Sludge Watch ==> Evolution at Work: Watching Bacteria Grow Drug Resistant

[Maureen Reilly]

Many sludge victims develop staph aureus infections . . . some have died . . 
. .

There has been much discussion in the press about hospital acquired 
antibiotic resistant infections. Increasingly hospitals are see patients 
with community acquired antibiotic resistant infections.
We need to look at how these infections are leaving the hospital.  That 
means we need to look at how infections sewage and effluent from hospitals 
are creating antibiotic resistant epidemics in communities.

Look at the use of sewage treatment plant effluent on parks, nursing homes, 
golf courses, hotel grounds, athletic playing fields.  These effluents carry 
antibiotic resistant bacteria...and we are spreading them around our 
communities.

Many hospitals routinely administer vancomycin before any operation just as 
a preventive measure.
That means we will soon be seeing more and more vancomycin resistant 
diseases in communities that recycle sewage effluent into the community.

It should be easy enough to conduct an experiment to look at outbreaks of 
community acquired antibiotic resistant disease and compare communities that 
do and don't use sewage effluent for park irrigation.

Sewage sludge spreading is another way to send these antibiotic resistant 
pathogens into the environment....on food chain lands.

Whatever are we thinking?

.................................


http://online.wsj.com/article_email/SB118125892494028425-lMyQjAxMDE3ODAxODIwNTg4Wj.html

SCIENCE JOURNAL
By ROBERT LEE HOTZ




Evolution at Work:
Watching Bacteria
Grow Drug Resistant
June 8, 2007

Day by day, the doctors unwittingly helped the bacteria infecting their 
young heart patient to evolve. The more intensively they treated his 
affliction with antibiotics, the more the microbes resisted the therapy.

In a strict medical sense, the young man, identified only as Patient X, died 
of complications from a congenital heart ailment and a Staphylococcus aureus 
infection.

More broadly, evolution killed him.

The life-and-death struggle inside his infected heart was driven by the same 
evolutionary forces of natural selection and adaptation that are causing a 
pandemic of drug-resistant diseases world-wide. The emergence of such 
immunity among infectious diseases is one of the most well-documented 
problems in modern public health. Until now, however, researchers knew 
little about how bacteria multiplying inside the human body overcome the 
drugs designed to control them.

JOIN THE DISCUSSION



Join Robert Lee Hotz and other readers in a discussion on bacterial 
evolution and antibiotics.Last month, an international team of 11 
scientists, led by biologists at Rockefeller University in New York, for the 
first time identified the genetic changes that occurred as Staph bacteria 
developed resistance to successive antibiotics, step by step, in the living 
test tube of a sick man. To document events inside these virulent cells, 
Rockefeller University biologist Michael Mwangi and his colleagues analyzed 
the infection's genetic code as it changed in a series of blood samples 
taken during the patient's stay. Their work, reported in the Proceedings of 
the National Academy of Sciences, details how the molecular mechanics of 
survival are strengthening many deadly diseases.

Patient X died in October 2000 after a 12-week hospital stay. His case comes 
to light now because researchers only recently developed the computational 
techniques needed to sequence generations of bacteria. The hospital, which 
also wasn't identified, gave the patient's Staph samples to the Rockefeller 
team for research purposes. The techniques still are too slow and expensive 
for clinical use.

When Patient X was admitted to the hospital, he was already suffering from a 
Staphylococcus aureus infection, but it was still vulnerable to antibiotics. 
During treatment, however, the bacteria quickly developed stronger 
resistance to four antibiotics, including vancomycin, the drug of last 
resort for intractable infections, the scientists reported. As living 
bacteria, the Staph were driven to survive.

Every time the patient took his medicine, the antibiotics killed the weakest 
bacteria in his bloodstream. Any cell that had developed a protective 
mutation to defend itself against the drug survived, passing on its special 
trait to descendants. With every round of treatment, the cells refined their 
defenses through the trial and error of survival. "It means that during a 
normal course of treatment there is an evolutionary revolution going on in 
your body," said Stanford University biologist Stephen Plaumbi, author of 
"The Evolution Explosion: How Humans Cause Rapid Evolutionary Change."

These resistant microbes, all disease-producing organisms spawned by the 
original infection, quickly accumulated 35 useful mutations. Each one 
altered a molecular sensor or production of a protein.

Researchers then matched these gradual genetic changes to increasing levels 
of drug resistance, shocked that it took so little to undermine the 
foundation of modern infectious-disease control. "We have now really looked 
into the belly of the beast and seen the mechanism," said Rockefeller 
microbiologist Alexander Tomasz.

Nearly two million people catch bacterial infections in U.S. hospitals every 
year and 90,000 of them die -- seven times as high as a decade ago as germs 
become immune to almost every antibiotic developed during the past 60 years. 
The most common is the Staphylococcus bacteria. World-wide, some two billion 
people carry these bacteria; up to 53 million people are thought to harbor 
antibiotic-resistant forms.

On average, people who contract Staph infections stay in the hospital three 
times as long and face five times the risk of dying. But these infections 
are becoming more prevalent outside hospitals. Antibiotic-resistant Staph 
infections increased almost sevenfold from 2001 to 2005, researchers 
reported last week in the Archives of Internal Medicine. Contagions such as 
tuberculosis, pneumonia and bubonic plague also are becoming immune to the 
drugs that once kept them at bay.

The death of Patient X highlights the speed of natural selection in 
fostering antibiotic resistance. "When you talk about the evolution of an 
arm or an eye or a species, you might be talking about millions of years. 
You can get bacteria resistant in a week," Dr. Mwangi said.

The Rockefeller researchers believe that a better understanding of evolution 
will lead to better antibiotic treatments. They want to disable the genes 
that allow these disease bacteria to mutate and adapt. The Staph bacteria 
that evolved inside Patient X now have such strong defenses that, in recent 
tests, they easily withstood even the next generation of clinical 
antibiotics. For the time being, the microbes are keeping one step ahead.

• Email me at ScienceJournal at wsj.com.