Microscopic "Tuning Forks" Help Determine Effectiveness of Antibiotics 36
sciencehabit writes "A patient admitted to a hospital with a serious bacterial infection may have only a few hours to live. Figuring out which antibiotic to administer, however, can take days. Doctors must grow the microbes in the presence of the drugs and see whether they reproduce. Rush the process, and they risk prescribing ineffective antibiotics, exposing the patient to unnecessary side effects, and spreading antibiotic resistance. Now, researchers have developed a microscopic 'tuning fork' that detects tiny vibrations in bacteria. The device might one day allow physicians to tell the difference between live and dead microbes—and enable them to recognize effective and ineffective antibiotics within minutes."
Re:Another rambling bullshit summary (Score:5, Interesting)
That's nice that a new technique is developed to measure/observe bacteria, but what's with all that bullshit about rushed bacterial infection?
PR idiots.
As a clinical (critical care, if you care to know) physician, I too am a bit puzzled by the description.
Patients in septic shock are very sick and the prescription of antibiotics is a delicate subject....antibiotics need to be started within a few hours of diagnosis, and getting it wrong (prescribing an antibiotic to which the bacteria is resistant) and the patient has a 50% increase in mortality. To this end we use the broadest spectrum antibiotics available, and most hospitals develop an "Antibiogram [wikipedia.org]" specific for their institution [nih.gov] and their pt population. These antibiotics are so powerful, it is rare, but not unheard of, for organisms to be resistant to them.
The process goes like this:
Pt is admitted to an ICU
Cultures of all likely sources (urine, lung, blood, CSF, abscess fluid) are obtained
Antibiotics are started (sometimes before the cultures are drawn, but ideally after), as well as other therapies
Over the next few days the antibiotics are "De-escalated" as dictated by the cultures (see below)
Hopefully the pt recovers and their care is down-graded and ultimately discharged
The cultures [wikipedia.org] are sent to the lab after being draw and in a process [wikipedia.org] that (time-wise) parallels the above:
The sample is extracted from the specimen container and are plated [youtube.com] on a growth medium or placed in a broth
They are allowed to grow for (around) 24 hours
The plates are examined to determine if anything actually grew (may take up to 3 days for blood)
If something grew, two processes happen:
The culture is sent through a variety of tests [youtube.com] (gram-stain, etc) to determine the species of bacteria which will dictate the next step.
The specimen is then re-suspended in a culture medium and plated and allowed to grow in the presence of antibiotics [youtube.com] thus yielding that particular organisms antibiogram
A you can see, there really isn't anywhere to rush the process. And I would be very interested to see how they can speed this up with their technology....the who purpose of the plating is to amplify the bacteria from the milieu of the body fluids and to find the dominant organism growing.
In addition, some cultures are already "contaminated" with body flora (e.g. upper respiratory and stool) and the purpose of the culture is to amplify pathological bacteria from the benign-normal flora.
Longer video that gives a better front to back description [youtube.com]
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The process goes like this:
They are allowed to grow for (around) 24 hours
The plates are examined to determine if anything actually grew (may take up to 3 days for blood)
If something grew, two processes happen:
The culture is sent through a variety of tests [youtube.com] (gram-stain, etc) to determine the species of bacteria which will dictate the next step.
The specimen is then re-suspended in a culture medium and plated and allowed to grow in the presence of antibiotics [youtube.com] thus yielding that particular organisms antibiogram
A you can see, there really isn't anywhere to rush the process.
qPCR, RT-PCR, and/or ELISA tests to determine which bacteria are common and which antibiotic resistance genes are heavily expressed at the infection site or the blood stream. Would only take a few hours from taking the sample to having results, as opposed to 1-3 days to do a culture.
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qPCR, RT-PCR, and/or ELISA
Doesn't this assume you know what bacterium you are looking for, that you have the right primers, and that you know where the antibiotic resistance genes are? There seem to be too many variables to test for all of them. And why qPCR instead of regular old PCR? qPCR machines are pricey.
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Also PCR and ELISA are much more expensive and time consuming processes than plating or "brothing", and you also have to have a reasonable clue as to the organism that you expect to encounter (see below) - If I knew the bug before hand, I'd treat for it. Those in my position often get surprised by the organism that finally grows. I once had a case of endocarditis in a cardiac transplant patient, the culture came back with an unusual o
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Expense: Yes, those techniques are more labor and/or equipment intensive than culturing. I'm going on the assumption that there are cases where having the answer in 3 hrs instead of 3 days would drastically improve the outcome. How about this: If the only benefit to getting the result 20-70 hrs sooner was that patients ended up spending one less day in an ICU, the technique would save money if it cost less than ~$5k.
Knowing what to look for: You can differentiate A LOT of pathogens using a single set of pr
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The talk about early diagnosis and saving lives is simply a lot more sexy and easier to sell than antibiotic stewardship. The grandstanding about this particul
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The real usefulness of a technique like this (as I understand from the sepsis researchers that I've interacted with), is improved antibiotic stewardship -- preventing overuse of antibiotics and reducing the time the patient need be treated.
Please see my line about "De-escalated" - that is antibiotic stewardship in action.
These rapid assays can provide a better and more timely means to monitor a patient's response to treatment.
Again, where can this be applied in a "noisy" real world scenario? The researcher took an already cultured (i.e. purified) sample to prove the concept. I am trying illustrate the complexity of translating this into a real world application.
The talk about early diagnosis and saving lives is simply a lot more sexy and easier to sell than antibiotic stewardship.
They are two sides of the same coin....the bug I treat today with the tightest adequate spectrum of coverage is the bug I do not have to treat with the big guns later, or worse, have t
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However, growth to visible cultures is composed of hundreds of generations, and if you had a more sensitive detector of bacterial reproduction, that didn't have to wait so many generations, you could reach colclusions[sic] a lot faster; limited primarily by the drug uptake rate.
Hmmm....me thinks you should look into your math...:-) (I'm being purely humorous at this point, not meant to be mean, but with real math)
doubling time is about 20 min in ideal circumstances so 100*20 is 2000 min or ~ 33.3 hrs
100 generations == 2^100 bacteria or 1,267,650,600,228,229,401,496,703,205,376
each bacteria weights [harvard.edu] about 9.5^-13g
so total bio mass is about 13,343,690,528,718,204g or 13,343,690,528,718kg or 1.3e13kg
for reference, the earth weighs...5.9e24 kg, (moon is merely 7.3e22, the USS Io
Re:I read that as "Microsoft Tuning Forks" (Score:5, Funny)
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This is still in the research stadium (Score:2)
From TFA:
"It's a brilliant method," provided subsequent investigations confirm the researchers' interpretation of their data
I can, however, already hear the feet of the major pharmaceutical multinationals stampeding to get to Dublin....
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Entering the hospital may be first mistake (Score:3)
Since you're most likely to contract a hard to cure infection....in hospital..
Re:Entering the hospital may be first mistake (Score:5, Interesting)
Medical error ranks third [therasim.com] among causes of death in the US.
Estimates of risk vary depending on which complications are counted, but it's always in the top 10. Any trip to the hospital results in a 1 in 300 [guardian.co.uk] chance of dying from medical mistake. For comparison, your chance of dying in an airplane accident is 1 in 10,000,000 per flight.
A rational plan would spend time and effort where it will do the most good. Instead of inventing new cures and treatments, perhaps we should be looking into ways to make our existing process safer?
For comparison, the risk of death by medical error is higher than the risk of death from diabetes. I'm not saying that diabetes research should be halted, but shouldn't higher risk factors be addressed as well?
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The "EHR" is working on it, though whether it will succeed or not is anyone's guess. Maybe after everything is barcoded out the wazoo with 50 things to beep for each step of the hospital stay, they'll be able to get your kosher bacon cheeseburger mostly correct. One of these bracelets has the barcode that I need to beep to get the right baggie to put on the IV stand (that needs to also be beeped) before I can beep the needle and finally beep the valve to open it to the correct drip rate.
Fighting against t
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While I don't dispute that there can be improvement in hospital processes, many of these people who died were already at risk. If I have a heart attack, a 0.3% risk of dying through medical error at the hospital is nothing compared to my risk if I don't go to the hospital. What was the average risk of death had a patient not undergone a hospital procedure? Maybe there are classes of patients who should not undergo procedures! It isn't terribly informative to quote such a statistic without any context, and w
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Since you're most likely to contract a hard to cure infection....in hospital..
After 5 return visits to an un-named hospital, notorious for infections, I used MMS - Master Mineral Solution - and have yet to see a recurrence of the infection two years later. The hospital insisted on a 5 day, intravenous, in hospital, course of treatment followed by an at home one week oral course. Within weeks I was re-hospitalized worse than before. To boot, they used IRS to get their money taken from my tax return, how nice. Talk about a monopoly, infect, treat, re-infect, re-treat, etc, etc, etc, ye
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The snake oil may not be a great idea, but it's inevitable. Consider, where else are you expected to pay the costs to correct the service provider's mistake? If the mechanic screws up your engine, he's liable for the repairs. if the plumber floods your basement, he's on the hook to make it right.
So why is it that when the hospital staff infect you with unwashed hands (REALLY! There's a problem getting doctors and nursed to wash their hands!!!) why do they think it's on the patient to pay the huge bill? They
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The AC clearly believed it to be that and seemed unlikely to be convinced otherwise. For such a person, the best hope is to remind them that unless western medicine can truly make a better offer, people will turn away from it and to the things he/she clearly disapproves of.
I am not familiar with that particular product, but I am familiar with a variety of traditional and alternative medicine. I have found some that is ineffective and some that is stunningly and even inexplicably effective.
Certainly I tend t
NGS sequencing of ribosomal sequences is faster (Score:2)
An RNASeq run, either targeted to the ribosome or total (given that rRNA takes the lion's share) is a little bit quicker than culture, as long as the bioinformatics side of it is appropriately set up (e.g. massively parallel mapping, and automated count summarisation).
Sample preparation will take a few hours, and there are sequencers that will get results out in a few hours -- the mythical Oxford nanopore sequencers will speed both of these things up as well.
Actual Article Summary (Score:3)
"We made a tiny bar that vibrates when it's surrounded by bacteria! It stopped vibrating when the bacteria were given antibiotics and we think this means the bacteria were dead. We don't know why it vibrates and currently we have no way of telling the difference between different kinds of bacteria."
Cool technology, but keep your pants on. This has very little application for a very long time.
Royal Rife (Score:3)
They should proceed with caution. They could end up quacks at any time. The famous Royal Rife machine used vibrations to kil bacteria. And here it is, all these years later, and it turns out bacteria *does* vibrate:
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Live/dead staining (Score:2)