The first hackathon of its kind in Israel will combine experts from different fields to find effective solutions to the problem of antibiotic-resistant bacteria* The arms race against resistant bacteria is one of the most painful issues, the usual method has probably exhausted itself and original ideas are needed. Those who have them are invited to participate
Dr. Aviad Hadar, Angle - news agency for science and the environment
In 2013, the World Health Organization defined the spread of antibiotic-resistant bacteria as a "global health emergency". In the hospitals, they have increased by about 35 percent in the last five years and they are already a significant threat to public health. In the arms race against bacteria, new medical developments are not enough and there is a need for the population and the health system to use the existing antibiotics wisely. In February 2019, Israel will host a hackathon to systematically deal with bacterial resistance to antibiotics.
Once upon a time everything was simple - a calm village life, without pharmaceutical companies, without industrial systems, without doctors, syringes and medicines. In this beautiful and romantic period, diseases such as tuberculosis and pneumonia would in many cases end in death in agony and as a result, at the beginning of the 20th century the average global life expectancy was reduced to 40 years. In 1928, in the period between the world wars, the British scientist Alexander Fleming discovered penicillin, the first substance that succeeded in eliminating disease-causing bacteria (pathogens), such as those that caused tuberculosis and bacterial pneumonia. Quite quickly this antibiotic and other antibiotics that were discovered of different types began to be widely used.
Resistance to the wonder drug
There were many scientists who believed that within a few years humanity would eliminate many of the pathogens. But the joy was premature. Only a few years after the sensational discovery, evidence began to emerge that bacteria have an impressive ability to develop resistance to antibiotic drugs and that they manage to survive treatment and continue to thrive.
How did the bacteria develop resistance to the drug that is supposed to kill them? Along with the development of microbiology and molecular biology in the years after the discovery of antibiotics, resistance mechanisms began to be revealed. The development of antibiotic resistance is a live and direct demonstration of rapid evolutionary processes in the bacterial population.
The action of the antibiotics on the bacterial colonies is an environmental stress; The bacteria that have a mutation that allows them to survive will live and reproduce while the other bacteria, those that are not resistant, will die and not reproduce. The mutations give the bacteria diverse mechanisms to deal with the antibiotics, which include the ability to break down the antibiotics, preventing them from entering the bacterial cell and even actively taking them out, and more. If this is not enough, bacteria also have the ability to transfer complete circular DNA segments (plasmid) between them in a process called conjugation. These segments can contain genes for resistance to different types of antibiotics. This is how some bacteria can accumulate several resistances to different types of antibiotics. After that, those resistant bacteria will pass on the resistance they have developed to their offspring, who will also be resistant, partially or fully, to those antibiotics.
There are additional and more complex resistance mechanisms, but the basis of things is the simple equation that the more bacteria are exposed to a certain antibiotic, the greater the chance of the creation and spread of resistant strains. Thus, every few years a new type of antibiotic must be developed that the bacteria are not yet familiar with. The problem is that today medicine is barely able to withstand this arms race.
The resistant bacteria cause longer and therefore more severe illnesses than those that the antibiotics kill and their resistance leads to more aggressive treatment that endangers the patients' lives. In addition, many of the carriers of these bacteria do not receive the appropriate treatment in time, which may lead to additional health damage that will lead to prolonged hospitalizations, and require treatment at a very high cost.
The resistant bacteria cause longer and therefore more severe illnesses than those that the antibiotics kill and their resistance leads to more aggressive treatment that endangers the patients' lives.
Targeted elimination
Beyond the personal health aspects, this widespread phenomenon has a serious economic impact on the economy. Here are some numbers: treatment with simple antibiotics is quite cheap, but if a broad-spectrum antibiotic is needed that can deal with the bacteria that have become more violent, the price will increase tenfold or more. A patient with salmonella, for example, will receive a few days' treatment with regular antibiotics. If it doesn't work, he is already very weak from the disease and now needs hospitalization which costs about NIS 2,000 per day. In 2015, there were more than 4,000 people hospitalized in Israel because they had to receive aggressive treatment against antibiotic-resistant bacteria, and in total there were more than 64 days of hospitalization at a cumulative cost of approximately NIS 128 million! In recent years, patients with infections caused by antibiotic-resistant bacteria stay in the hospital between two and three weeks on average.
What can be done about it? This is already a more complex question, in recent years expert committees have convened all over the world and in Israel, and in some countries, such as Great Britain, the issue has entered the top of the national priorities. Along with finding incentives for the pharmaceutical companies to concentrate on the development of new antibiotics, there is widespread agreement that the main efforts should be concentrated around the way antibiotics are used within the various health systems in the world (and also in the animal agriculture industry, which produces animal food, where antibiotics are frequently used even regardless of illness), This is because giving antibiotics unnecessarily and using them excessively accelerates and increases the rate of development of bacterial resistance and its scope.
"It is important to save antibiotics for cases where they are really needed and it is important that the public joins us in dealing with antibiotic resistance," says Dr. Zohar Barnet-Yitzchaki from the Ministry of Health's public health services. "You need to make sure that you take antibiotics only when necessary, according to the doctor's instructions, and that under no circumstances do you throw leftover medicine down the toilet or into the household garbage can (expired medicines or those that are no longer needed should be thrown only into designated bins located in pharmacies in Israel). Antibiotics are not a magic solution for every disease, and patients should understand that if their doctors do not prescribe antibiotics - it is because it is not the right treatment for them."
In 2016, Brent-Yitzhak led an interdisciplinary expert committee on antibiotic resistance in wastewater. The committee published data and recommendations to the relevant government ministries. "Every year over half a million cubic meters of wastewater is produced in Israel, most of which is purified and returned to use as irrigation water in agriculture. The aqueous environment of the wastewater, which also contains drug residues, including antibiotics, allows the antibiotic-resistant bacteria to thrive and exchange genetic information with other bacteria. The transfer of antibiotic-resistant bacteria from sewage treatment plants to farmers' fields and agricultural produce has not yet been proven, but it is important to continue monitoring the issue and prepare accordingly," he says. It is important to note that antibiotic residues can be treated in wastewater treatment plants using dedicated filters, advanced oxidation processes (use of ozone, etc.) and UV radiation. It is not always enough to use only one of the above processes and sometimes a combination of several of them is required, which may significantly increase the costs of wastewater treatment.
Creative solutions to the problem
In addition to the efforts of the health system and hospitals on the subject, this coming February, the Israeli Society for Ecology and Environmental Sciences, in collaboration with the Heschel Center for Sustainability, and the Interface Program for the Implementation of Science in the Government will organize the cathon to deal with bacterial resistance to antibiotics in a systemic way. In the hackathon, which is multidisciplinary and is not intended only for health professionals, groups will try for two days to find solutions to slow down the arms race against bacteria while taking a broad look at issues such as reducing the release of antibiotics into the environment, environmental design and planning to reduce infections, behavioral economics and raising public awareness, food systems, agriculture And water and more.
"Resistance to antibiotics is a serious health problem, especially in light of the fact that antibiotics are a limited resource and that people are more sick with infectious diseases due to treatment with immunosuppressants," explains Dr. Itzik Levy, an expert in infectious diseases from the Sheba Medical Center and the organizers of the catathon. "The fight to prevent the development of resistance to antibiotics is a multidimensional system, which on the one hand must reduce the use of antibiotics in industry and medicine and reduce the transfer of resistant bacteria, and on the other hand must reinvent means of combating microbes that do not cause evolutionary pressure that requires those microbes to develop resistance."
"The use of phages (viruses of bacteria, ah), antitoxins that do not kill the bacteria, vaccines and the like are just some of the non-antibiotic measures that must be developed in order to enrich the ammunition against infectious diseases," says Levy. "The caton that combines people from many fields who can think outside the box and collaborate and come up with creative solutions - as the bacteria, in contrast, collaborate among themselves in creating resistance to antibiotics - is exactly the right recipe for creating tools that may lead to a decrease in the incidence of this health hazard."
More of the topic in Hayadan:
- Researchers have developed antibiotics against antibiotic-resistant bacteria
- Researchers have discovered how a mutation in a ribosomal protein helps bacteria develop resistance to antibiotics
- Improving the monitoring of the three-dimensional structure of bacterial colonies to prevent their resistance to antibiotics
One response
The pharmaceutical companies are not interested in phages, since every phage that is found will reduce billions from their revenues. There are two solutions to this: to change the laws so that whoever finds a phage that treats a certain bacterium will receive exclusivity on the phage's market for 20 years, similar to a patent, or the governments will fund the research and development from their budgets (similar to vaccines). In the meantime, it is possible to use for certain needs liquids or pastes that contain nanometer crumbs of silver that are toxic to bacteria but not harmful to people. And by the way: copper is also toxic to bacteria, those who don't want the water in a vase of flowers to become cloudy with bacteria, can put a copper coin (10 cents or American cent).