Antibacterial Resistance in Pediatric Patients

A recent paper in the Journal of the Pediatric Infectious Diseases Society discusses the rising rates of antibacterial resistance in pediatric patients. It’s an alarming (but not surprising) paper that serves as yet another call to action. Modern medicine is in jeopardy; my hope is that it’s not to late to stop the oncoming catastrophe.

As always, Maryn McKenna over at Superbug has an excellent write-up.

If you’d like to read the paper, it’s here.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

Listeria monocytogenes

The FDA is currently reporting an outbreak of Listeria monocytogenes in some Hispanic-style cheeses. While Listeria isn’t listed in the top five pathogens that cause food poisoning, it’s number four on the list of foodborne pathogens that cause death. It also causes meningitis, encephalitis, and septicemia; in pregnant women, it can cross the placenta and cause abortion, stillbirth, or premature birth. Perhaps now would be a good time for a refresher course in this bacterium.

Listeria grows on blood agar; this growth can be enhanced by cold enrichment. Selective enrichment–inhibiting other organisms while bolstering the growth of Listeria–is recommended if the specimen is food or environmental in nature. Other characteristics include:

  • Short gram-positive rods
  • motile
  • Beta-hemolytic
  • Smooth, light gray, 1-2 mm colonies after 24-48 hours of incubation at 37 degrees C
  • Will grow at 4 degrees C
  • facilitative anaerobe
  • catalase positive
  • oxidase negative

Listeria can be hard to identify, not because it’s fastidious, but because it can be confused with organisms such as Group B Streptococcus, Erysipelothrix, and corynebacterium. Don’t let that happen to you!

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

 

 

 

Gut Flora and Chron’s Disease

I’m fascinated by the connection between gut flora and overall health. I just stumbled onto this article that discusses the connection between gut flora and Chron’s Disease. It’s based on this paper published in Cell. Recent articles about antibiotic’s role in obesity and papers on gut flora’s influence on the immune system  keep raising the issue: how much do common organisms like E. coli, Clostridium perfringes, and Bacteroides fragilis affect us? How can we use them to diagnose, prevent, or cure disease? I’ll be keeping my eye on future research.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

 

Antibiotic Stewardship

The draft of the federal budget released Tuesday allocates $30 million dollars in CDC funding in order to combat antibiotic resistance. Obviously the 2015 budget isn’t finalized, but even so, it’s encouraging that the Department of Health and Human Services recognizes the need for antibiotic stewardship.

What is antibiotic stewardship, you ask? Basically, it’s a program within a healthcare community that dictates the best practices for prescribing antibiotics. Such programs would be tailored for each setting based on population demographics and antibiograms. Perhaps a program would prohibit prescribing, say, ciprofloxacin for urinary tract infections because a rise in the percentage of strains of E. coli resistant to fluoroquinolones has been noted. Maybe the program would discourage prescribing more than two antibiotics at once to a patient, or suggest antibiotics other than vancomycin (such as levoquin) when treating MRSA.

Creating a stewardship program requires input from several departments (Infectious Disease, Pharmacy, Epidemiology, and the Microbiology Laboratory) as well as acceptance by the clinician population at large. In my experience, this has been the limiting factor. Physicians don’t like being told what they can and can’t do for their patients or the insinuation that they might lack the proper knowledge about antimicrobials and microbiology to provide good patient care. This is a hurdle that hospitals will have to overcome in order to make stewardship programs a success. (Mentioning that such programs can save money and shorten hospital stays could help tip the scales.)

If you’d like to institute a stewardship program at your institution, here are a few links to get you started:

CDC’s Vital Signs about prescribing practices
Antibiotic management guidelines at John Hopkins
Professional practice resources from the Association for Professionals in Infection Control and Epidemiology
The ever-insightful Maryn McKenna over at Superbug discusses the topic at length

Does your institution have an antibiotic stewardship program? If so, what steps did you have to take in order to implement it?

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Vinegar to the Rescue

Can a common pantry staple kill bacteria? Possibly, according a paper recently published in mBio. Researchers mixed acetic acid–the main ingredient in white vinegar–with suspensions of bacterial cultures and found that a exposure times as little as 20 minutes reduced the viable bacterial population by 710. The researchers then performed the same experiment, this time swapping out hydrochloric acid for the vinegar; they noted no bactericidal effect. Mycobacterium tuberculosis required a longer kill time (30 minutes vs. 20 minutes) to reach a 810 reduction in population.

These results suggest that vinegar could be used as a cheap-yet-effective disinfectant in resource-poor laboratory settings.

 

 

 

MALDI-TOF podcasts

Recently Dr. Nate Ledeboer from the University of Wisconsin talked with Lab Medicine about the clinical applications of MALDI-TOF in the clinical microbiology laboratory. The first podcast discusses anaerobic identification and the second discusses the identification of mycobacteria and fungi.

If you’re interested in listening to more Lab Medicine podcasts, you can find them here and here. 

 

 

Want Some Wine With That?

The other day I read an interesting tidbit about acne bacteria found in grapevines. Propionibacterium acnes–an anaerobic gram-positive bacilli that lives on human skin and occasionally causes acne–was found in the bark and pith of grapevines in Italy. The researchers could have assumed the bacteria was a contaminant, but they didn’t. Inspired by Frank Zappa’s propensity for thinking outside the box, they delved a little deeper and realized this strain has been living on grapevines for thousands of years.

The best part? They named it Propionibacterium acnes type Zappae.

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.