Seeing the World in New Ways

It seems we humans don’t quite understand our place in the world.

“Everything that you can actually see with your eye is just the smallest sliver of life on this Earth,” says Bonnie Bassler, professor of microbiology at Princeton University, in the New York Times video, “Seeing the Invisible,” posted below. “Most of life is invisible,” she says. “We still have this idea that we’re the most central feature of Earth, [yet] it’s the humans that are the bystanders. But now we get [that] most of life is microbial. If you look at the Tree of Life, only this tiny little part is every single thing you’ve seen.”

In all of life, only Animals, Plants, and some Molds and Fungi can be seen by us (top right). This causes us to overvalue our role in the world and grossly undervalue the role unseen organisms play in our daily lives.

Dr. Bassler continues: “Every higher organism is covered inside and out with bacteria. And humans would not be alive if [if it weren’t for] these little 24/7 partners. And they have all kinds of fabulous behaviors.” For example, they talk (do they gossip?). “We discovered that bacteria can communicate using a molecular language. We used to think that social behaviors were the purview of higher organisms. What we now understand is that bacteria were probably the first organisms on this Earth to ever communicate with one another.”

But why are we “covered inside and out with bacteria”? Should we try and get rid of them? To the contrary; the new understanding is that we need them to be healthy: they aid digestion, build nutrients, and help us fight disease – and more.

Remember, Dr. Bassler described bacteria as our “partners.” And just like when we mistreat our human partners, when we mistreat our bacterial partners, we will pay a price, and a heavy one at that.

A virus that eats bacteria. If we could see these things, would we take infectious disease more seriously?

A case in point is our misuse of antibiotics – poisons – which attack all our bacteria, not just the bad guy, much like cancer radiation therapy attacks all cells not just cancerous ones. So instead of being left, say, bald, weak, thin, and nauseous, we are left more prone to infection, obesity, childhood diabetes, food allergies, celiac disease, and even cancer.

A leading exponent of this new science is Martin Blaser, MD, professor of medicine at New York University. It’s all laid out very nicely in his well-received 2014 book “Missing Microbes: How the Overuse of Antibiotics is Fueling our Modern Plagues.” The “plagues” being the above-mentioned diseases.

The overuse of antibiotics is also driving the rising tide of antibiotic resistance, the idea that we’re going back to a pre-penicillin era because bacteria have  figured out how to outsmart our antibiotics. That matters because, for example, more than 200,000 patients get infections every year while receiving healthcare in Canada and more than 8,000 of these patients die as a result. In the US, where they track individual pathogens, methicillin-resistant Staphylococcus aureus (MRSA) alone (one of many “Gram positives,” on the Tree of Life) causes more than 80,000 severe infections and more than 11,000 deaths every year. So without antibiotics, where will we be?

The solution to this global crisis, says infectious disease specialist Brad Spellberg, MD, will only come if we change the way we think about our microbes: “This whole thing about winning the war against microbes … nah! We’re not going to win a war against organisms that outnumber us by a factor of 1022 , outweigh us by a hundred million-fold, replicate 500,000 times faster than we do, and have been doing this for 10,000 times longer than our species has existed!”

In other words, when it comes to understanding our place in the world we are not who we think we are – and neither are they.

The invisible world made visible:

Overcoming the Disadvantages of Topical Antibiotics is Necessary to Achieve Universal Decolonization

Disinfecting the skin prior to surgery has long been a standard of care. Whether with iodine, chlorhexidine washes or other antiseptic surfactants, reducing the bacterial load on the skin surface has been established as an important mechanism to control the rate of post-surgical infection. The nose, which is a warm, moist environment ideal for bacterial growth, however had been difficult to decolonize.

Up to 30% of patients are carriers of Staph aureus. Colonization rates of the serious antibiotic resistant version of Staph aureus, known as MRSAid (one of the 3 major superbugs), range from 2% in Canada to 80% in Shanghai. Ordinarily, these pathogens do not impact patients until they are weakened by illness or surgery. Post-surgical infection is a risk for patients colonized with this pathogens and therefore has led to the need for removing or reducing the bacterial load carried around by these patients just prior to surgery.

In several studies, the nose has been identified as the key reservoir of Staph aureus and MRSA, representing 40% of the bacteria load in one small area. Because the nose is not washed on a regular basis, unlike other body parts, Staph aureus can easily flourish in the nose and become a source of contamination for other body parts. Because of delicate mucosal tissue and the presence of cilia in the nose, the antiseptic washes used for hardier skin surfaces are not appropriate for use in the nose. Instead, nasal decolonization has been done by topical antibiotics such as mupirocin.

Topical antibiotics have 3 significant disadvantages that have resulted in many infection control experts rejecting pre-surgical nasal decolonization protocols. With sub-optimal patient compliance, infection control experts fear the resulting antibiotic resistance formation brought about by sub-optimal doses of antibiotics that occur when patients stop mid-way through their antibiotic treatments. Poor patient compliance, despite advisories about the severity of MRSA and Staph aureus infections, is the leading disadvantage of antibiotics.

The problem is the inconvenience and unpleasantness of antibiotic creams in the nose. Patients are known to dislike the Vaseline™-type viscosity of mupirocin and often do not comply with the 3 times a day for 5 days treatment protocol. Incomplete doses of antibiotics leads then to antibiotic resistance which in turn adds to, not subtracts from, the risks already present with patients colonized with Staph. This is the primary reason why many hospitals have not opted for nasal decolonization protocols despite the 30-40% reductions in surgical site infection rates demonstrated in clinical trials.

The second disadvantage of antibiotics is the time required to decolonize. On average, decolonization using topical antibiotics requires about 5 days which implies that patients need to be screened and identified early enough for the efficacy of antibiotics to kick in.

The third disadvantage of antibiotics, however, is the inconvenience to patients and the costs to the health care system to culture for and identify Staph aureus and MRSA carriers.  Because of antibiotic resistance concerns, only carriers of Staph and MRSA are given nasal decolonization therapy. New rapid diagnosis technologies have emerged, but prior to Photodisinfection, there was little acceptance of these rapid diagnostics because antibiotics, the decolonization remedy, still required 5 days treatment for effect. The saving of 2-3 days prior to a 5 day treatment protocol did not justify, to many, the additional cost of same-day rapid diagnosis.

Technologies that overcome the disadvantages of topical antibiotics and allow for universal nasal decolonization are going to play an important role in health care associated infection control. These technologies must not generate resistance, must be safe for all surgical patients, even if they are not carriers of Staph aureus or MRSA. Finally, these technologies need to be easy to use, easy for patients to tolerate and fit well into the pre-operative work flow.

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