In September
2002, a patient with a chronic foot ulcer checked
into a Pennsylvania hospital. Doctors later discovered
that the ulcer contained Staphylococcus aureus bacteria,
one of the most common causes of hospital infections.
The bacteria were resistant to vancomycin, the antibiotic
of last-resort in fighting infections. It was only
the second case of vancomycin-resistant staph reported
in the United States. The Pennsylvania physicians
also had evidence the bacteria had acquired these
resistance genes from another species of bacteria
often found in hospitals, Enterococcus faecalis.
Antibiotic resistance is a frightening reality.
Now, scientists are a step closer to understanding
how antibiotic resistance spreads in the microbial
world because the genomes of two gut bacteria have
been sequenced.
The microbes, which usually live harmlessly in our
intestines, are Bacteriodes thetaiotaomicron and
Enterococcus faecalis.
Their genomes contain an incredible amount of mobile
elements—DNA that can move around on chromosomes,
among organisms and even between species. Mobile
DNA can carry genes for virulence and drug resistance,
as well as benign genes.
“These mobile elements give bacteria the ability
to quickly pass on traits,” says Ian T. Paulsen,
who led the enterococcus genome-sequencing project
at the Institute for Genomic Research (TIGR) in Rockville,
Maryland.
Until sequencing the entire genome, scientists did
not realize that a quarter of enterococcus’ genome
is made-up of mobile DNA. In fact, its genome contains
one of the highest percentages of mobile elements
ever seen in bacteria. Within these regions are genes
for vancomycin resistance and for virulence.
It had long been established that enterococcus has
mobile elements, says Gary M. Dunny of the University
of Minnesota in Minneapolis, who studies the bacterium.
“But until now, we have never had a picture
of the entire genome of one strain and the total
number of mobile elements, which is remarkably high,” he
says. TIGR sequenced a strain from a patient with
the first case of vancomycin-resistant E. faecalis
in the United States.
Bacteriodes is also rich in mobile elements, although
these do not harbor antibiotic resistance genes.
Jeffrey I. Gordon of Washington University School
of Medicine in St. Louis, Missouri, led the bacteriodes
project.
“Bacteriodes is not carrying these genes now,
but they can pick them up,” says Abigail A.
Salyers of the University of Illinois in Urbana-Champaign.
Salyers has also served as president of the American
Society of Microbiology.
“There is much greater potential for transferring
resistance genes than we thought,” she adds.
The genomes of bacteriodes and enterococcus reinforce
something scientists have been concerned about for
years: the remarkable fluidity of the bacterial gene
pool. This fluidity allows bacteria to exchange DNA
to enhance their ability to cause disease or their
resistance to antibiotics.
“It’s really becoming a problem now
because we’re running out of antibiotics,” says
Michael S. Gilmore of the University of Oklahoma
in Oklahoma City. Gilmore studies enterococcus, and
wrote a commentary accompanying the two papers in
Science.
Bacteriodes, enterococcus and staph are just a few
examples of bugs that are becoming increasingly difficult
to treat. The widespread use of antibiotics puts
selective pressure on only the hardiest bacteria
to survive—which often carry virulence or drug
resistance genes.
“We’re facing something we’ve
never faced before—the loss of a cure,” says
Salyers. New antibiotics are expensive and difficult
to develop and “pharmaceutical companies are
shutting down antibiotic programs,” she adds.
Hospitals are breeding grounds for some of these
dangerous microbes. When you enter a hospital, your
intestines carry a normal consortium of microbes.
But taking antibiotics can kill susceptible bacteria
and leave room for resistant enterococci to take
up residence.
These bacteria are lurking on medical instruments
and surfaces—just waiting to be ingested and
find a niche in your body. The drug-resistant, opportunist
enterococci are then poised to infect other parts
of the body like surgery wounds, the urinary tract
and bloodstream.
The gut environment also contributes to the spread
of dangerous genes because enterococcus and bacteriodes
live along with over 500 species of bacteria. In
fact, there are more bacteria in our intestine than
cells in our body.
These gut bacteria are in contact with one another
and with other bacteria that pass through the intestine,
where they can swap virulence and resistance genes.
“Your colon is a like a singles bar,” says
Salyers. “Bacteria are passing DNA around like
there’s no tomorrow.”
These bacteria don’t just stay in your body,
but pass into the water, soil and food supply we
all share. |