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.