<h2>Microbiome Renovation</h2>
Transplants are a vital part of healthcare, <a href="https://optn.transplant.hrsa.gov/news/us-organ-transplants-and-deceased-donors-set-new-records-in-2016/">giving tens of thousands of people</a> in the United States a new lease on life. While organ transplants are relatively commonplace, a new form of transplantation is emerging to fight a life-threatening infection — one that impacts nearly half a million Americans, and is annually responsible an estimated 15,000 to 30,000 U.S. deaths.
However, these doctors aren&#8217;t transplanting an organ; they&#8217;re taking the fecal matter of ultra-healthy people and transplanting it into patients battling a Clostridium difficile (C. diff) infection, which causes severe diarrhea in sufferers.
<figure id="attachment_123422" style="width: 562px" class="wp-caption aligncenter"><img class="wp-image-123422 size-full" src="https://wp-assets.futurism.com/2018/02/ClostridiumDifficile.jpg" alt="Yellowish clusters of Clostridium difficile, the bacterial gut infection that fecal transplants have proven robust at treating." width="562" height="394" /><figcaption class="wp-caption-text">Clostridium difficile. Image source: Wikimedia Commons/CDC</figcaption></figure>
The Infectious Diseases Society of America (IDSA) has<a href="https://academic.oup.com/cid/advance-article/doi/10.1093/cid/cix1085/4855916"> issued new guidelines</a> that promote the use of fecal transplants to treat this infection. Poop transfers, if you will, may sound like a surreal way of treating any kind of illness, let alone a bacterial infection. Yet C. diff infections are most often the <a href="https://futurism.com/study-asserts-a-full-course-of-antibiotics-might-not-be-necessary-and-could-be-harmful/">result of antibiotic use</a>, which decimates the natural defenses of a healthy gut microbiome.
Fecal transplants are meant to take the <a href="https://futurism.com/scientists-harness-power-gut-bacteria-promote-health/">microbiomes of healthy donors</a> and allow them to flourish in the recipients, killing any C. diff infection along the way.
In the new guidelines, the ISDA notes a success rate nearing 90 percent of transplants, though long-term data on the effectiveness of the treatment is not yet available. A new registry is being developed by the American Gastroenterological Association, with support from the National Institute of Allergy and Infectious Diseases, to track 4,000 patients for ten years in hopes of gathering this kind of data. Thus far, weight gain has been reported in some transplant patients. <a href="https://www.statnews.com/2018/02/15/fecal-transplants-c-diff-idsa/">STAT reports that</a> some are concerned depression, allergies, diabetes and asthma — all believed to be associated with the gut microbiome — could also be transferred.
Prior to the advent of fecal transplants, patients had to undergo surgery to remove infected colons if other options were exhausted. The new guidelines will empower healthcare providers to utilize fecal transplant treatments in more cases, especially in patients who have been <a href="https://futurism.com/superbug-resistant-to-all-available-u-s-antibiotics-claims-victim/">resistant to traditional antibiotic</a> treatments.

Doctors are discovering the power of poo.

Fecal transplants see success in 90 percent of bacterial gut infections

Health & Medicine

New guidelines recommend increasing utilization of fecal transplants for the treatment of C. diff infections, which destroy the gut microbiome.

Fecal Transplants See Success in 90 Percent of Bacterial Gut Infections

This is a totally different type of transplant.

<h2>Micromotors </h2>
Nanoengineers at the University of California San Diego have demonstrated for the first time using micromotors to treat a bacterial infection in the stomach. These tiny vehicles, each about half the width of a human hair, swim rapidly throughout the stomach while neutralizing gastric acid and then release their cargo of antibiotics at the desired pH. Researchers published their findings on Aug. 16 in Nature Communications.
<figure id="attachment_99345" style="width: 800px" class="wp-caption aligncenter"><img class="size-full wp-image-99345" src="https://wp-assets.futurism.com/2017/09/drugdeliveri.jpg" alt="" width="800" height="355" /><figcaption class="wp-caption-text">Nanoengineers at UC San Diego have developed the first drug-delivering micromotors for treating bacterial infection. Image Source: Laboratory for Nanobioelectronics at UC San Diego</figcaption></figure>
This micromotor-enabled delivery approach is a promising new method for treating stomach and gastrointestinal tract diseases with <a class="textTag" href="https://phys.org/tags/acid/" rel="tag">acid</a>-sensitive drugs, researchers said. The effort is a collaboration between the research groups of nanoengineering professors Joseph Wang and Liangfang Zhang at the UC San Diego Jacobs School of Engineering. Wang and Zhang pioneered research on the in vivo operation of micromotors and this study represents the first example of drug-delivering micromotors for treating <a class="textTag" href="https://phys.org/tags/bacterial+infection/" rel="tag">bacterial infection</a>.
Gastric acid can be destructive to orally administered drugs such as antibiotics and protein-based pharmaceuticals. Drugs used to treat bacterial infections, ulcers and other diseases in the stomach are normally taken with additional substances, called proton pump inhibitors, to suppress <a class="textTag" href="https://phys.org/tags/gastric+acid/" rel="tag">gastric acid</a> production. But when taken over longer periods or in high doses, proton pump inhibitors can cause adverse side effects including headaches, diarrhea and fatigue. In more serious cases, they can cause anxiety or depression.
The micromotors have a built-in mechanism to neutralize gastric acid and effectively deliver their drug payloads in the stomach—without the use of proton pump inhibitors.
&#8220;It&#8217;s a one-step treatment with these micromotors, combining acid neutralization with therapeutic action,&#8221; said Berta Esteban-Fernández de Ávila, a postdoctoral scholar in Wang&#8217;s research group at UC San Diego and a co-first author of the paper.
Each <a class="textTag" href="https://phys.org/tags/micromotor/" rel="tag">micromotor</a> consists of a spherical magnesium core coated with a protective layer of titanium dioxide, followed by a layer of the antibiotic clarithromycin, and an outer layer of a positively-charged polymer called chitosan that enables the motors to stick to the <a class="textTag" href="https://phys.org/tags/stomach+wall/" rel="tag">stomach wall</a>.
This binding is also enhanced by the propulsion of the micromotors, which is fueled by the stomach&#8217;s own acid. The magnesium cores react with gastric acid, generating a stream of hydrogen microbubbles that propel the motors around inside the stomach. This reaction also temporarily reduces the amount of acid in the stomach, increasing the pH level enough to allow the micromotors to release the drug and perform treatment. The normal stomach pH is restored within 24 hours.
<h2>In Vivo</h2>
Researchers tested the micromotors in mice with Helicobacter pylori infections. The micromotors—packed with a clinical dose of the antibiotic clarithromycin—were administered orally once a day for five consecutive days. Afterwards, researchers evaluated the bacterial count in each mouse stomach and found that treatment with the micromotors was slightly more effective than when the same dose of antibiotic was given in combination with <a class="textTag" href="https://phys.org/tags/proton+pump+inhibitors/" rel="tag">proton pump inhibitors</a>.
The micromotors are mostly made of biodegradable materials. The magnesium cores and polymer layers are dissolved by gastric acid without producing harmful residues.
Researchers say that while the present results are promising, this work is still at an early stage. The team is planning future studies to further evaluate the therapeutic performance of the micromotors in vivo and compare it with other standard therapies against stomach diseases. Researchers also plan to test different drug combinations with the micromotors to treat multiple diseases in the <a class="textTag" href="https://phys.org/tags/stomach/" rel="tag">stomach</a> or in different sections of the gastrointestinal tract. Overall, the researchers say that this work opens the door to the use of synthetic motors as active delivery platforms for in vivo treatment of diseases.
This article was provided by <a class="textTag" href="http://www.ucsd.edu/portal/site/ucsd" rel="news">University of California &#8211; San Diego</a>. Materials may have been edited for clarity and br

It can neutralize gastric acid and then release their cargo of antibiotics at the desired pH.

Drug-delivering micromotors treat their first bacterial infection in the stomach

Epidemic bacterial disease

Researchers believe it's a promising new method for treating stomach and gastrointestinal tract diseases with acid-sensitive drugs

Drug-Delivering Micromotors Treat Their First Bacterial Infection in the Stomach

It could be a simple, one-step, all-around treatment.

<h2>Stealthily Spreading</h2>
Researchers have found evidence that drug-resistant superbugs, which have been labeled &#8220;nightmare bacteria,&#8221; are spreading faster and more stealthily inside US hospitals than previously thought.
In the US, the bacteria, known as <a href="https://en.wikipedia.org/wiki/Carbapenem-resistant_enterobacteriaceae">carbapenem-resistant Enterobacteriaceae</a> (CRE), infect roughly 9,300 people per year and <a href="https://www.eurekalert.org/pub_releases/2017-01/htcs-db011217.php">kill around 600</a>. And now researchers think they might spread from person to person asymptomatically &#8211; which explains why doctors are often unable to detect it.
&#8220;While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease,&#8221; <a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">said William Hanag</a> from the Harvard T. H. Chan School of Public Health.
&#8220;We need to look harder for this unobserved transmission within our communities and healthcare facilities if we want to stamp it out.&#8221;
<a href="https://www.cdc.gov/hai/organisms/cre/">CRE are a class of drug-resistant bacteria</a> that are even able to withstand carbapenems &#8211; last-resort drugs that are administered after all other antibiotics fail.
Enterobacteriaceae are a large family of bacteria that include bugs such as <a title="Salmonella" href="https://en.wikipedia.org/wiki/Salmonella">Salmonella</a>, <a title="Escherichia coli" href="https://en.wikipedia.org/wiki/Escherichia_coli">E. coli</a>, and <a title="Shigella" href="https://en.wikipedia.org/wiki/Shigella">Shigella</a> &#8211;all of which are common causes of food poisoning and stomach bugs.
When they&#8217;re not drug-resistant, these bacteria can easily be treated by antibiotics, but antibiotic resistance has increasingly been spread within the family.
The bacteria are known to thrive in hospitals and long-term care facilities, where they evolve and pass genes back and forth over time, eventually becoming deadly CSE superbugs that drugs cannot treat, and earning the researchers&#8217; title of &#8220;<a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">nightmare bacteria</a>.&#8221;
An official report last week showed that a <a href="http://www.sciencealert.com/a-us-woman-has-been-killed-by-a-superbug-resistant-to-every-available-antibiotic">US woman has already died from one superbug</a> &#8211; an antibiotic-resistant strain of pneumonia (not a type of CSE), which was resistant to all available antibiotics in the US.
<figure id="attachment_68034" style="width: 700px" class="wp-caption aligncenter"><img class="size-full wp-image-68034" src="https://wp-assets.futurism.com/2017/01/enterobacter.jpg" alt="Centers for Disease Control and Prevention" width="700" height="462" /><figcaption class="wp-caption-text">Photo credit: Centers for Disease Control and Prevention</figcaption></figure>
<h2>&#8220;Riot of Diversity&#8221;</h2>
Now, Hanage and his colleagues have discovered that CSE superbugs, at least, might be spreading at a much faster rate than expected, and are starting to avoid our normal &#8216;surveillance&#8217; methods by spreading asymptomatically.
&#8220;You know the phrase &#8216;Shutting the stable door after the horse has bolted?&#8217; The horse has not only bolted, the horse has had a lot of ponies, and they&#8217;re eating all our carrots,&#8221; <a href="https://www.statnews.com/2017/01/16/cre-superbug/">Hanage told Helen Branswell at Stat News</a>.
To figure out how rapidly CRE was diversifying and spreading, <a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">the team analyzed </a>over 250 samples from hospitalized patients in three different Boston-based facilities and one in California.
When finished, they found that CRE populations <a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">were way more diverse</a> than previously thought, meaning that drug-resistant genes had spread more rapidly and easily between the strains than expected.
The team called it a &#8220;<a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">riot of diversity</a>.&#8221;
Sometimes the species they found <a href="https://www.statnews.com/2017/01/16/cre-superbug/">didn&#8217;t even carry</a> the genes known to suppress carbapenems, but were still able to survive them, suggesting that they&#8217;ve found new ways to avoid these antibiotics that we don&#8217;t even know about yet.
&#8220;There are many different ways in which they can be resistant,&#8221; <a href="https://www.statnews.com/2017/01/16/cre-superbug/">Hanage told Stat News</a>.
To make things worse, the team wasn’t able to see a clear pattern of transmission for these CRE strains &#8211; the resistance seemed to be spreading even without any obvious cases of illness or infection.
&#8220;The best way to stop CRE making people sick is to prevent transmission in the first place,&#8221; <a href="https://www.hsph.harvard.edu/news/press-releases/drug-resistant-nightmare-bacteria-diversify-spread/">Hanage said</a>.
&#8220;If it is right that we are missing a lot of transmission, then only focusing on cases of disease is like playing Whack-a-Mole; we can be sure the bacteria will pop up again somewhere else.&#8221;
The team hypothesizes that these transmissions might be happening from person to person asymptomatically, though they will need to <a href="https://www.statnews.com/2017/01/16/cre-superbug/">carry out further studies</a> to verify this is the case.
The research has been published in <a href="http://www.pnas.org/content/early/2017/01/10/1616248114.abstract">Proceedings of the National Academy of Sciences</a>.

An antibiotic resistant bacteria, CSE, is rapidly spreading through hospitals across the United States, infecting 9,000 and killing 600 people per year.
The spread of the superbug is difficult to track as individuals who contract it and spread it are often asymptomatic. 

Drug-Resistant “Nightmare Bacteria” Are Quickly Spreading Through U.S. Hospitals

This killer superbug spreads silently.

<h2>Resilient Bugger</h2>
The issue of <a href="https://futurism.com/?s=superbugs" target="_blank">superbugs</a> that have incredible <a href="https://futurism.com/?s=antibiotic+resistance" target="_blank">antibiotic resistance</a> isn&#8217;t new. In 2016, the <a href="http://www.un.org/en/index.html" target="_blank">United Nations (UN)</a> even <a href="https://futurism.com/un-classifies-antibiotic-resistance-as-a-crisis-putting-it-on-par-with-ebola-and-hiv/" target="_blank">elevated the problem of antibiotic resistance</a> to crisis level, declaring it a &#8220;fundamental, long-term threat to human health, sustainable food production and development,&#8221; in the words of UN Secretary-General <a href="http://www.un.org/apps/news/story.asp?NewsID=55011" target="_blank">Ban Ki-moon</a>.
The antibiotic resistance crisis and the growth of superbugs go hand in hand, obviously, and for the first time ever, the <a href="https://www.cdc.gov/" target="_blank">Center for Disease Control and Prevention (CDC)</a> has now <a href="https://www.cdc.gov/mmwr/volumes/66/wr/mm6601a7.htm?s_cid=mm6601a7_e" target="_blank">issued a report</a> about a patient dying from a superbug that&#8217;s immune to all 26 antibiotics available in the United States.
The report reads:
<blockquote>On August 25, 2016, the Washoe County Health District in Reno, Nevada, was notified of a patient at an acute care hospital with carbapenem-resistant Enterobacteriaceae (CRE) that was resistant to all available antimicrobial drugs. The specific CRE, Klebsiella pneumoniae, was isolated from a wound specimen collected on August 19, 2016. After CRE was identified, the patient was placed in a single room under contact precautions. The patient had a history of recent hospitalization outside the United States. </blockquote>
The patient was a 70-year-old woman previously hospitalized in India due to a fractured leg, which lead to an infection of the bone. The infection appeared to be resistant to the 26 antibiotics available in the U.S. Post-mortem analysis of the superbug, however, revealed that it was somewhat susceptible to fosfomycin, an antibiotic that isn&#8217;t approved in the U.S. for treatment of the patient&#8217;s type of infection.
<h2>The Path to Superbugs</h2>
<figure id="attachment_67492" style="width: 287px" class="wp-caption alignright"><img class="size-medium wp-image-67492" src="https://wp-assets.futurism.com/2017/01/13383468143_3d6884d0a8_z-287x300.jpg" alt="antibiotic resistance superbugs bacterial infection" width="287" height="300" /><figcaption class="wp-caption-text">Klebsiella pneumoniae bacterium. Credits: NIH NIAID</figcaption></figure>
So how did this superbug manage to become resistant to 26 types of antimicrobial drugs?
One possible way of developing resistance to certain or all antibiotics is through an exchange of bacterial plasmid — a loop-free floating DNA that bacteria can pass back and forth between each other. Say bacteria A is colistin resistant and it meets bacteria B in your gut, which is resistant to carbapanems. While these bacteria remain inactive, they can continue to exchange plasmids with other bacteria that you might get exposed to. The result is a pan-resistant superbug.
Perhaps even more troubling than this particular superbug&#8217;s resistance to all 26 antibiotics, though, is its particular resistance to one, colistin. Colistin is often considered the last-resort antibiotic, and resistance to it is usually caused by the mcr-1 gene. However, according to the CDC, &#8220;Because of a high minimum inhibitory concentration (MIC) to colistin, the isolate was tested at CDC for the mcr-1 gene, which confers plasma-mediated resistance to colistin; the results were negative.&#8221;  So not only was this superbug resistant to colistin, we don&#8217;t know why it was resistant.
The victim in the CDC&#8217;s report was kept in isolation during her hospital visit, and thus far, no one has observed any recurrences of this CRE bacteria in the other patients from the hospital. However, there&#8217;s no guarantee yet that this superbug is officially gone. Even if it is, other universally resistant superbugs are likely to emerge in the future. So is there anything that we can do at the moment to fight superbugs? Thankfully, a number of <a href="https://futurism.com/?s=fighting+superbugs" target="_blank">initiatives and studies</a> are currently being worked on, so hopefully an alternative to current antibiotics will be found before one of these superbugs spreads significantly.

The CDC has issued a report about a patient dying from a superbug that's immune to all 26 antibiotics available in the United States, including one considered a "last-resort."
A number of initiatives and studies are currently being worked on, so hopefully an alternative to current antibiotics will be found before one of these superbugs spreads significantly.

/Bacterial Infection

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Drug-Resistant “Nightmare Bacteria” Are Quickly Spreading Through U.S. Hospitals

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Superbug Resistant to All Available U.S. Antibiotics Claims Victim

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