Bariatric surgery in obese patients changes the composition of the intestinal flora
In people with morbid obesity who undergo a crash diet, the diversity of the intestinal flora (microbiota) is temporarily reduced. When these patients subsequently undergo bariatric surgery (stomach reduction), the intestinal flora recovers over time with a composition similar to that found directly 1 week after the surgery. According to investigators, such a "healthy" composition of the intestinal flora may contribute to weight loss in people with morbid obesity after bariatric surgery.
Bariatric surgery is the only proven effective long-term treatment in people with morbid obesity. It is known that people with morbid obesity have a different intestinal flora composition than people with a normal weight. However, details of these differences and their interpretation have not been properly investigated.
Looking for the causes of pain in osteoarthritis
People with knee osteoarthritis who have a lot of pain have more nerve endings in their knee than people with osteoarthritis who have little pain. This is the conclusion of a study by Dr. Niels Eijkelkamp of UMC Utrecht. In new research, financed by ReumaNederland, he will look for the cause: the connection between inflammation and the nervous system.
Dr. Niels Eijkelkamp (LTI) is one of the top researchers in the field of osteoarthritis pain. His mission is to better understand the pain in osteoarthritis and to be able to treat it well. Three years ago, his first research was started, financed by ReumaNederland.
Nursing of carriers of the ESBL bacteria is safe in multiple-bed rooms
Carriers of the highly resistant ESBL-producing Enterobacteriaceae (ESBL-E) can be nursed in a hospital together with wardmates in a multiple-bed room if contact precautions are taken without without additional risk of infection. Dutch research, coordinated from Amphia Hospital and UMC Utrecht, has shown that the risk of infection by nursing in a multiple-bed room is not higher as compared to a single-bed room.
To prevent the spread of highly resistant bacteria such as the ESBL-producing Enterobacteriaceae (ESBL stands for 'extended-spectrum beta-lactamase') in hospitals, infection prevention guidelines now recommend that contact precautions be applied to patients that are carrier of this bacterium, preferably with nursing in a single-bed room. However, the availability of single-bed rooms is limited in many hospitals. In addition, studies are ambiguous on the added value of single-bed rooms in controlling the spread of resistant bacteria.
“Sugarcoating the search for a new vaccine”
Nina van Sorge (Medicalxpress)
“Nieuwe antibiotica in beeld voor moeilijke infecties”
Dani Heesterbeek and Jos van Strijp (Trouw)
“Veelbelovende samenwerking antibiotica en immuunsysteem”
Dani Heesterbeek and Suzan Rooijakkers (De Nieuws BV, NPO Radio 1)
ESBL-producing bacteria ESBL stands for Extended Spectrum Beta Lactamase, which is an enzyme produced by certain bacteria that inactivates certain types of antibiotics (in particular penicillins and cephalosporins) and as a consequence makes these bacteria insensitive (= resistant) to these antibiotics. The bacteria that produce ESBLs are often common intestinal bacteria (for example Escherichia coli). About 5 percent of the Dutch population carries ESBL-producing bacteria. These bacteria are harmless as long as they are in the gut of healthy people. They can sometimes cause infections, such as difficult-to-treat bladder infections. Infections with these bacteria are a problem especially for vulnerable people and patients in the hospital.
Research The study used data from previous studies on the occurrence of ESBLs and on the different types of ESBLs in different sources. These sources were patients, healthy people in the general population, people with professional contact with animals, travelers, pets, cattle, wild birds, food and surface water. A mathematical model has been used to estimate the extent of these sources’ contribution to human infections. The research was made possible in part by the 1Health4Food public-private research program and the European subsidy program for research and innovation in Europe Horizon-2020 through the One Health European Joint Programme.
Reference Mughini-Gras L, Dorado-Garcia A, Duijkeren E van, Bunt G van den, Dierickx CM, Bonten MJM, et al. Attributable sources of community-acquired carriage of Escherichia coli containing β-lactam antibiotic resistance genes: a population-based modelling study. Lancet Planetary Health 2019;3:357-369
Researchers from National Institute for Public Health and the Environment, Utrecht University, UMC Utrecht, the Animal Health Service and Wageningen Bioveterinary Research (all members of the ESBLAT consortium) have previously shown that ESBL antimicrobial resistance is common in humans, animals, food and the environment. However, ESBL types in humans were found to differ from those in animals and food. The most important source of contamination for humans remained unknown until now. New research published in Lancet Planetary Health shows that humans themselves are the most important source of ESBL antibiotic resistance.
According to a mathematical model, human-to-human transmission is responsible for more than 60 percent of all humans that are carriers of ESBLs in their intestines. The contribution of food was estimated at around 19 percent, contact with pets at 8 percent, hobby/recreational contact with livestock at 4 percent and swimming in surface water and contact with wild birds at 3 percent. This means that ESBLs are mainly transferred between people and that people get ESBLs to a lesser extent through animals, animal food and the environment. These results indicate that ESBL transmission and contamination has a true One Health character. The results also show that continuous exposure from different sources such as humans, animals, food and the environment maintains the occurrence of ESBLs in the population.
Human-to-human transfer is the main source of ESBL antibiotic resistance
Dr. Eijkelkamp, can you tell what came out of this initial study? "We looked at the differences between people with osteoarthritis that have a lot of knee pain and people who have little or no pain. It is about the pain at rest, so without moving and stressing the knee. We looked at people who differ in the pain they experience, but whose osteoarthritis is about the same, with the same amount of damage to the cartilage. We made a significant discovery: people with a high pain score appear to have more nerve endings in their knees."
How come? "We know that knee inflammation can make the nerve endings grow. Those fused nerves may cause the pain. It is also becoming increasingly clear that the nervous system and the immune system communicate with each other. Our other research has already shown that immune cells can "turn on" nerve cells in the spinal cord. In this way too, inflammation in osteoarthritis can cause the pain that people experience."
What does this mean for people with osteoarthritis? "One osteoarthritis patient has much more pain than another while the amount of joint damage is the same. In some osteoarthritis patients the pain is persistent, even after having received a knee prosthesis. How is that possible? Is that due to the nerve endings in the joint or to more sensitive nerve cells in the spinal cord? We want to find out."
How are you going to do that? "In our previous study, we collected spinal cord fluid in patients. It concerned 21 patients with a high pain score and 21 patients with little pain. We will now examine the collected spinal fluid for the different types of proteins that are present in osteoarthritis patients with a high pain score. With this we hope to find the mechanism that causes osteoarthritis pain. Our research team will also map the communication between the immune cells and the nerve cells. With disrupted communication, pain can occur or is maintained.
What is the benefit of people with osteoarthritis? "Ultimately, our goal is: better treatments and therefore less or no pain! That would be fantastic. If we know the cause of the pain - from the nerve endings or from the spinal cord - then we can look for a specific, targeted pain treatment. This can help people for whom pain relief is not yet effective. That would be a huge step forward!"