Saturday, August 30, 2014

War or Peace with our ancestors? Conversational learning on microbial folley

Microbes invented evolution and they are likely to outlive us.

Currently we are having a discussion on our 'input' processing forum tabula rasa on emergence of antibiotic resistant strains with voiced concerns on the ticking time bomb for the patient community. A few excerpts from that copied below:

  • Boudhayan Dm I was having a similar discussion with Rakesh avoid failure and not lose our patient we r misusing the antibiotics realising little that we sowing the seeds of ultimate failure......we the doctors with the mentality of having a thriving private practice r the biggest culprits......that is why we need to discuss we practice the art of medicine and not the science....please pardon me for being outspoken
    9 hrs · Unlike · 1
  • Rakesh Biswas It may not be very frightening really in the course of evolution. Bacteria came before us in time, we are perhaps just a collaboration of these organisms who specialized over the ages and yet retained perfect systems co-ordination and it is likely that these organisms will remain on Earth (or other Earth like bodies) long after we (the human race) have departed. The antibiogram shows how we are failing to eliminate them but we need to realize that we need to make peace with them and not be at war with them constantly. Sanchita Das, Biswaroop Chatterjee, what are the micro pointers that we may look for to characterize the pathogenicity of this organism recovered from a wound swab? Could it be a harmless wayfarer who happened to jump into the wound and may not be very active in its progression? How do we decide other than clinically circumstantial suspicion.
  • Anasua Deb Couldnt refrain myself from commenting. Such MDR strains , Iguess, would be more likely to be hospital acquired than a community acquired one. The Urine culture was most likely to be from a catheterized patient and the wound swab any case of SSI. Correct me if I am wrong. In case of a CAUTI, to prevent the persistence of MDR strains, decatheterization at the earliest possible time would be prudent. Surprised to see even polymyxin B resistance in that patients. The strains being carbapenemase producer, the other resistance patterns were expected. However, for carbapenemase producers, cephamycins ( cefamandole clinically, and invitro tested by cefoxitin) are options. The reports do not mention about the cephamycin group. However, even among carbapenemase, the AmpC coprodusing type would not be responding to this group.
  • Navin Kaore Sir ..Sampling should be done very carefully.. we will get the good results if we take good samples.. An aspirated sample from the depth of wound ...
    And also we need to have a strict antibiotic policy for use of antibiotics in hospital settings as to who can prescribe which level of drugs ....we ourselves are exposing the microorganisms to higher antimicrobials ...and now finding it difficult ro deal with ..
  • Anasua Deb As of differentiating between the colonizer and pathogens, clinical suspicion is THE clue. Presence of pus cells on microscopy would further suggest an inflammatory response following invasion and can be another pointer. Also, in case of isolates like pseudomonas, acinetobacter spp, which can be laboratory contaminants as well, repeated isolation from the samples collected on consecutive occasions would be confirmatory. The harmless wayfarer once getting access to the raw denuded surface would turn very much active for deriving nutrients, unless hosts immune response is strong enough to curtail them.
  • Navin Kaore And as Anasua Deb said all the strains should be subjected to at least phenotypic methods for detection of antimicrobial resistance pattern ..
  • Abhishek Pathak Well said Rakesh Biswas.....sir but the point is even if they are harmless.....if we take it with a pintch of salt......even the, few years back, they were sensitive to those tested antibiotics....and these changing paradigm of sensitivity and no new antibiotic in the armamantorium, surely, the clock is ticking..........
  • Rakesh Biswas Thanks Abhishek, Anasua, Navin, Boudhayan for these thoughtful comments. Yes the evolutionary clock has been ticking for a long time now and humans are just a millisecond in that frame (just playing the time-bomb devil's advocate). I was hinting at a possible radical shift in our scientific mindset from being at war (as currently with our failing armamentarium that makes us even more scared) to being at peace with our primordial ancestors who invented evolution and the entire biome that has become a recent focus of research in the scientific community. Here's an article shared a while back by Prof Vinay Kumar which may throw more light into why we need this peace:
    Giving mice common intestinal bacteria eliminated peanut allergies

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