The cautionary tale of the phage cocktails

A lovely little case report has just come out in AAC, about a patient with pretty terminal multidrug-resistant Acinetobacter baumanii infection being treated with a cocktail of bacteria-destroying phages.

I like to hear little radio reports from planet phage every now and then, as I do get asked  about them quite a lot when talking antibiotic apocalypses.

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It’s well worth a read for those who want a quick insight, as it’s like a microcosm of the phage therapy world all in one patient – all the hopes, limitations, concerns, all in a very nicely written article.

Clever science? tick. Phages being inactivated by the patient’s own body? tick. Development of resistance by the bacteria? tick.  But also… possible clinical effect in someone with few options, and an excellent discussion about synergy between phages and antibiotics, Which I think boils down to ‘if you hit it with enough things simultaneously it goes down eventually’.

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Antibiotic Resistance explained using Game of Thrones

Someone on twitter suggested that if we described the threat of antibiotic resistance in terms of Game of Thrones, it might be easier to grab attention and understand. I mean, it’s all in the news about how resistant superbugs are going to kill us all…

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So here we go: (Massive spoilers for GoT warning)

White Walkers = near-unkillable superbugs

So for a long time, bad guys could be killed with sharp, pointy things, and heavy, smashy things. Like bacteria can be killed with antibiotics.  Only some people/things/bugs have managed to change and can no longer be killed by sharpness or smashing or even the strongest antibiotics. This is bad. Modern life sort of depends on us being able to kill things that want to kill us. If we can’t, it’s a bit of a game over, really.

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But right now, they seem like they’re a long way away, and they only affect wildlings/ other people you don’t really care about but read about in the Daily Mail.

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Antibiotics and resistance – there is a problem, but it’s not my fault!

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When I talk to my hospital colleagues, and my patients,  about antibiotics, overuse, and resistance, there is certainly no lack of awareness. Unprompted I frequently get told exactly what the problem is.

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There’s one answer I rarely get.

“I’m probably part of the problem, and I am changing what I am doing, to do my bit”.

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Is this reflected in what is said online? 

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Probiotics -seeds of change, or unnecessary chimpanzees?

AKA What I say when people ask me about Yakult.

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“Probiotics -what do you think of them?” 

I get asked this quite a lot, when I talk about antibiotics, gut bacteria, and our own microbial community, or ‘microbiome’,  in general.

So first up, let’s just say, I love Microbiomes. I think the whole area is fascinating, I’m lucky enough to work in the area,  and I firmly believe a better understanding will transform how we see health, and how we treat our patients.

I think…we’re not quite there yet.

As I’ve heard it described many times, Microbiome science is generally still in the ‘cataloguing’ stage. We’ve just been given the tools for the first time to go and explore these incredibly complex ecosystems, previously hidden from our eyes. And we’re going into Amazon rainforest, Appalachian plains, and snowy mountains, and we’re cataloguing and counting everything we find there.  It’s a wonderfully exciting time.

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We’re finding that some people have incredibly diverse guts, full of  rarely-seen species – (Amazon rainforest guts) – and others maybe have guts more like Siberian tundra – more sparse, fewer different species (that we can see).

Some scientists are finding they can correlate the presence of certain species with health conditions. You might say guts of patients with diabetes are less likely to contain oak trees, or guts of obese patients have far more monkeys than ants, compared to those of normal bodyweight.   Great.  This is all interesting stuff.

What can we do with this, and how does it relate to probiotics? 

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The wild garden of the gut bacteria 

This is an entry for the  American Society of Microbiology Agar Art competition, and yes, it’s created using poop! Or more correctly, bacteria from poop.

You can see more of the agar art at:

http://www.facebook.com/media/set/?set=a.10154367491515200.1073741836.62453295199&type=3

Update: We’ve now got a full gallery of  our art at http://modmedmicro.nsms.ox.ac.uk/art-from-the-gut/

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Photography is by Chris Wood, of Oxford Medical Illustration, whose awesome work is all over this blog. The images are photographed over a lightbox, to bring out the colors and transparency of the agar.

 

 

There’s a lot more behind it than I could fit into 200 words! So I  so here’s the longer description.

What’s the science behind this? 

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We often talk about bacteria as harmful things. Images in the media, advertising, even Doctors and Scientists, portray a healthy, desirable world as one free of bacteria- sterile, washed and scrubbed clean.  It’s becoming increasingly clear that this isn’t true. Recent advances in scientific research have enabled us to study bacteria in new ways, helping us realise that we wouldn’t be able to survive in this world without bacteria – we live together, and often help one another.  One of the most important places this happens is in our partnership with the bacteria in the gut. We provide them with food and habitat. They, in return, help protect us from harmful bacteria, help regulate the immune system so it fights infections but doesn’t get over-reactive (which may stimulate auto-immune diseases), and also affect our metabolism, or hormones, even possibly our mood…

Some people have compared the bacteria that live in our gut to a ‘garden’ – a healthy gut is one that is populated with many different types of bacteria, living together – in this setting, bacteria are desirable and beautiful.  Some bacteria are almost always beneficial, some are harmless, and some can be harmful. They all interact with one another, forming an ecosystem- they compete for nutrients, interact and communicate with one another.  But much like a garden, some types of bacteria can get out of control and cause damage if the careful balance between human and bacterial community is disrupted. For instance, previously harmless gut bacteria can sometimes escape the gut and enter our bloodstream if our immune system isn’t working well, or if our gut wall is damaged. Perhaps, rather than partnership, we should consider the relationship between our bacteria as a mutually-beneficial truce, occasionally broken by both sides when circumstances change.

You can see the techniques used here:

Thanks to That’s Oxford TV!

What’s going on in the images? 

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