Human Practice

Human practice allows us to explore the scientific, medical and social aspects of our work that helped us to shape our project. We divided human practices into professional help, public opinion and public engagement. For professional help, we contacted infection control specialists and a bacteriophage (phage) researcher. The information we received made us more aware of the challenges and limitations of bacteriophages, and we learnt to look beyond the box for solutions that helped us to improve the lab procedures.

In the public opinion category, it was important to gather data and perspective from public health nurses and the general public through a survey. This helped us to realize the importance of an alternative treatment method to antibiotics, and that people are willing to try out phages to treat infections. The information resulted into ideas of how to turn the research into a product for personalized medicine.

Through public engagement it was important to have a dialogue with the community and in this way, engage and enlighten people about antibiotic resistant bacteria, our project and synthetic biology. As a part of public engagement, we had lectures, attended Researcher’s night and received attention in media.

Professional help

We contacted experts in the field of infection control and medical microbiology, to get a better understanding of the situation of antibiotics and resistant bacteria. It was important to get an opinion from the experts on the use of bacteriophages as an alternative to antibiotics. We also communicated with a bacteriophage researcher to get his opinion on our project. By having a dialogue with the professionals we could reflect on the ethical, safety and sustainability aspects of our research.

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Infection Control Experts

We met Bjørn Waagsbø, a senior consultant at the department of infectious diseases and the leader of the antibiotics-team at St. Olav’s Hospital in Trondheim, with the goal to gain more information about antibiotics and resistant bacteria. According to Waagsbø, Norway is to a small scale affected by resistant bacteria. However, the most common resistant bacteria are Methicillin-resistant Staphylococcus aureus (MRSA), Extended spectrum betalactamase (ESBL) and Vancomycin-resistant enterococci (VRE). Waagsbø pointed out that typically health workers and some tourists that have been vacating in South-Europe are detected with these resistant bacteria. He further stated that resistance is a problem today because of prolonged and wrong use of antibiotics, people travelling and release of nonbiodegradable antibiotics in nature.

Marianna and Sheida talking to senior consultant Bjørn Waagsbø.

We explained the experimental details behind our project and Waagsbø was impressed by the idea, and thought it was interesting that we wanted to do research on an existing technology. He concerned us with the issue with pharmaceutical companies that develop new broad spectrum antibiotics to earn profit, rather than expand on new ideas that are unrelated to antibiotics. The interesting part with phage therapy in his opinion was the specificity of phages and that it works in a completely different manner from antibiotics. This can open a door for personalized medical treatment.

Professor Gunnar Skov Simonsen at the University of Tromsø.

We Emailed with Gunnar Skov Simonsen, a Professor of Clinical Mircobiology at the University of Tromsø and Director of the Department of Microbiology and Infection Control at the University Hospital of North-Norway in Tromsø. He is also in charge of Norm – The Norwegian Organization for Surveillance of Antimicrobial Resistance. We asked him, how can we prevent resistant microbes, in addition to use less antibiotics. According to Simonsen it is important to avoid the need of antibiotics by reducing the incidences of infections. This can be achieved by vaccination, clean water and infection control in hospitals. Other antibacterial strategies are antibacterial surfaces (metals, nano-paint) and antivirulence methods.

We also asked for his opinion for the use of phage therapy as an alternative to antibiotics. He wrote that phage therapy has many fans and sceptics. From his point of view phage therapy has its challenges with routine use in hospitals and resistance against phages is also an issue. However, he suggested that chronic infections may be treated with “personalized” phages that correspond to its host bacteria. Simonsen states that restrictive use of the antibiotics is completely necessary today, but in the future phage therapy may be a solution.

Bacteriophage researcher

We talked to Hans Petter Kleppen on the phone. He took his PhD at the Norwegian University of Life Sciences (UMB). His thesis was entitled “Studies of bacteriophages infecting lactic acid bacteria of industrial food fermentations”. Today he is working as senior scientist at ADC Pharma AS, where he is studying phage therapy on Versiniosis caused by the bacteria Yersinia ruckeri in Atlantic salmon.

Hans Petter Kleppen, a senior scientist at ADC Pharma AS

Kleppen was thrilled that we were working with phages and was more than happy to help us. He gave us useful information, literature recommendation and new perspectives to review, such as the kind of favourable traits we want the phages to evolve. He also explained the procedures that would favour lytic versus lysogenic cycles that was important to consider, and mentioned that addition of magnesium or calcium was good for the growth of phages.

We also talked about the pros and cons of phage therapy. According to Kleppen, phage therapy is an effective agent against multi-resistant bacteria, because the mechanism behind developing resistance in bacteria has no correlation to phages. This is the main advantage of phage therapy. Another benefit of phages is that they are specific and will only grow in their host bacteria, and in this way, leave other bacteria unaffected. The drawback of phage therapy is that the disease-causing bacteria must be identified, leading to strict diagnostic requirements.

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Public opinion

Antibiotic resistance is an increasing problem in the world, and new solutions to antibiotics are important. Phage therapy, where you use virus to treat bacterial diseases and infections can sound scary. To analyze people's knowledge and attitude to this topic, we reached out to public health nurses and conducted a survey.

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Dialogue with public health service nurses

Monica Brun Løkkeberg (left) and Kristin Fredriksen (right), public health nurses at the university campus at NTNU

We had a dialogue with Monica Brun Løkkeberg and Kristin Fredriksen, who are public health nurses at the university campus at NTNU. They are in weekly contact with students during the semesters. We contacted them to get a better understanding of the importance of antibiotics and how common antibiotics are in treating sexually transmitted diseases (STDs). This made us consider the impact of our work on public health.

According to the nurses, in a busy week at the health station there may be up to 10 young people with STDs that are treated with antibiotics. The most common are Chlamydia and Mycoplasma (Mycoplasma hominis infection and Mycoplasma genitalium). The latter may be treated with many antibiotic cures. A further search on the internet, showed that the Mycoplasma bacteria lack cell wall and that is why it is not affected by some antibiotics. It was also stated that it is common to treat the partner of STD patients with antibiotics, which is to prevent further spreading of STDs.

Monica thinks the use of antibiotics is scary today. Especially with all the media attention regarding antibiotic resistant bacteria. Consequently, the doctors are more careful of writing prescription drugs containing antibiotics. We agree that this is a positive development. Norway is very restrictive in the use of antibiotics compared to other countries. For instance, one can buy throat lozenge such as Strepsils, containing antibiotics in other European countries.

What kind of attitude/standpoint exist among the students? The nurses said that it is obvious that antibiotics is a “quick fix”, that is, an easy and safe solution. Based on this, the students may take it for granted that the use of antibiotics is slowly declining. Some students may be ignorant and trust the physicians.

To end the conversation, we asked what they thought of virus as an alternative. They said that the specificity of virus can be an advantage, in comparison to broad spectrum antibiotics. At the end, it was pointed out that viruses are no scarier than bacteria.

Survey

We made a survey to gain public opinion about antibiotics, resistant bacteria, and the use of bacteriophages to treat infections. The survey was shared through our social media leading to 137 responses.

Based on the background information from the participants, the majority were between 21-30 years old, females, and a large number had post secondary education and master degree. They were young and educated, which without questions affected the survey results.

Most people hear about antibiotics sometimes and often. They think antibiotics are used in medicine and livestock in Norway, where the majority rank that the use of antibiotics in medical treatment as very important. While, more than half of the participants think it is unnecessary to use antibiotics in animal/livestock feed.

People say that they know a little bit and a good bit about antibiotic resistant bacteria. The majority thinks resistant bacteria is a problem today, and will also be an issue in the future. Almost all the participants are willing to use less antibiotics if necessary. Some people are comfortable using virus as an alternative to antibiotics, while others would use virus if they need to.

Conclusion: Based on this survey, young, educated people have general knowledge about antibiotics and are aware of its importance. They are enlightened about antibiotic resistant bacteria and are willing to take up the battle. Some of them would use virus, while others would use it if needed.

Click here to download survey results.