Month: February 2018

PROMPT: Freewrite/Brainstorm (No proof-read)

Step 1:

One thing that I came into this class wanting to learn about is nosocomial infections. I have been working in critical care for nearly 2 years now as a CNA2, and have been working in a hospital. One thing that we have to be careful about is any injuries/illness that can be linked to their time in the hospital wont be reimbursed, so the hospital has to pay for it. This is most often related to bed sores, pneumonia, C. diff, CAUTIs, VAPs, and other sepsis related illnesses. One thing that I never took into account with regards to infectious disease prevention and the immune system is the state of our microbiomes. I never really considered the fact that staying in the hospital can alter your microbiome, and can lead to complications, increased length of stay, and overall worsening of patient outcomes. It has been really interesting to learn about the microbiome and its impact on our health and how it can protect us from infection.

Step 2:

“staying in the hospital can alter your microbiome”

Step 3:

Staying in the hospital can alter your microbiome. Due to antibiotic treatment, nutrition deficiencies, exposure to pathogens by healthcare workers, etc., the microbiome you walk into a hospital with likely is drastically different than the one you will leave with. Currently, there are not much treatment options that are used commonly to counter this inevitable change. I think it would be really interesting to learn about techniques and methods utilized by specific hospitals/clinics/centers in other areas/countries where they have spent time studying the microbiome and how to prevent dysbiosis. Im sure some great research has been done, and some other facilities utilize cutting edge techniques, but the knowledge hasn’t spread throughout healthcare.

Step 4:

In a hospital you can become really focused on numbers, observable symptoms, and the visible state of the patient and completely disregard what you cant see. Its easy to disregard this part of human biology since there are other critical things in plain view. I think this is part of the reason why the microbiome is not a larger part of the care plan in patients, especially the ones who are in Critical Care settings. Infection is very prevalent in hospitals, its not a secret that many people succumb to nosocomial infections, and some of which can be fatal. There is an underutilized natural defense system we all have, its microscopic, but it still can provide a lot of protection. By ignoring this system, and additionally altering it, we cause dysbiosis and destroy a very valuable asset. I think I will look into the strategies employed by other facilities regarding protections of the integrity of microbiome, and write my paper on how effective they are, and the importance of factoring in the microbiome in patient care plans.

PROMPT: Describe your personal philosophy about how and when you have taken, or would take, antibiotics. What experiences or prior knowledge do you have that shaped that personal philosophy?

Having nearly 2 years of experience in healthcare, I have become quite familiar with drug-resistant organisms. I would say that due to the various classes I have taken in addition to the time I have spent working in hospitals, my personal philosophy on antibiotic usage is quite biased. Antibiotics are an incredible resource that have drastically improved the outcome for patients around the world. While it’s impossible to calculate an exact number of lives that have been saved since the creation of the first antibiotic in 1928, estimates put the number at 80-200 million or more. (1) However, with great power comes great responsibility. The misuse of antibiotics has lead to an epidemic of infections of strains of pathogenic bacteria which have developed resistance to nearly all antibiotics. (1) This is why strict adherence to proper use of antibiotics is serious.

It is important to note that antibiotics have an incredibly important role in healthcare and treating patients suffering from various infections. If your physician EVER prescribes an antibiotic, it is essential that you follow the specific instructions for the prescription. Additionally, even if you start feeling better, DO NOT STOP taking the antibiotics as prescribed. The premature discontinuation of antibiotic treatment can cause a relatively benign infection to come back as a much more serious, drug-resistant, infection. This contributes to the problems that lead to the few cons of antibiotic usage.

Antibiotics are a double-edged sword. While they have saved countless lives as previously stated, they have lead to the rise of deadly bacteria that we either struggle to or are no longer able to treat. Had antibiotics been used only in specific cases as needed, we would not be facing this epidemic we are in today. In 2009 alone, over 3,000,000kg of antibiotics were administered to humans. Even more surprisingly, 13,000,000,000kg of antibiotics were administered to US livestock. (2) Compared to the typical 125-1000mg dosage of antibiotics, it’s clear that antibiotics were over-used and overprescribed.

The 13 billion kilograms given to livestock was primarily given as preventative treatment, rather than for treating livestock afflicted by an infection. The farms raising the livestock do this to try to prevent an outbreak of infections that can wipe out an entire farm’s cattle due to the small shared spaces livestock are kept in at factory farms.

Bacteria replicate quickly, with a high chance of mutations occurring in their genome. These mutations can either lead to no change, be harmful, or be beneficial. Since bacteria replicate so quickly, one bacteria turns to two, which turns to four, then eight, 16, 32, 64… and so on. In a relatively short time, 1 bacteria can turn into a colony containing millions of bacteria. If even as many as 1 in 1000 bacteria have a serious mutation, the amount killed off due to harmful mutations is insignificant as the colony still has 99.9% of the bacteria living without mutations. However, if that mutation happens to lead to a beneficial change in the bacteria, especially if it leads to resistance to antibiotics, that 1 in 1000 becomes incredibly significant.

Now, take those millions of bacteria in the colony, and place them in a cow at a farm. The cow then receives antibiotics, which leads to the death of 99.9% of the bacteria. However, the remaining bacteria now have all the space they need to replicate and virtually 0 competition for nutrients. Not only this, but they are resistant to the antibiotic, so treating the cattle with the same antibiotics to try and treat the infection does nothing. The resistant pathogen is now free to colonize the host without being killed by antibiotics, and without competition from other microbes.

The 1 in 1000 number I used is not a scientifically based statistic, it was used to illustrate my argument. The real number is MUCH less frequent, but it is still significant when put in a real-world context. With 3 million kilograms of antibiotics being given to humans, and another 13 billion being given to livestock, it’s clear to see how even incredibly low rates of mutation can still end up with the development of drug resistance.

As I said before, with great power comes great responsibility. We are sitting on the edge of a bubble of an epidemic that is ready to burst. If we continue to use antibiotics haphazardly, we will ultimately run out of antibiotics to treat even common infections. Antibiotics have a critical role in healthcare and should 100% be taken as directed by a physician. However, we must improve the way they are used before we are stuck in a situation we can’t get ourselves out of.

1. Ventola, C. L. 2015. The Antibiotic Resistance Crisis: Part 1: Causes and Threats. J Clin Pharm Ther 40(4), 277–283.
2. Spellberg B, Bartlett JG, Gilbert DN. 2013. The future of antibiotics and resistance. N Engl J Med 368:299-302.

Writing Exercise #5

PROMPT: What choices do you make in terms of food/nutrition/product use and consumption that may have an impact on your microbial communities? Consider choices that are intentional, and choices that are perhaps non-intentional.

There are many different products and foods which my consumption can have an impact on my microflora. A lot of these things are a part of my daily life and I don’t think twice about their implications. From medications to foods, to supplements, they all can influence the specific balance organisms that make up the composition of my microflora.

The thing that probably has the biggest, non-intentional, impact is the over-the-counter Proton Pump Inhibitor (PPI) I take daily, omeprazole. Due to my chronic gastritis, I have to take this medication daily to decrease the amount of stomach acid produced. The decrease in acid production leads to a reduction in the pH/acidity of my entire GI tract. Studies have shown that the use of antacids increases the risk of developing a C. difficile infection. (1) Interestingly, it has repeatedly been demonstrated that the specific type of medication I take, PPIs, have the highest associated increase in risk of infection. The reason these drugs cause an increased risk of infection is not explicitly apparent. However, the reasoning behind the association is clear upon further thought. Most organisms can only live in a small pH range, and their optimal environment for reproduction is an even smaller range. The pH of stomach acid can go as low as 1.5, which is incredibly inhospitable. By suppressing the production of stomach acid, the pH raises to a more neutral level. This allows other microbes to colonize an environment where they usually wouldn’t have a chance.

A more obvious influence on my microbial flora comes from some of the foods I eat. Yogurt and cheese are two food items which commonly come to mind when thinking about microorganisms in food. Bacteria is added to milk, and thru fermentation make yogurt. Fungal species, as well as bacteria, are added to milk, and perform fermentation of the lactose in the milk and make cheese. That means that if you consume cheese or yogurt, your introducing live microbial cultures to your body. This is an example of how food can have a direct impact on my microflora.

While I don’t drink often, I do have the occasional alcoholic beverage. Interesting, beer impacts my microflora in two different ways. First, beer production requires yeast, an Ascomycota fungus named Saccharomyces pastorianus, is used to ferment glucose into ethyl alcohol. That means that drinking a beer would mean drinking a beverage which contains residual yeast from the fermentation process. (However, most commercial breweries filter/remove any microbes before bottling the beverage) Additionally, another impact on my microflora stems from the ethyl alcohol, or ethanol, itself. Ethyl alcohol has antimicrobial effects, so the consumption would likely kill some of the microbes found in my GI tract.

There are many different ways which I can alter the distinct composition of my microbiome. Some ways have a more significant impact than others, and some ways are more direct than others. Additionally, some ways are less readily visible and require deeper thinking to understand their influence, but play an essential role in the balance of my unique microflora.

1. Dial S, Delaney JAC, Barkun AN, Suissa S. 2005. Use of Gastric Acid–Suppressive Agents and the Risk of Community-Acquired Clostridium difficile–Associated Disease. JAMA. 294(23):2989–95.

PROMPT: Brainstorm a list of behaviors that an individual could engage in that could cause changes to a gut microbial community. For each behavior you list, discuss how that behavior could change the microbial community, and what potential health impacts (beneficial, detrimental, neutral) that change could be for the individual’s health