Wednesday, January 31, 2007
The Good Bacteria We Need
The Good Bacteria We Need
Gut Feeling: Some Bacteria Need to Survive
Monday, January 29, 2007 / Dr. Dennis Godby
Americans fill 300 million antibiotic prescriptions every year – one for every man, woman and child. Antibiotics have undoubtedly saved many lives, including my son at 6 years of age, and have significantly reduced suffering for millions of others. However, this column is about the other critically important part of the story about antibiotics that does not seem to be reaching the masses, and could be jeopardizing the American people’s health – maybe even yours or your loved one’s health.
The very word “antibiotic” means “against life.” Antibiotics kill harmful and beneficial bacteria. How often do you hear people talking “around the kitchen table,” about the good, essential to life bacteria in our gut, where 100 trillion plus bugs live - a greater number of bacteria than all the cells of the body - 100 to 500 bacterial species.
When the balance between the “good” (about 85%) and the “bad” bacteria and yeast (about 10-15%) is disrupted, a condition can develop called “dysbiosis” – which is almost always caused by heavy use of antibiotics. If left untreated, it can result in very serious, and tragic health consequences.
There are many things you can to improve your levels of friendly flora (bacteria) in your gut. Nutrition makes a huge difference in the body’s population of gut bacteria. Adding soluble fiber to your diet helps to grow friendly bacteria; reducing or eliminating sugar and other simple carbohydrates, which grows unfriendly bugs, is very helpful. Eating: tempeh (fermented soy), sauerkraut, cultured foods like organic, unsweetened yogurt or kefir that contain live cultures, identified on the label, such as: L. acidophilus, or B. Bifidobacterium, contribute greatly to gut health.
For best results with treating or preventing dysbiosis, friendly flora supplements called “probiotics” are also available. However, it is imperative to choose a brand where the probiotics have been assayed for: high levels of live, beneficial organisms and contains no contaminants. Very few brands meet this criteria. The absolute minimum dosage is 2.5 billion live organisms per day, and up to 20 billion for more serious conditions. Studies have shown that, amazingly, it takes approximately 18 months of supplementation with a high quality probiotic to replenish the flora after just one 7-day course of antibiotics.
Probiotics, clinically and in research, are known to: significantly improve digestion, help increase tolerance to lactose, reduce blood cholesterol, enhance immune system, deactivate potential cancer-causing chemicals, enhance and balance estrogen, protect against food poisoning, and many other benefits
Friday, January 26, 2007
Community-acquired methicillin-resistant Staphylococcus aureus skin infections
1: Int J Dermatol. 2007 Jan;46(1):1-11.
University of Houston Health Center, University of Houston, Houston, Texas.
Correspondence Philip R. Cohen, md 805 Anderson Street Bellaire, TX 77401-2806 E-mail: firstname.lastname@example.org
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia.
The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection.
International Journal of Dermatology
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Community-acquired methicillin-resistant Staphylococcus aureus skin infection presenting as a periumbilical folliculitis.
1: Cutis. 2006 Apr;77(4):229-32
University of Houston Health Center, Texas, USA.
Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a clinical problem of increasing global incidence. CAMRSA most commonly presents as abscess and cellulitis of the skin and soft tissue. However, the lesions of cutaneous CAMRSA infection are pleomorphic and may appear as erythematous pustules of superficial folliculitis. This report presents the cases of 2 patients with CAMRSA skin infection that presented as a superficial folliculitis. The distribution of CAMRSA-related, erythematous, folliculocentric pustules was periumbilical, in contrast to the lesional location of methicillin-susceptible S. aureus (MSSA)-associated folliculitis, which typically appears on the axillae, bearded area, buttocks, and extremities. CAMRSA should be considered in the diagnosis of periumbilical folliculitis or superficial folliculitis arising in areas not typically affected by MSSA-related folliculitis, such as the chest, flanks, and scrotum.
PMID: 16706240 [PubMed - indexed for MEDLINE]
Monday, January 22, 2007
Bacterial Infections in Cirrhosis
1: Can J Gastroenterol. 2004 Jun;18(6):405-6.
Yale University School of Medicine, New Haven, Connecticut 06520-8019, USA. email@example.com
Hospitalized patients with cirrhosis are at increased risk of developing bacterial infections, the most common being spontaneous bacterial peritonitis (SBP) and urinary tract infections. Independent predictors of the development of bacterial infections in hospitalized cirrhotic patients are poor liver synthetic function and admission for gastrointestinal hemorrhage. Short term (seven-day) prophylaxis with norfloxacin reduces the rate of infections and improves survival and should therefore be administered to all patients with cirrhosis and variceal hemorrhage. Cirrhotic patients who develop abdominal pain, tenderness, fever, renal failure or hepatic encephalopathy should undergo diagnostic paracentesis, and those who meet the criterion for SBP (eg, an ascites neutrophil count greater than 250/mm3) should receive antibiotics, preferably a third-generation cephalosporin. In addition to antibiotic therapy, albumin infusions have been shown to reduce the risk of renal failure and mortality in patients with SBP, particularly in those with renal dysfunction and hyperbilirubinemia at the time of diagnosis. Patients who recover from an episode of SBP should be given long term prophylaxis with norfloxacin and should be assessed for liver transplantation.
PMID: 15190398 [PubMed - indexed for MEDLINE]
Division of Digestive Diseases, Yale University School of Medicine, VA CT Healthcare System, 333 Cedar St - 1080 LMP, P.O. Box 208019, New Haven, CT 06520, USA.
Patients with cirrhosis have altered immune defenses and are considered immunocompromised individuals. Changes in gut motility, mucosal defense and microflora allow for translocation of enteric bacteria into mesenteric lymph nodes and the blood stream. Additionally, the cirrhotic liver is ineffective at clearing bacteria and associated endotoxins from the blood thus allowing for seeding of the sterile peritoneal fluid. Thus, hospitalised cirrhotic patients, particularly those with gastrointestinal hemorrhage, are at high risk of developing bacterial infections, the most common being spontaneous bacterial peritonitis. Given the significant morbidity and mortality associated with spontaneous bacterial peritonitis and the fact that half of the cases are community acquired, all hospitalised cirrhotic patients should have a diagnostic paracentesis to exclude infection. Those admitted with gastrointestinal bleed and a negative paracentesis require short-term prophylaxis with norfloxacin. A third generation cephalosporin is the treatment of choice for spontaneous bacterial peritonitis and, once the acute infection is resolved, secondary prophylaxis with oral norfloxacin is warranted. Patients who develop renal dysfunction at the time of active infection have the highest mortality and require adjunctive albumin therapy. This article reviews the pathogenesis of SBP, the evidence behind the antibiotics used, the rationale for adjunctive albumin therapy in the setting of acute renal failure, and the role of prophylactic antibiotics in specific high-risk populations.
PMID: 17223498 [PubMed - in process]
J Gastroenterol Hepatol. 2005 Apr;20(4):599-605.
Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a serious complication of cirrhosis with ascites, having high recurrence despite antibiotic prophylaxis. Small bowel dysmotility and bacterial overgrowth have been documented to be related to SBP. The purpose of the present paper was (i) to study whether addition of a prokinetic agent to norfloxacin ameliorates the development of SBP in high-risk patients; and (ii) to identify risk factors for SBP development.
METHODS: A prospective, single blinded, randomized controlled trial was conducted in high-risk cirrhotic patients with ascites who had either recovered from an episode of SBP or who had low ascitic fluid protein. Norfloxacin 400 mg once daily (group I) or norfloxacin 400 mg once daily with cisapride 20 mg twice a day (group II) was given and occurrence of side-effects of therapy and mortality were recorded.
RESULTS: Of the 94 patients, 48 (51%) were in group I, and 46 (49%) in group II. The actuarial probability of developing SBP at 12 month in group I was 56.8% and in group II, 21.7% (P = 0.026). Treatment failure was observed in five patients (10%) in group I and none in group II (P = 0.003). The actuarial probability of death at 18 months was 20.6% in group I and 6.2% in group II (P = 0.1). Low serum albumin, low ascitic fluid protein and alcoholic cirrhosis were related to development of SBP (P <>
CONCLUSIONS: Prophylaxis with norfloxacin and cisapride significantly reduces the incidence of SBP in high-risk cirrhosis patients; low serum albumin, low ascitic fluid protein and alcoholic cirrhosis predispose to the development of SBP in high-risk cirrhosis patients; and low ascitic fluid protein should also be considered as a risk factor for the development of SBP requiring prophylaxis.
Key Words: Ascites, Cirrhosis, Cisapride, Norfloxacin, Prokinetics, SBP, Spontaneous bacterial peritonitis
Tuesday, January 16, 2007
Methicillin-Resistant Staphylococcus Aureus (MRSA) - Evolved Bacteria not a Pandemic
Tuesday January 16, 2007
A recent outbreak of Methicillin-Resistant Staphylococcus Aureus (MRSA) in professional athletes' locker rooms in the US has been spotted in Canada.
However, Dr. Mohammad Kahn, the Medical Health Officer with the Kelsey Trail Health Region said it is not the beginning of a pandemic outbreak."It has nothing to do with the pandemic," Kahn said."It is a common bacteria, that has, with the passage of time and with some factors in place, developed a resistance to a group of antibiotics."
He said the bacteria commonly referred to as staph or staphA is common on the skin and around the nostrils and can become infective in some people, but not everybody."
It is in every human being, but is not infective. It becomes infective in certain conditions. If a person has low immunity or if a person has some conditions then the bug becomes infective."Originally thought to exist only in hospitals or care homes it is being spotted more frequently in different communities.
Although it hasn't been found in Melfort Kahn said there have been reports of it in the northern parts of the health region.
Even though MSRA is resistant to some antibiotics it can be treated using different medications."
It is not that dangerous, it could be treated with antibiotics, but the thing is it should be diagnosed early and then use the proper antibiotics to be effective against this bug."
Symptoms of the staph infection include skin lesions, which should be tested quickly. To slow down or even stop the spread of the infection doctors urge people to wash their hands with soap or use an alcohol based gel and to cover sneezes or coughs to prevent spreading it through the air.
Treatment to rid colonized patients of MRSA
Updated Tue. Jan. 16 2007 8:23 AM ET
TORONTO -- Canadian researchers have shown for the first time that a treatment to rid hospital patients who are carrying but not yet infected with a potent superbug can work, potentially offering hospitals a way to both reduce the risk of illness for individual patients and lower levels of dangerous bacteria in their facilities.
A seven-day course of treatment with the new combination therapy was effective over the long term (three months) in eradicating methicillin-resistant Staphylococcus aureus - better known as MRSA - from between 60 and 70 per cent of treated patients, said the study, reported Monday in the journal Clinical Infectious Diseases.
Even at eight months 54 per cent of treated patients remained free of the bacterium, which is a major cause of hospital-acquired infections and is becoming a significant source of serious illness among non-hospitalized people as well.
Lead author Dr. Andrew Simor said this is the first study to show therapy to "decolonize" MRSA carriers can be effective over an extended period of time.
"Lots of treatment has been shown to work for a shorter period of time. But what's the point? If you clear it for a month or two but then you're positive again, you haven't gained anything," said Simor, head of microbiology at Toronto's Sunnybrook Health Sciences Centre.
The treatment is a combination of antibiotic ointment applied to skin sites where the bacteria is normally found, baths with antiseptic soap and oral antibiotics.
MRSA is one of a number of types of bacteria that are said to "colonize" people.
The bacteria can lurk in the nostrils, groin or around the anus of people who've been exposed to it without making them sick. But the bacteria can go on to trigger illness, especially when carriers go into hospital for medical care.
Between 20 and 30 per cent of carriers go on to develop an MRSA-induced illness, ranging from skin or wound infections to abscesses to pneumonia.
And MRSA carriers aren't simply a risk to themselves. They can infect other patients - which is why hospitals isolate people known to be MRSA carriers. Placing patients in isolation eats up scarce resources, says Dr. John Embil, head of infection control for the Winnipeg Regional Health Authority and director of the infection control unit of the Canadian Healthcare Association.
"The reality is in every single facility it is a colossal problem because we're decreasing the readily available number of rooms if we have to isolate people," Embil said from Winnipeg.
It's been estimated that an MRSA infection picked up in hospital adds between four and 21 days to the length of a hospital stay and costs, on average, $15,000 to treat per patient.
Simor said the most recent estimate of MRSA's cost to the Canadian health-care system is at least $250 million a year.
The treatment he and his co-authors - from several Toronto and Vancouver hospitals and from McMaster University - devised costs about $20 to $30 per treatment course.
Previous efforts to clear colonized hospital patients of MRSA have been mixed. And when they have worked the effect has been short lived.
For this study, patients found to be colonized with MRSA were randomized to receive either no decolonization treatment or were given the combination treatment.
Embil found the results impressive, but said one study doesn't generally lead to a complete switch in treatment protocols.
"You always have to be careful. You can't jump and change your entire practice based on one report. However it's certainly a very important and valuable report that may help us rethink what we do and how we do it," he said, suggested his team will likely try to decolonize carefully selected patients using this "more aggressive approach."
A commentary in the journal by Dr. Suzanne Bradley of the University of Michigan Medical School in Ann Arbor said it would be important to ensure that the treatment didn't have unintended consequences, clearing carriers of more benign strains of MRSA only to open them up to recolonization with more dangerous strains causing an upswing in so-called community-acquired cases.
"We must be vigilant that our attempts to eradicate old strains do not facilitate the acquisition of strains that contain virulence determinants," Bradley wrote.
And Simor himself raised another possible concern, saying infection control specialists would need to watch to ensure the treatment didn't accelerate antibiotic resistance in MRSA strains.
"That remains a potential concern and a potential drawback," he said.
Wednesday, January 10, 2007
Toward Pinpointing The Location Of Bacterial Infections
Science Daily — In an advance in the emerging field of bacterial imaging, scientists are reporting development of a method for identifying specific sites of localized bacterial infections in living animals.
Bradley D. Smith at the University of Notre Dame and colleagues describe the method in a report scheduled for the Jan. 10 edition of the Journal of the American Chemical Society, a weekly publication.
The researchers previously discovered fluorescent molecular probes containing zinc that could be used to discriminate between common pathogenic bacteria -- such as E. coli and Staphylococcus aureus -- and mammalian cells.
In new research, they report using the probes to pinpoint the sites of staph infections in living laboratory mice. In everyday medicine, physicians may have difficulty distinguishing localized bacterial infections from sites of sterile inflammation.
"Bacterial imaging is an emerging technology that has many health and environmental applications," the researchers note.
"For example, there is an obvious need to develop highly sensitive assays that can detect very small numbers of pathogenic bacterial cells in food, drinking water, or biomedical samples. In other situations, the goal is to study in vivo the temporal and spatial distribution of bacteria in live animals."
Note: This story has been adapted from a news release issued by American Chemical Society.
Friday, January 05, 2007
Pseudomonas aeruginosa colonisation in bronchiectatic patients and clinical reflections.
Department of Chest Disease, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey. firstname.lastname@example.org.
Bronchiectasis is characterized with irreversible dilatation according to destruction of epithelium, elastic and muscular layer. Most important cause of bronchiectasis is chronic bacterial infections. Pseudomonas aeruginosa colonisation is frequently seen in bronchiectatic patients.
We aimed to find out P. aeruginosa colonisation frequency and clinical, radiological and spirometric reflections due to colonisation. We analysed 83 cases retrospectively. Mean age was 58.2 and 54.2% of them were female. Bronchiectasis were localised 19.3% in left lung, 19.3% right and 61.4% bilateraly. 29 (35.8%) normal, 28 (34.6%) obstructive, 7 (8.6%) restrictive, 17 (21%) mixt type disorders are detected in spirometric measures. Sputum culture performed in 50 cases. No microorganism colonisation determined in 30 (60%) cases, P. aeruginosa colonisation 16 (32%), Haemophilus influenzae 2 (4%), 1 (2%) Streptococcus pneumoniae and Proteus mirabilis 1 (2%) cases. P. aeruginosa colonisation determined more frequent in males (p<> 0.05). In cases with colonisation; clubbing and hemoptysis were significantly frequent (p<> 0.05). Hospitalization rate was higher in P. aeruginosa colonised cases (p> 0.05).
It is an important problem about mortality because of higher hemoptysis and hospitalisation requirement rate in P. aeruginosa colonised cases.
PMID: 17203422 [PubMed - as supplied by publisher]
Monday, January 01, 2007
New Method to Quickly Detect E. Coli and Salmonella Bacteria
Dec. 29, 2006
Researchers at Purdue University have used a new technique to rapidly detect and precisely identify bacteria, including dangerous E. coli, without the time-consuming treatments usually required.
The technique, called desorption electrospray ionization, or DESI, could be used to create a new class of fast, accurate detectors for applications ranging from food safety to homeland security, said R. Graham Cooks, the Henry Bohn Hass Distinguished Professor of Chemistry in Purdue's College of Science.
Using a mass spectrometer to analyze bacteria and other microorganisms ordinarily takes several hours and requires that samples be specially treated and prepared in a lengthy series of steps. DESI eliminates the pretreatment steps, enabling researchers to take "fingerprints" of bacteria in less than a minute using a mass spectrometer.
"This is the first time we've been able to chemically analyze and accurately identify the type of bacteria using a mass spectrometer without any prior pretreatment within a matter of seconds," Cooks said.
New findings show how the Purdue researchers used the method to detect living, untreated bacteria, including E. coli and Salmonella typhimurium, both of which cause potentially fatal infections in humans.
"There is always an advantage to the analysis of living systems because the bacteria retain their original properties," Cooks said.
The findings are detailed in a paper appearing in the journal Chemical Communications. The paper was written by chemistry graduate students Yishu Song, Nari Talaty and Zhengzheng Pan; Andy W. Tao, an assistant professor of biochemistry; and Cooks.
Mass spectrometry works by turning molecules into ions, or electrically charged versions of themselves, inside the instrument's vacuum chamber. Once ionized, the molecules can be more easily manipulated, detected and analyzed based on their masses.
The key DESI innovation is performing the ionization step in the air or directly on surfaces outside of the mass spectrometer's vacuum chamber. When combined with portable mass spectrometers also under development at Purdue, DESI promises to provide a new class of compact detectors.
Purdue researchers are focusing on three potential applications for detecting and identifying pathogens: food safety, medical analysis and homeland security. Such a detector could quickly analyze foods, medical cultures and the air in hospitals, subway stations and airports, Cooks said.
The researchers are able to detect one nanogram, or a billionth of a gram, of a particular bacterium. More importantly, the method enables researchers to identify a particular bacterium down to its subspecies, a level of accuracy needed to detect and track infectious pathogens. The identifications are based on specific chemical compounds, called lipids and fatty acids, in the bacteria.
"We can determine the subspecies and glean other information by looking at the pattern of chemicals making up the pathogen, a sort of fingerprint revealed by mass spectrometry," Cooks said. "Conventional wisdom says quick methods such as ours will not be highly chemically or biologically specific, but we have proven that this technique is extremely accurate."
The procedure involves spraying water in the presence of an electric field, causing water molecules to become positively charged "hydronium ions," which contain an extra proton.
When the positively charged droplets come into contact with the sample being tested, the hydronium ions transfer their extra proton to molecules in the sample, turning them into ions. The ionized molecules are then vacuumed from the surface into the mass spectrometer, where the masses of the ions are measured and the material analyzed.
Such a system could alert employees in the food and health-care industries to the presence of pathogens and could provide security personnel with a new tool for screening suspicious suitcases or packages.