This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility: The World Health Organization (WHO) regards antimicrobial resistance, including antibiotic resistance, as one of the world's major health challenges. A new fundamental understanding of antibiotic resistance could therefore potentially have a far-reaching impact on global public health, animal health and the environment.
The traditional understanding of antibiotic resistance is that, based on a laboratory test, a bacterium is either susceptible to or resistant to specific antibiotics. This has been crucial to how infections are diagnosed, patients are treated, and antibiotic resistance is monitored and controlled in humans, animals, food and the environment worldwide. However, we might need to set that understanding aside in the coming years, according to a group of researchers who, in a new opinion piece in the journal Trends in Microbiology, describe a possible paradigm shift in our understanding of antibiotic resistance.
Recent research from the DTU National Food Institute has shown that antibiotic resistance depends on the context in which resistant bacteria are found. Factors such as temperature, oxygen levels and pH have a significant impact on whether a bacterium, even one carrying a resistance gene, behaves in a resistant manner. This has been an eye-opener for the researchers, who believe that this new knowledge has the potential to turn many years of thinking about antibiotic resistance on its head while offering hope for far more effective ways to combat this global threat.
"We need to view antibiotic resistance as something that can change, depending on the shifting microenvironment in which bacteria move," says Professor Frank Møller Aarestrup of the DTU National Food Institute, adding: "This means that far more factors come into play. We need to find out what is required for a bacterium carrying a resistance gene to actually be resistant to antibiotics. Is it at a pH of 5 or 8, whereas we currently measure at a fixed pH of 7.2?
What oxygen levels and temperatures are involved? Is the bacterium resistant if the patient has a fever or not? Is the bacterium in the gut, where there is no oxygen, or in the bloodstream, where oxygen is present?" Current standard laboratory tests do not take into account whether the bacterium is in the gut or in the blood, or whether the patient has a fever, which are some of the biological conditions the bacterium encounters in the body.
"Resistance genes do not function in a vacuum. They are found in different bacteria and in varying microenvironments. We must therefore not only ask which resistance genes a bacterium possesses, but also when they actually make the bacterium resistant," says Professor Thomas Bjarnsholt from the University of Copenhagen and Copenhagen University Hospital.
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