Rachel Gomes Intervention LeSpar AMR Workshop The Nottingham Edition

On the following up of the Learned Society Partnership (LeSpar) Antimicrobial Resistance workshop see here) last week. Today I bring you incredible interesting research presented by Rachel Gomes (Assistant Professor in Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham) that took place on the 7th of July at MediCity this year.

Rachel covered "Antimicrobial resistance in the outside environment: Challenges and Opportunities". Her presentation was the one I liked the most at the LeSpar workshop - Nottingham Edition. Interesting, focused, realistic, and most of all almost linking the urban with the industrial settings. Lets read through the elements Rachel Gomes presented us with:

• Everything started back in the 30s with humans and animals being exposed to antimicrobials present in the environment. A particular farm was processing faeces. Immediately an intriguing question emerges from this scenario, "What is the influence of waste management practices on AMR?
• By defining the outside environment we find particulates (matter in the form of minute separate particles). Landfill is where we have the inappropriate disposal of antibiotics that accumulate in these particles.These accumulated antibiotics will be leached (transported to municipal wastewater treatment plants)!
• In Australia there are different classes for direct water reuse, e.g., Class A is for water that can be reused in car washing. However, worldwide, rapid urbanisation and water shortages has led to utilising reclaimed water irrigation, thus our motivations for considering AMR in the outside environment have grown in number and importance.
• In England  and Wales there are 23 water companies.These protect the quality of water and treat effluents released to the received water environment. Their individual systems are not designed to deal with AMR substances. We are talking of substances that have already been linked to acting as endocrine disruptors.
• Observations of wastewater effluent adversely affecting fish has now lead to more than £200M of investment by water companies. Although, the future demands for "new" analytics to track the metabolism and fate of these chemicals present in the wastewater treatment process of aquatic environment.
• Bacterial bordellos, has mentioned in (Edge, 2010); an article that explores the mix of bacteria in activated sludge processes and the fate of antibiotic resistance genes in sewage treatment plants (unfortunately, I personally wasnt able to find his article).
• After the privatisation of the water treatment industry a lot of questions have emerged: Which unit processes do actually form the treatment program? What are the effects of the treatments in terms of UV exposure and chlorination on the horizontal transfer to AMR? What level of detail is considered appropriate to understand AMR in the outside environment? Considering AMR as an emerging pollutant what sites should we monitor? What implications does AMR have on managing wastewater/wastes? How can we better understand complexity?

This was Rachel Gomes oral participation with a very interesting presentation that took me back to those years as a Biotechnological Engineering student, back in Portugal. I managed to ask Rachel if she thought that we could use a barcode footprint system to make the end-user more responsible for correct handling and disposal of the antibiotics. Rachel replied among other things that "...it becomes educational. Cannot force people to do it... companies are talking about recycled antibiotics".

See you next time where I will share with you guys University of Birminghams Jan Krefts contribution. A very interesting view on antimicrobial resistance and gut microbiota. Until then, keep reading The Toxicologist Today. Cheers!

1st image kindly taken from UNESCO-IHE,  Ecological sanitation, [http://ocw.unesco-ihe.org/mod/page/view.php?id=616], last visited on the 13th of July 2015, last update on the 8th of May 2010.

Read More..

Jan Kreft Intervention LeSpar AMR Workshop The Nottingham Edition

Jan Kreft from the University of Birmingham shared with the audience at the MediCity a very interesting perspective (with loads of questions outside the box) on Antimicrobial resistance in the human gut. But before we move on to Jans participation, if you havent had the opportunity to read also Chris Dodds contribution and Rachel Gomes contribution, already posted in the blog, just click on the names to do so.

Now moving onto Jans presentation, his most remarkable shared views and points are listed below:

• There is diagnosed antimicrobial resistances present in people who have not taken any antibiotics ever or that for a long time never took them. How was such resistance acquired?
• Resistances are found even in individuals from the Yanomani tribe in Brazils Amazon [1] that were never in contact with humans.
• The prevalence of antimicrobial resistance will decline if the use of an antibiotic is discontinued because of a fitness cost of carrying the resistance. Resistance rises if an antibiotic is used because of positive selection for the resistance. So we have to ask ourselves if discontinuing works? And why does resistance persist?
• Fitness costs, diversity, variation of costs and diversity of microbes, hitchhiking (when a gene is coupled to another gene that is positively selected, e.g., resistance to mercury). We have to consider an approach to the real world.
• There is a huge bacterial diversity in gut also affecting the spread of plasmids. There are huge numbers of bacteria in the gut, ~ 5E13 individual cells. The heterogeneity  goes from small to large scale.

• Will a more prudent use of existing antibiotics be enough? What can we do? Give a narrower spectrum of antibiotics, higher dose or lower dose? Should we give a combination of two drugs rather than one? Should we invest in new drugs, ideally new classes of drugs (new strategies)?
• On the other hand should we start attacking directly the resistance genes and plasmids preventing a possible transfer? Should we prevent infections as they mean fewer treatments? What kind of research do we need? 
• We need to consider consequences of diversity of strains, plasmids, resistance genes and quantitative models to optimise treatment at population level.
• We cannot deal with complexity without models. Take for example the developed iDynoMics software, a free software available online.

Next post will have the final contribution taken from the Learned Society Partnership seminars on antimicrobial resistance - Nottingham Edition, that took place on the 7th of July this year. It will be about getting funding (by Lizzie Garratt) and some final notes on the most important questions that have emerged from the event. Hope to see you soon, have a nice time!

[1] The Yanomami: An isolated yet imperiled Amazon tribe, The Washington Post, [http://www.washingtonpost.com/wp-srv/special/world/yanomami/], last visited on the 21st of July 2015, last update on the 25th July 2014.

2nd image kindly taken from Natural selection, Wikipedia, [https://en.wikipedia.org/wiki/Natural_selection], last visited on the 21st of July 2015, last published on the 14th of July 2015.

Read More..