Thesis proposal about antibiotic resistance pathogens in fomities - Dissertation Example

?Thesis Proposal Inserts His/Her Inserts Grade Inserts 16.11 In modern time the extensive use of antibiotics in treatment of bacterial infections has led to some organisms developing resistance to some antibiotic. Antibiotic resistance can be defined as a form of drug resistance in which the targeted microorganisms can resist exposure to the same drug (Hawkey, 3) Spontaneous genetic mutation in bacteria may confer resistance to microbial drug. Few pathogens exhibit resistance to antibiotics. Genes that confer resistance to drugs can however be transferred between microorganisms (Hawkey and Jones, 7). This transfer can occur through three different ways namely; transformation, transduction or by conjugation. This transfer makes many bacteria to develop resistance. Antibiotic resistance can, therefore, occur naturally. In this natural occurrence, the causative gene becomes shared between organisms in close proximity of one another (Birgit Strommenger, 3). In such occurrence, the bacteria cannot be exposed to treatment. Exposure to antibiotics at this stage can cause evolutionary stress which leads to the development of the resistant trait. Plasmids can be defined as DNA molecules separate from the chromosomal DNA with the ability to replicate on their own (Abad and R M Pinto, 65). Most antibiotic resistant genes reside within these plasmids. The ability of plasmids to replicate independently makes it extremely difficult to kill the microorganisms residing in them. Some organisms possess several resistant genes. Multidrug resistant is the formal name given to such organisms. Informally, they can be referred as superbugs. Executive summary This is a research based proposal which seeks to explore into the area of antibiotic resistance by commonly found infectious bacteria. The proposal focuses on gastrointestinal infection causing microorganisms which exhibit antibiotic resistance traits. The proposal further seeks to establish the existence of these bacteria within the hospital environments (Neely AN, 724). The relationship between the organism and Hospital Acquired infections falls among the aspects which this proposal seeks to explore. The proposal further aims at establishing the various fomites within the hospitals which may carry host to these pathogens. The factors which aid the pathogens in the spread have also been put into consideration within this proposal. Introduction The extensive use of antibiotics in modern day medical treatments has brought about many challenges into the field of medicine. Several microorganisms when exposed to these drugs develop resistance to the drug. This in turn translates to a difficult dilemma to medical practitioners. The only way to treat these infections is through exposing them to drugs. This exposure, however, makes them develop resistance to the same drugs (Hawkey, 4). This proposal explores the various pathogens which have developed this trait. The role of these pathogens in Hospital Acquired Infection and the transmission routes for the pathogens are also evaluated. Causes of antibiotic resistance Numerous reasons have been cited for the widespread resistance to antibiotics in modern medicine. The extensive use of antibiotic in modern medicine has been one of the major contributors to this emerging trend. Overreliance on antibiotic has been a leading factor to the development of multidrug resistance among pathogens (Hawkey and Jones, 7). The multidrug resistant pathogens have also become prevalent between many bacterial species which did not previously exhibit these characteristics. This can be attributed to the ability of certain bacteria to transfer the resistant gene to others. The misuse and overuse of antibiotics by both doctors and patients alike has been quoted as the major cause of drug resistance. Other factors have been the addition of antibiotics into animal feeds, and fraudulent practices among the manufacturers within the pharmaceutical industry. There is a need for the individuals involved within the industry to induce remedies to these factors. This would be the most efficient way of handling drug resistance in pathogens. Several studies have been done to try and come up with solutions for curing infections associated with drug resistant microorganisms. The easier method would be dealing with the agents that spread the pathogens (Theobald, 222). This would be better as the pathogens might be able to develop resistance to new drugs which may be introduced. Recent research, on cleaning in hospitals, indicates that hand touch sites, like computer keyboards, habitually get contaminated with hospital pathogens. Nosocomial infections are defines as infections whose development is highly favoured by the hospital environment (Hirai Y, 195). They can also be referred as Hospital Acquired Infections (HAI). The favourable condition within hospital environments is provided by there being numerous people, with different infections, within the same area. Fomites can be defined as the inanimate objects with the ability to host pathogens and transmit it to an individual who comes into contact with it. Fomites play an important role in spread of Hospital Acquired Infections as they act as transmission agents (Neely AN, 724). Being inanimate, fomites do not exhibit symptoms of infection with bacteria making it hard to detect the presence of bacteria on them (Axel Kramer,1). There are numerous fomites within the hospital environment which accelerate nosocomial infections. Equipment commonly shared between hospitals personnel can be the common fomites through which pathogen are carried can be highly attributed to low hygiene levels observed by hospital staff members. Within the intensive care units, for example, mortality in critically ill nonate has been attributed to hospital acquired infections. The rate of spread for these infections becomes high in the intensive care units when proper hygiene fails to be observed. This should be done by the hospital staff as well as the patients being treated. The pathogens There exist several pathogens known to exhibit drug resistance traits. Extensive studies have been conducted with the aim of coming up with new drugs to cure infections caused by these pathogens. These pathogens exist from different species within the same genus (Hirai Y, 196). There are some which can be able to survive within hospital environments. The most common names which have been identified to survive within hospitals environments include Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter (Culligan, 63). Drug resistant pathogens cause different types of infections in the body. There are several of them which affect the gastrointestinal tract of humans. When these infections occur certain common symptoms are exhibited by the patients. The general ones include diarrhoea, dehydration, nausea, and vomiting. Clostridium difficile Clostridium difficile has been identified as one of the drug resistant pathogens associated with gastro intestinal infections. It is among the most widespread pathogens known to cause nosocomical infections (Stroehlein, 238). This pathogen can be found almost everywhere in the world. Immunoblot is a commonly used analytical technique of identifying specific proteins in tissue extracts. The identification of this strain can be done through time-space clustering of incident cases with identical immunoblot types. The nosocomical strain of C. defficile causes diarrhoea in the infected patients (Stroehlein, 237). The other symptoms associated with infection by these bacteria include vomiting and dehydration. It the infection occurs in the gastrointestinal tract. The bacterium can be transmitted in several routes within hospital environment (VK Viswanathan,2). The most common route of transmission of this pathogen, in hospitals, has been identified as patient-to-patient mode. This conclusion was arrived at by observing the hospital staff taking care of individuals infected with a positive culture of clostridium defficile. Medical staffs, working in the wards hosting infected patients, are the most common transmission agents of the pathogen. When a worker visits the ward, he/she carries with him/her the pathogens on the hands. The pathogens are then transmitted to susceptible individuals from the hands of the person carrying them (VK Viswanathan, 3). This pathogen can also be found on several fomites within the hospital premises. Though this deduction has not been proved, several factors exist to support the theory. The organism has been known to be prevalent in the hands of care givers of affected patients. This directly means that the pathogen can exist outside the body of an individual (Neely AN, 725). In the hospital environment, the places which the care givers touch may also contain the organisms. These would include fomites like chairs and door knobs. This pathogen can also be associated with community acquired infections. Person to person route of transmission comes as the easiest mode through which these pathogens enter the gastrointestinal tracts of people (Culligan, 82). When susceptible individuals come into contact with infected people, the bacteria can be interchanged between them. When an individual gets infected with the pathogen, it would be necessary to isolate the person. Delayed identification of these infections has led to serious outbreaks of this pathogen. The ability of the microorganism to get transmitted from person to person in a very short period of time has been the accelerating factor. Isolation of infected persons can assist in minimising infection rates since this bacteria exhibits characteristics of antibiotic resistance. Metronidazole, one of the drugs used to treat these infections, has been established to be non-responsive to this strain (Kraft, Kochergin and Tsyganova, 861). The pathogen has developed resistance to this particular antibiotic exposure. The organism show frequent presence in the hands of hospital personnel who take care of infected patients. Several individuals do not exhibit symptoms of infections of this pathogen. These can be referred as symptom-free carriers (Birgit Strommenger, 97). These people are known to possess systemic immune response to toxin A of clostridium defficile. The individuals who posses this immune response are less likely to acquire a recurrent infection of the same pathogen. This can be attributed to the resistance which develops after the first infection. The microorganisms, though, leave behind a strain which makes it impossible for another infection to occur. Vancomycin-resistant enterococci (VRE) Enterococci can be identified as a group of gram negative bacteria mainly found in the human gut (Abad and R M Pinto, 67). These bacteria do not cause infection only in the gut. The infections caused by these bacteria target various part within the body. These bacteria show resistance to numerous antibiotics. Vancomycin has been extensively used in the treatment of enterococci related infections. In recent years, however, resistance to vancomycin has been discovered among some species of enterococci. Not all species display this resistance however. The most common species showing this resistance are Enterococcus faecium and Enterococcus faecalis (Hawkey, 5). Between the two E faecium is common than the other. Most known infections of the bacteria have been associated with the Enterococcus faecium species. These pathogens acquire resistance through gene transfer from unrelated species of antibiotic resistant pathogen. The most common source from which they acquire these resistant genes has been identified as Staphylococcus aureus. VRE is also able to transfer the same genes to other pathogens which are resistant to antibiotics (Lynch, Lappin-Scott and Costerton, 69). This ability makes VRE to be extremely difficult to treat when infections of its nature occur. The other problem related to this pathogen is that it does not show resistance to a single antibiotic. This pathogen has been characterized as possessing resistance to numerous antibiotics. Vancomycin is one of those antibiotics which VRE has shown resistance to in recent years. These pathogens can easily exist within the hospital environment. They are transmitted through person to person within hospital wards (WHO, 5). This pathogen has the ability to exist if fomites in hospitals. Though it resides in the bowels of infected individuals, the bacteria can be transferred from the bowels when a person touches an infected area. Healthcare workers in hospitals can easily transmit this pathogen from wards hosting infected patents to other wards (Lecointre, Rachdi and Darlu, 1690). About 30% of all enterococcal infections in recent times have been caused by vancomycin resistant enterococci. The pathogens have the ability to live harmlessly in the human body. When antibiotics arte used, other bacteria get killed and the population of enterococci increases. This may make these bacteria to invade various places in the body and therefore cause infection (Marguilies, 154). In hospital cases, the pathogen gets transmitted from infected persons when others come in to contact with the infected patients. Healthcare personnel carry this pathogen in their hands. The places which they touch become fomites to host these bacteria. The effects of infection by this pathogen are fatal as the pathogen has been associated with meningitis and pneumonia (Weber DJ, 825). These diseases have been classified as killer diseases. The symptoms of this pathogen, however, vary depending on the point of infection. Proper cleanliness can immensely minimize cases of infection by this pathogen. Their resistant nature continues to cause great concern in the medical field in relation to treatment of related infections. Since the pathogen is multidrug resistant, the most common way of dealing with infections of its nature is through a combination of several antibiotics. Possible remedy These organisms have shown a level of susceptibility to cleaning, though there can only be found little evidence to support the vulnerability of these microorganisms to the cleaning process (Weber DJ, 825). The use of disinfectants during cleaning appears to have an effect in reducing infections in patients within hospital wards. General cleaning within hospitals can therefore offer useful assistance in dealing with drug resistant microorganisms in hospital environments. Since there exists linkage between cleaning and reduced pathogenic infections, cleaning can reduce the infections. This will avoid the need to treat the infections from drug resistant pathogens as there shall be no infections occurring (WHO, 5). The unfortunate thing is that, cleaning process gets carried out as an infection control process in response to outbreaks. Habitual cleaning process would be most efficient in the quest to limit the existence of these pathogens in hospital surfaces. Works cited Abad, F X and A. Bosch R M Pinto. "Survival of enteric viruses on environmental fomites." Applied and Environmental Microbiology (1994): 60 -71. Axel Kramer, Ingeborg Schwebke and Gunter Kampf. 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