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Georgia Kersche

Wed, 02/23/2022 - 21:01

Hi Pierce,
Great summary of Dr. Bai's talk last week! It was great to hear from someone still at the beginning of their career as a physician to get a different perspective, as you mentioned during the discussion.

Annually, fewer and fewer antibiotics are effective against ESKAPE pathogens. As I believe someone pointed out during class, bacteria are outsmarting us! ESKAPE pathogens are associated with a high mortality and significantly increase healthcare costs when attempting to treat resistant infections (1). While the development of novel antibiotics is finally picking up speed, some investigation into alternatives is also warranted . One of the several strategies I have read about is silver nanoparticles. Silver nanoparticles are used as antibiofilms to protect surgical implants and also show promising antimicrobial activity in vivo (2). Silver nanoparticles release ions that disrupt the electron transport chain and signal transduction pathways that leads to damage in cellular structures (3). While toxic to bacteria, they have so far demonstrated good safety profiles in animal models and humans (3). Photodynamic therapy has also shown promise. A beam of light of the right wavelength transfers electrons create radical oxygen species that are toxic to cells. In vitro studies on blue light treat topical wounds, and an ideal wavelength of 415nm causes minimal harm to healthy underlying tissue (4). However, pathogens that overexpress efflux pumps limit the potential of photodynamic therapy, and is limited mostly to topical applications (2). These and other alternatives made me wonder how Dr. Bai's discussion of noninferiority trials extends to these types of therapies. Do you think that direct comparisons of these alternatives between each other and traditional antibiotics are our future? I look forward to hearing your thoughts, or hearing about other alternatives folks come across!

1. Founou, R., Founou, L., & Essack, S. (2017). Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLOS ONE, 12(12), e0189621.
2. Mulani, M., Kamble, E., Kumkar, S., Tawre, M., & Pardesi, K. (2019). Emerging Strategies to Combat ESKAPE Pathogens in the Era of Antimicrobial Resistance: A Review. Frontiers In Microbiology, 10.
3. Munger, M., Radwanski, P., Hadlock, G., Stoddard, G., Shaaban, A., & Falconer, J. et al. (2014). In vivo human time-exposure study of orally dosed commercial silver nanoparticles. Nanomedicine: Nanotechnology, Biology And Medicine, 10(1), 1-9.
4. Halstead, F., Thwaite, J., Burt, R., Laws, T., Raguse, M., & Moeller, R. et al. (2016). Antibacterial Activity of Blue Light against Nosocomial Wound Pathogens Growing Planktonically and as Mature Biofilms. Applied And Environmental Microbiology, 82(13), 4006-4016.

Georgia Kersche

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