Thesis Statement for Literature Review of the Topic of Antibiotic Resistance

    Although six journals  cannot realistically present the whole scope of  the issue of antibiotic resistance, it appears they do present an insight of the solidarity on this crucial problem in the medical laboratory science field.This multifaceted attack consists of the laboratory research workers, who identify and detect the resistant microorganisms so that they can provide information to physicians on treatment, coupled with the need to develop new drugs against the ongoing onslaught of ever-evolving bacteria.

Professional Literature Review Citations: Antibiotic Resistance

 
1. Huhulesca, S., Simon, M., Lubnow, M., Kaase, M., Wewalka,G., Pietzka, A.T.,et al."Fatal Pseudomonas aeruginosa pneumonia in a previously healthy woman was most likely associated with a contaminated hot tub." Infection (2011) 39; 265-269.

     This journal thesis is in the title of the article. It described the unfortunate event in a German hospital of a 49 year old woman who died due to infection from Pseudomonas aeruginosa. It depicted a cataloged list of samples taken at autopsy of the victim, and the molecular diagnostic testing done on them to prove the identification of the organism. Also samples from the hotel hot tub, showers, and sink were taken to find further evidence of the causative agent. Her pneumonia developed suddenly after ending a visit to a wellness hotel and spa while on vacation. Pseudomonas aeruginosa has exclusively been shown to inhabit soil, water, and tolerates temperature conditions above 42 degrees Centigrade. It's also known to be capable of mutating while in its host after invading its victim. The major focus of the supportive details of the journal was to inform both professional and public health officials of the deathly nature of this organism. The article ended mentioning Austrian laws governing the use, cleaning, and maintenance of hotel spas, (hot tubs), to prevent his occurrence in the future.


 
2. Kusradze, Ia, Diene, Seydina M., Goderdzishvili, Marina, Rolain, Jean-Marc. "Molecular detection of OXA carbapenemase genes in multi-drug-resistant Acinetobacter baumannii isolates from Iraq and Georgia." International Journal of Antimicrobial Agents (2011) 38: 164-168.

     This study involved molecular detection at the gene level for drug resistance to imipenem (IPM) of 12 Acinetobacter baumannii strains taken from various regions of the world. Two are from Belgium, eight (8) from Iraq, and two from Georgia, (former Russian state). These isolates that were resistant came from war-inflicted injuries of soldiers of Iraq, (2007) and the Georgian-Russian war in 2008. The article showed the highly complex use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or (MALDI-TOF-MS) to identify the organisms. PCR (polymerase chain reaction) technique was used to test for the particular gene that imparts the organisms' resistance to the drugs' active site enzyme (carbapenemase). Further testing showed different strains were resistant to a host of other antibiotics as well except colistin, which is a current treatment for Acinetobacter. The read on this journal again shows the future use possibly on a consistent level of the molecular diagnostic techniques which can give physicians quick identification as to whether an organism possesses resistance.


 
3. Ormerod, L.P. "Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment." June 14, 2005. British Medical Bulletin 2005; 73 and 74: 17-24.

     On this workup in the bulletin a thorough delineation on how drug treatable TB became MDR-TB. It explains the two separate mutations that must occur if the transformation to resistant mode is present. The resistance is to two of the triad of standard protocol drugs for TB- isoniazid and rifampicin. The mutation occurs on the organisms' gene codon sites. Due to this dual mutation MDR-TB is now classified as "basic" (just resistant to the 2 mentioned above drugs); or MDR-TB plus", meaning 2 plus more antibiotics that it is show to be resistant upon testing. The rest of the journal details the worldwide spread of the MDR-TB problem with treatment difficulties whereby patients do not correctly stick to the regiment program prescribed by their doctor. This further enables the organism to mutate again, and to be spread by the host victim to others. The author noted that along with HIV and malaria, MDR-TB is the WHO's (World Health Organization) top 3 priorities that extended from the late 1990's on into this decade.


 
4. Patti, Gary J., Kim, Sung Joon, Yu, Tsyr-Yan, Dietrich, Evelyne, Tanaka, Kelly S.E., Parr, Thomas R., et al."Vancomycin and Oritavancin have Different Modes of Action in Enterococcus faecium." Journal of Molecular Biology. October 9, 2009, Vol: 392, issue 5: 1178-1191.

     Due to increased incidence of vancomycin resistant organisms since 1986, particularly VRE,(resistant enterococcus), new drugs are being developed like Oritavancin. The new antibiotic still acts upon blocking cell wall construction in the organism but the dosage needed is less toxic (500 times less) than vancomycin. This report investigated at the chemical molecular level how the two drugs alter the cell wall synthesis of the organism. This enterococcus is a clinically important pathogen seen in hospitalized patients. Oritavancin is a semi-synthetic derivative of a vancomycin analog (page 1179).


 
5. Pitout, Johann D. D. University of Calgary, Calgary, Alberta, Canada. "Infections with Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae, Changing Epidemiology and Drug Treatment Choices." (2010) Drugs. Vol 70 (3): 313-333.

     This twenty page article has focused sections on another problem of my review on resistance. The most important data exists on former treatable Escherichia coli organisms that usually cause urinary tract infections and eventual blood sepsis to mortality problems if the resistant microbe is not found quick enough. The author departmentalizes information on the origin of the gene that confers resistance through either gene mutation or plasmid transfer on the active site of the existing Beta-Lactamase resistant microbe. Other gram-negative bacteria ( like the Enterobacteriaceae mentioned above), are also included: Klebsiella species, Pseudomonas aeruginosa; but with E. coli the urgency is required due to variation in production of CTX-M enzymes by this organism. Over 80 variants of this enzyme is classified based upon amino acid sequences, but the result produces a block on the Beta Lactam ring of the antibiotics molecule which neutralizes the effect of the drug. The classes are grouped numerically, with CTX-M-15 the culprit in E. coli. Community acquired versus hospital nosocomial rendered infections present problems most often in treatment, due to delay in treatment in various parts of the world. Frequent world travel also creates more opportunity for resistance to transfer across the community to the patients in hospitals if infection control protocols aren't vigilant.

6. Yeh, J.Y., Hall, G.S., Sekeres, J., Endimiani, a., Bonomo, R.A., Shrestha, N.K.,et al. Cleveland Clinic, University School of Medicine, Cleveland, Ohio, and Cleveland Department of Veterans Affairs Medical Center. "Treatment and outcomes in carbapenem-resistant Klebsiella pneumoniae(CR-Kp) bloodstream infections." Diagnostic Microbiology and Infectious Disease 2011; 69: 357-362.

     This journal presented the evidence of infection rates and treatment of 60 cases of CR-Kp circulatory infections. The cases of the patients ranged from January 2007- May of 2009. Positive blood cultures were the primary basis for investigation. The patients were designated differently whether they met survival or succumbed to their disease at the 14-day hospital time phase. Isolates were tested for their resistance against tigecycline and colistimethate,(colistin), amikacin, and gentamicin. The percentage study was changed due to 9 patients expiring before their cultures were finalized, so they received no tested therapy drugs against their CR-Kp. Mortality rates rose when patients have existing metabolic or chronic conditions such as diabetes, heart problems, and renal (kidney) disease. Certain drug limitations exist with colistin and tigecycline. Colistin is quite toxic to the renal system and low blood levels with tigecycline prevent its use where higher levels are required to maintain effective clearance of resistant organisms.


 
All Sources of the Review were Downloaded November 11, 2011 from the Electronic Journal Center located within the University of Cincinnati's Blackboard Website @ < http://blackboard.uc.edu>


 

 

 

 

 

 

 


 

Literature Review Journal Citations: Antibiotic Resistance

Journals on Antibiotic Resistance

Citation Listings:

Huhulescu, S. Simon, M., Lubnow, M., Kaase, M., Wewalka, G., Pietzka, A.T., et al. "Fatal Pseudomonas aeruginosa pneumonia in a previously healthy woman was most likely associated with a contaminated hot tub." Infection (2011) 39: 265-269. 

     This journal thesis is in the title of the article. It described the unfortunate event in a German hospital  of a 49 year old woman who died due to infection from Pseudomonas aeruginosa. It depicted a cataloged list of samples taken at autopsy of the victim, and the molecular diagnostic testing done on them to prove the identification of the organism. Also samples from the hotel hot tub, showers, and sink were taken to find further evidence of the causative agent. Her pneumonia developed suddenly after ending a visit to a wellness hotel and spa while on vacation. Pseudomonas aeruginosa has exclusively been shown to inhabit soil, water, and temperature conditions above 42 degrees C. It's also known to be capable of mutating while in its host after invading its victim. The major focus of the supportive details of the journal was to inform both professionals and public health officials of the deathly nature of this organism. The article ended mentioning Austrian laws governing the use, cleaning, and maintenance of hotel spas(hot tubs), to prevent this occurrence in the future.

Kusradze, Ia, Seydina M. Diene, Goderdzishvili, Marina, Rolain, Jean-Marc. "Molecular detection of  OXA carbapenemase genes in multidrug-resistant Acinetobacter baumannii isolates from Iraq and Georgia." International Journal of Antimicrobial Agents 38 (2011) 164-168.

     This study involved molecular detection at the gene level for drug resistance to imipenem (IPM) of 12 Acinetobacter baumannii strains taken from various regions of the world. Two are from Belgium, eight (8) from Iraq, and two from Georgia(former Russian state). These isolates that were resistant came from war-inflicted injuries of soldiers of Iraq,(2007) and the Georgian-Russian war in 2008. The article showed the highly complex use of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry or (MALDI-TOF-MS) to identify the organisms. PCR(polymerase chain reaction) technique was used to test for the particular gene that imparts the organisms' resistance to the drugs' active site enzyme(carbapenemase). Further testing showed different strains were resistant to a host of other antibiotics as well except colistin, which is a current treatment for Acinetobacter. The read on this journal again shows the future use possibly on a consistent level of the molecular diagnostic techniques which can give doctors a faster result identification for an organism which may be resistant.

Ormerod, L.P."Multidrug-resistant tuberculosis (MDR-TB): epidemiology, prevention and treatment." June 14, 2005. British Medical Bulletin 2005; 73 and 74: 17-24.

     On this workup in the bulletin a thorough delineation on how drug treatable TB became MDR-TB. It explains the two separate mutations that must occur if the transformation to resistance mode is present. The resistance is to two of the triad of standard protocol drugs for TB- isoniazid and rifampicin. The mutations as is usual operates in the organisms' gene codon sites. Due to this dual mutation MDR-TB is now classified as "basic" (just resistant to the 2 mentioned above); or "MDR-TB-plus", meaning 2 plus more antibiotics that it is shown to be resistant upon testing. The rest of the journal details the worldwide spread of the MDR-TB problem, with treatment difficulties whereby patients do not correctly stick to the regiment program prescribed by their doctor. This further enables the organism to mutate again, and to be spread by the host victim to others.  The author noted that along with HIV and malaria, MDR-TB is the WHO's(World Health Organization) top 3 priorities that extended from the late 1990's on into this decade.

Patti, Gary J., Kim, Sung Joon, Yu, Tsyr-Yan, Dietrich, Evelyne, Tanaka, Kelly S.E., Parr, Thomas R., et al. "Vancomycin and Oritavancin have Different Modes of Action in Enterococcus faecium." Journal of Molecular Biology . October 9th, 2009, Volume 392,issue 5:1178-1191.

      Due to increased incidence of vancomycin resistant organisms since 1986, particularly VRE(resistant entercoccus), new drugs are being developed like Oritavancin. The new antibiotic still acts upon blocking cell wall construction in the organism, but the dosage needed is less toxic (500 times less) than vancomycin. This report investigated at the chemical molecular level how the two drugs alter the cell wall synthesis of Enterococcus faecium, a clinically important pathogen seen in hospitalized patients. Oritavancin is a semi-synthetic derivative of a vancomycin analog(page 1179).

Sources in Citation List were downloaded from the Electronic Journal Center: http://blackboard.uc.edu

Popular Audience Analysis of Needs

     My popular audience  is the average citizen of the 21st century. Notably these are people that one would meet on the street, at the local supermarket, or at your physician's office. They are daily concerned about paying their bills, saving for their child's education, and the state of their general health. If they are not, they should be rather quickly. The availability and development of new antibiotics against resistant bacteria or fungi is rapidly evolving and consuming medical researchers. The popular audience should avail themselves to information on how bacteria mutate and are able to become resistant. These same people need to keep abreast of current clinical trials for development of new antibiotics. Also they should keep in mind under what conditions antibiotics warrant being prescribed and when they absolutely shouldn't use them at all. Thirdly, once they do find themselves taking an antibiotic, they should keep to the dosage and schedule of duration that their physician prescribed for them. In this way they take an active role in their own healthcare, because in the long run it benefits both them, their families, and others in their community where antibiotic resistance is concerned.  My popular webpage will attempt to key in on these concerns and provide links to more medical and clinical data on the subject of antibiotic resistance.  

Genre Analysis

Rough Draft of Genre Analysis on Subject of Antibiotic Resistance


 
     Antibiotic resistance is at the forefront of research investigation. What goes on in laboratories in this nation and across the globe sometimes gets missed in every day activity. The populace at large has resources that can clue them in to this ongoing medical crisis. The following discussion provides an analysis of popular and professional audience perspectives on this issue. How they portray their structure, style, content, and language is important to the purpose of the message they present.

     On the popular corner I found CNN's MRSA: Protect Your Kid from a Superbug," which focused on a 2 year old girl who experienced exposure to MRSA. (Methicillin-resistant Staphylococcus aureus)¹ In a New York Times web article, "Free Antibiotics May Contribute to Drug Resistance Officials Say," the CDC got involved by warning the pharmacies that offering free treatments of antibiotics may encourage stockpiling and eventual resistance in the community.² In Wikipedia a long profile under Antibacterials provided more scientific knowledge about the cause of resistance, how bacteria acquire it in their DNA structure, and an example of antibiotic misuse.³
      The professional treatment of antibiotic resistance in "Update in Antifungal Drug Resistance: Mechanisms of Aspergillus fumigatus,"⁴ and Single-nucleotide Polymorphism-based differentiation and drug resistance detection in Mycobacterium tuberculosis from Isolates or Directly from Sputum,"⁵ targets the laboratory research on the forefront of this issue. Both scientific journals provided introductory abstracts followed by a detailed workup of the testing done. The journals utilized data structured in filed comparison form, tables, and graphs of the specific microorganism involved in their study.

     In detailing each genre, typical patterns of information and audience specific language occurred. CNN's article raised awareness of the community at large of the presence of MRSA. By use of the 2 year old girls' picture, her parents' interview, and a statement from the CDC, CNN merged the emotional side of the problem, the data gathered by the parents about the microbe, and the authoritative side from the CDC. Her parents mistook what they thought was a pimple, when it was MRSA. One day it looked as if it was indeed a pimple, but the next day it was painful and reddened, with their daughter experiencing a high fever as well. Dr. Patrick Romano was quoted as stating,"The number of children hospitalized with MRSA infections, mostly acquired from within the community, has more than doubled since 2000."¹ CNN offered guidelines for patents about what they should know and recognize about MRSA infections. Those guidelines were directed from the ISDA (Infectious Diseases Society of America). The discourse lasted two and a half pages, and presented a comment area at the end of the web article.

     The New York Times article conveyed two problems. The CDC encouraged the pharmacies who were giving out free antibiotics to rethink their offers. They also suggested the companies would better serve the public by offering free vaccines. Even though the public still needed a prescription to fill the free drug item, the CDC was concerned presenting such a program during the cold and flu season may promote the problem of antibiotic resistance. Colds and flu are caused primarily by viruses and antibiotics and are of no use in that situation. People however still seek out a physician who will prescribe them one for treatment when none is indicated. This phenomenon was felt by Dr. Anne Gershon of the IDSA, when she stated, "Giving away antibiotics could lead to stockpiling of drugs."² Another usual problem seen is while patients are taking an antibiotic, they stop using it when they feel better, which in the long run can also promote the mutation of left over bacteria to more resistant forms. This short journal offered mostly an informative appeal.

     In Wikipedia's profile on Antibacterials, they provided under a subsection called Resistance and Misuse an in depth look at how bacteria hijack other DNA material.³ They utilized pictures of DNA elements and the structures bacteria use to incorporate other microbial material. One noted misuse of antibiotics was the livestock industry's use of drugs to increase the weight of their animals at market. I feel this is unethical. Europe was noted to have outlawed this practice. The Senate and House bills Wikipedia provided did not denote whether any laws were passed recently on this issue.

     It takes more time to read and interpret the two professional journals I found. Technologists in laboratory medicine, particularly those in microbiology and mycology (study of fungus) would find a plethora of data on drug resistance. They must have a background or knowledge of DNA sequencing and the current techniques for molecular diagnostic testing. The one journal on tuberculosis was quite thorough in its discussion of the disease, the TB bacteria which causes the problem, and the various technical applications utilized to test certain gene mutations related to resistance. The aim was to find a rapid screening procedure that could be used directly on a patients' sample.⁵ The turnaround time for results would provide the physician with a better insight on whether the patients' strain of bacteria is resistant to certain drug protocol for TB.

     The second journal on fungus described the overall battle to find new drugs to combat resistant fungi which primarily cause invasive aspergillosis (IA).⁴ This journal was a complete overview of current anti-fungals and their resistance patterns. The causative agent Aspergillus fumigatus was explored at each level with schematics of mutant gene sites, patterns of resistance, and other scientific nomenclature that would be too complex to discuss in this moment of time. The layout of the journal was excellent as it was subdivided into categories related to the fungus. If one were interested in a particular part of the journal's study then all that information was found in one area.

     Summarily both the popular and the professional genres obviously differ in their language, layout, and their overall motivation. Popular search and news engines like CNN and Wikipedia are informative in their rhetorical appeal. They must provide a broad stance in order for the public at large to comprehend their stories and articles. However in this case of antibiotic resistance, it doesn't eliminate the seriousness of the subject. The approach by way of language must be understood in simpler terms. They too can provide authoritative citations as the popular articles I mentioned above. On the professional side, the medical researchers involved in the battle to find new antibiotics utilize their scientific forums and journals to keep updated on their side of the issue. Although these researchers may not be on the minds of the public on a daily basis, they are nevertheless concerned with the same problem as the public. Both audiences must stay aware and alert to issues like MRSA and TB resistant microbes. Each audience therefore will find a venue, (whether CNN or the next issue of American Journal of Microbiology) to stay on top of the problem of antibiotic resistance.

Works Cited

1. Rice, S. CNN Medical Producer. MRSA: Protect Your Kid from a Superbug. 8 Sep 2011 Available from http://www.cnn.com/2011/09/01/health/child-mrsa-infections/index.html Downloaded 17 Oct 2011
   
2. Parker-Pope,T. Free Antibiotics May Contribute to Drug Resistance, Officials Say. New York Times. 2009 Mar 5 Available from http://www.nytimes.com/2009/03/05/health/policy/05drugs.html Downloaded 17 Oct 2011
   
3. Antibacterials: Resistance and Misuse. Wikipedia, the free encyclopedia, pages 1-16 Available at http://en.wikipedia.org.wiki/Antibacterial Downloaded 15 Oct 2011
   
4. Chamilos, G., Kontoyiannis, D.P. Drug Resistance Updates 8 (2005) 344-358. Aspergillus
   fumigatus, An Update on anti-fungal drug resistance mechanisms, Elsevier Ltd. Available online at www.sciencedirect.com or www.elsevier.com/locate/drop Downloaded and on PDF from http://blackboard.uc.edu (Electronic Journal Center) 18 Oct 2011
   
5. Arnold, C., Westland, L., Mowat, G., Underwood, A., Magee, J., Gharbia, S." Single-nucleotide polymorphism-based differentiation and drug resistance detection in Mycobacterium
   tuberculosis from isolates or directly from sputum." Clinical Microbiology Infectious 2005: 11: 122-130. Journal allowed reprint from European Society of Clinical Microbiology and Infectious Diseases. Downloaded and on PDF from http://blackboard.uc.edu (Electronic Journal Center) 18 Oct 2011
   

Professional Perception of the Antibiotic Resistance of Microorganisms

     The professional perception surrounding antibiotic resistance revolves around the crucial need to develop new antibacterial and anti-fungal treatments for resistant disease causing organisms. The popular audience may not conceive of this battle going on behind the scenes in research labs around the world. Therefore the point of view of this battle as described in the journals I read is a personal challenge, vested with teamwork of other people working in antibiotic research, who see it as their lifelong desire to make life better for those who suffer from infectious diseases.
     The two journals I selected from the Electronic Journal Center reflected a small picture of the research challenge of clinical laboratory personnel who are at the forefront of this issue. I preferred to read the whole article, not just the abstract, because it gave me a better feeling for the dedication,time, and money being spent deciphering effective treatments for an old nemesis- TB, (Mycobacterium tuberculosis). The second journal dealt with a fungal disease process, IA (Invasive Aspergillosis), and trends in research of developing new drugs for the high mortality rate seen with its causative agent, Aspergillus fumigatus. (a. & b.)
     With  the tuberculosis problem, that journal provided information on a molecular diagnostic technique that tests for resistant changes in the DNA. It occurs mostly through mutation on gene sites, and the test keys in on those DNA mutated sequences. They acknowledged that old methods of culturing specimens from patients is time consuming, and doesn't provide the physician with a rapid enough result that would inform him/her that their patient may have a TB strain that is resistant. This molecular test is performed more rapidly, and can be designed to find MDR 's( Multiple Drug Resistant) patterns in not just TB but other subspecies of Mycobacterium and other infectious disease organisms as well. (b.) 
     In IA, the agent is a fungal organism. The journal examined the challenges in treatment of patients with resistant strains of this problem. My deciphering of this information was more difficult as it featured elements of lab medicine I am less familiar with at this time. I do understand their research indicated a multi-focal attack in finding more than one agent to act against this fungus. Some like Amphotericin B are highly toxic to liver and kidney organs. If the patient is already immuno-compromised, ( HIV, etc.), then the situation becomes more difficult. (a.)
     Summarily it appears that most professionals on the hot seat in investigating antibiotic (drug) resistant microorganisms realize they are in for the long haul. Microbes are minute living organisms and can rapidly adapt to almost any chemical bombardment thrown at them. They beg, borrow, and can steal DNA,(or RNA and protein sequences) from their surrounding environment to make themselves more resistant to pharmaceuticals that us more complex humans can throw at them. It reminds me of how the Martians were defeated in "War of the  Worlds."

Works Cited from Electronic Journal Center

a. Chamilos, G. , Kontoyiannis, D.P., Drug Resistance Updates 8 (2005) 344-358, Aspergillus fumigatus, An update on anti-fungal drug resistance mechanisms. Elsevier Ltd.(Available online at www.sciencedirect.com or www.elsevier.com/locate/drop
Downloaded and on PDF from http://blackboard.uc.edu  (Electronic Journal Center) 18 Oct 2011

b. Arnold, C., Westland,L., Mowat, G., Underwood, A., Magee, J., Gharbia, S. Single-nucleotide polymorphism-based differentiation and drug resistance detection in Mycobacterium tuberculosis from isolates or directly from sputum. Clinical Microbiology Infectious 2005; 11: 122-130. Journal allowed reprint from European Society of Clinical Microbiology and Infectious Diseases.
Download on on PDF from http://blackboard.uc.edu (Electronic Journal Center) 18 Oct 2011

Popular Perceptions Regarding Antibiotic Resistant Microorganisms

     Health care in our country and around the world has become a crucial issue of concern. One element that will stay in the foreground is antibiotic resistance of germs, or better termed bacteria. Pathogenic or disease-causing bacteria which once were treatable with a standard protocol of antibiotics now are showing up in labs and patients as resistant and ever-changing to new regimens of treatment. How does the public perceive of this issue, and how do informative organizations present this problem? I found three common organizations on the internet that dealt fairly well with the matter.

      In CNN's Health line, an article dealt with MRSA  treatment with a  2 year old child. On the New York Times Money & Policy page of all things presented a report of pharmacies handing out free prescription drugs at low cost to consumers. Thirdly on Wikipedia's subheading under Antibacterials, a very detail-oriented sub-captioned report offered readers multiple pages of information on bacterial resistance, with a scientific noted background on how bacteria develop resistance, and how to avoid being a patient in that situation. Wikipedia listed 93 separate notations on this whole workup. Their article sub paragraphs on use and misuse of antibiotics noted authors from Trends in Microbiology, ( a knowledgeable scientific journal).
   
     All three of the websites I found appeared to present an informed concern on the subject of drug resistance. Two, (CNN & NY Times) provided comment/feedback sections at the end of their articles. The latter also promoted the issue in a matter-of-fact structure. They were up front about cause and effect of misuse and prescribing of antibiotics. Wikipedia dealt with it further by mentioning the use of antibiotics in agriculture to provide livestock animals with more weight. I might add that I wasn't aware that cattle or cows would gain weight if given antibiotics. They directly related this to an increase seen in pathogenic colon (stomach) bacteria called Salmonella, Campylobacter, and Enterococcus, just to name a few. Wikipedia seemed very detail oriented, and used more professional scientific vocabulary than I imagined they would have in this scenario.

     Overall these three popular sites approached the subject of antibiotic resistance on a very broad scale. Their articles appeared to provide background and information that the general public would find useful and would lead them to other sites that generate more questions about this critical subject in medicine. Their use of vocabulary would not go over anyone's head who hadn't taken say a microbiology or even a biology course.However,  Wikipedia I found the most scientific laden with wording and structure. On a rhetorical scale it appeared that the information I viewed was objective and informative, but given the issue at hand, didn't become overwhelmingly technical. They treated the issue quite seriously in their formats.

Works Cited:

Antibacterials: Resistance and Misuse. Wikipedia, the free encyclopedia, pages 1-16
http://en.wikipedia.org/wiki/Antibacterial  Downloaded  15 Oct 2011

Parker-Pope, T. Free Antibiotics May Contribute to Drug Resistance, Officials Say. 2009 Mar 5 Money and Policy Page, NY Times.
Available from:http://www.nytimes.com/2009/03/05/health/policy/05drugs.html
Downloaded 17 Oct 2011

Rice, S. CNN Medical Producer. Empowered Patient- MRSA: Protect Your Kid from a Superbug,
8 Sept 201l.
Available from http://www.cnn.com/2011/09/01/health/child-mrsa-infections/index.html Downloaded 17 Oct 2011