

The human digestive system also benefits greatly from the activity of bacteria. When food is taken in and digested, only a certain amount of nutrients can be taken up from the food by the body. The body needs and requires a number of vitamins, minerals, proteins and carbohydrates in order to maintain function and growth. Many of these are available in food directly while others are available but are not able to be used unless they are converted into another form. Bacteria act as the means by which some of these “hidden” nutrients and vitamins are extracted and put into use by the body. Think of bacteria as “factories” which help to break down food, take in the vitamins and nutrients in their inactive form and convert them to the active form that can be taken in and used by humans.

Within the last 15-20 years, there has been a steady increase in the availability of probiotics, supplements of bacterial cultures that when used properly can provide health benefits. Probiotics are not new as they were first identified in the early 20th Century as a method to assist in maintainance of balance between beneficial and harmful bacteria. Further research has shown that probiotics can also help with digestive ailments such as Irritable Bowel Syndrome (IBS), Diarrhea and reduce the chances of ulcers caused by a bacteria named Helicobacter pylori (H. pylori). Research into the use of probiotics have been very positive. Many people benefit greatly from their use. There are issues of safety which have not been fully studied and mild side effects do occur such as gas, bloating or a mild bacterial infection. Probiotics and their use illustrate the point very effectively that maintaining a balance in the normal types of bacteria that live in the digestive system with those that could cause harm is a very important function. When harmful bacteria are not kept in check by equally beneficial bacteria, the effects on human life could potentially be fatal.

Bacterial flora balance can increase or decrease due to many factors. Health is a major factor and can change as one becomes older and disease becomes prevalent. If antibiotics are needed, the proper use of antibiotics is key. If antibiotics are used when they are not needed, bacteria could become resistant and harder to treat. Antibiotic resistance is fast becoming a major problem worldwide due to the misuse of antibiotics when they are not needed or having an antibiotic prescribed when a viral infection is diagnosed. Bacteria and viruses are two completely different life forms which require different types of drugs in order to attack and kill them. Antibiotics will not attack viruses but instead will attack the bacteria that is it specified to kill and leave an unbalanced bacterial flora which could cause disease. Other factors include diet, hormonal state and even personal hygiene. Finally, genetic factors can have an effect on the rise and fall of bacterial levels.

Life in general is based on very fine balance in many respects from bacterial levels, to pH (Acid-Base balance). As illustrated in this article, having the right balance of beneficial bacteria has a major role in assisting us in maintaining our health. Bacteria are versatile organisms that reproduce quickly, adapt and evolve far faster than most other living species on earth. We benefit from that versatility when it comes to the role that bacteria play in our body’s defense and digestion. Unfortunately we succumb to that same versatility when we are infected by bacteria. So now, think of bacteria as a frienemy, it can be good at times or it can be bad.

Reference:

An Introduction to Probiotics. National Center for Complementary and Alternative Medicine. Website accessed August 30, 2009.