Pneumonia, urinary tract infections, sepsis: diseases like these can become fatal without antibiotics. Some bacteria have developed the ability to break down beta-lactam antibiotics like penicillins and cephalosporins, making them ineffective. Once a patient’s body has been colonized by these resistant bacteria, they can persist for a long time, reports Professor Sarah Tschudin Sutter’s research group in the scientific journal Nature Communications.
The team at the Department of Clinical Research of the University of Basel and University Hospital Basel analyzed multiple samples taken from over 70 individuals over a period of ten years. The researchers looked at a much longer period of time than previous studies and focused on older people with pre-existing conditions. Their key question: whether and how resistant Klebsiella pneumoniae and Escherichia coli bacteria in the body change over this long period and how they differ in various parts of the body.
Recurring illness
DNA analysis indicates that the bacteria initially adapt quite quickly to the conditions in the colonized parts of the body, but undergo few genetic changes thereafter. The resistant bacteria could still be detected in the patients up to nine years later. "These patients not only repeatedly become ill themselves, they also act as a source of infection for other people - a reservoir for these pathogens," says Dr. Lisandra Aguilar Bultet, the study’s lead author."This is crucial information for choosing a treatment," explains Professor Tschudin Sutter. If someone has previously been infected with resistant bacteria and later requires another course of treatment because of a new infection, there is a risk that standard antibiotics will again fail to work.
Transmission of resistance
In addition, the researchers found that in some patients, bacterial strains of the same species, as well as of different species (specifically, Klebsiella pneumoniae and Escherichia coli), share identical genetic mechanisms of resistance through what are known as mobile genetic elements (such as plasmids). The most likely explanation is that they have transmitted these elements to each other.Im Spital kommen besondere Schutzmassnahmen zum Einsatz, wenn eine Patientin oder ein Patient in der Vergangenheit durch resistente Bakterien erkrankt war. Im Alltag ist es schwierig, das Risiko einer Weitergabe der Erreger zu verringern.
Diese Ergebnisse zur bakteriellen genetischen Vielfalt, die bei einzelnen Patienten im Laufe der Zeit zu erwarten ist, können als wertvolle Grundlage für weitere Studien zur Analyse von Faktoren seitens der Bakterien und der Betroffenen dienen, die mit der Dauer der Kolonisation und dem Übergang von der Besiedlung zur Infektion zusammenhängen.
Original publication
Lisandra Aguilar Bultet et al.
Within-host genetic diversity of extended-spectrum beta-lactamase-producing Enterobacterales in long-term colonized patients.
Nature Communications (2023), doi: 10.1038/s41467’023 -44285-w
