Welcome to how Healthcare happens. My name is Brynn kentish. This is a brand new podcast from Cardiff and Vale, uh be showing you all the things that you never knew. The NHS did in this week's episode. We talked to David Thomas. Davith is a biomedical scientist in the oral pathology Labs at the University Dental Hospital Tavern. I discuss something that I always knew was a big problem in health care, but I never really understood much more about it than that and that is bacteria David and his colleagues represent the thin line between us beingFeet and a world where infectious diseases are the number one cause of deck. He has a really great way of explaining things. So it's quite a complex topic as you can imagine, but the way David explained it I think was great. He throws in a couple of fantastic film references in there. So keep an eye out for them and take heed of the lessons that we can all learn a second from David and how we can help these individuals fight fight against antimicrobial resistance all that and more. Coming up. Today's guest is David Thomas. He's a specialist biomedical scientist in oral pathology based at the University Dental hospital and the University Hospital of Wales in Cardiff. Welcome David. Hello there. Hey David. Can you tell me a bit about your role to start with? What is a biomedical scientist? What do you do? Biomedical scientists work in hospitals primarily in the labs. So whenever you hear a doctor saying we've done a test and it's gone to the lab so they might have taken some blood swab or any sort of sample from you the person in the labs that many different people but the majority of the people working there are biomedical scientists. So those are the people who will be conducting the laboratory tests on the sample and Reporting the results to the doctors. Jeff says, there's many different types of Consultants and Specialists nurses I assume there's probably lots of different types of biomedical science. There's lots of different Specialties within biomedical science. So in general, you've got the blood scientists or those Specialties are looking at the blood so blood group being Etc making sure you have the right Bloods to the two surgeries and two clinics people. They're looking at the biochemistry of the blood looking at chemicals in the blood helping to diagnose disease and monitor diseases like diabetes. For example, there's other people Looking at the immune system and that the diseases are involved in the immune system. There are other biomedical scientists that work in histology lab. So those are people that deal with whatever you have a biopsy taken they prepare the tissue to be looking under the microscope. So Pathologists can look at issue in determining whether there's any diseases going on there like cancer and then in my field microbiology, there are many different sub disciplines within that field as well. Right? So that's virologist. So there's Slabs that look at viruses. There's parasitology. There's mycology. So Labs that look at funguses and yeast and then as my speciality bacteriology, so the lab that looks at bacteria and infectious bacterial organisms, like like that. So as many and I'm sure I've missed outside as well in that list and more. Yeah, it's quite incredible, but there's so many members of Staff in the hospital that patients would never really come face-to-face with Probably don't know a lot about but it strikes me that the work that NHS does wouldn't function without this scientific backbone. There's a figure that's bandied about in our profession 80% of the decisions made by doctors are based on Laboratory Testing. I think that's probably a lot more than that. When you consider how much Laboratory Testing is involved in maintaining conditions like diabetes for examples or somebody would have a lot of blood tests and during the course of their treatment a lot of the work. Goes goes on behind closed doors, but it's really important for patient treatment. Yeah and innovation in healthcare as well because I can't imagine that things would progress without. Yeah, of course you guys do obviously the main research are the main Innovations recently has been in the genomics field where we're starting looking at the Genome of individual patients here in Wales. There's a hundred Genome Project that I'm aware of fascinating. I do hope to actually interview someone from the hundred genome projects maybe in a later episode that be very interesting. Yeah. Yeah, but let's go back to your speciality which is as you said bacteria, the extent of my knowledge around bacteria is that they make you ill or some of them at least make you ill indeed. I don't really know much more than that. So can you kind of explain what our bacteria do we know that our bodies human bodies are made up of a lot of individual Parcels that we call cells. Yes, there's lots of cells in the human body. So they're Specialists skin cells liver cells blood cells Etc bacteria. Unicellular, so I didn't visual bacterium is just made up of one cell it's microscopic. So you can't see them with the naked eye. You need a microscope to see them and bacteria everywhere in the world. Yeah in the environment that on the table in front of me that on the floor that on the doorknob that in the soil there in the air that everywhere and they exist everywhere. So you've got leaks which are boiling had two degrees Celsius with bacteria, right? And deep under the soil. There's bacteria deep in the ocean. There's bacteria high up in the air that's bacteria. You even have bacteria sometimes growing on radioactive nuclear reactors, you know, my old professor and universities used to tell me that whatever life can exist. It will exist that is usually in the form of bacteria and they're fundamentally different to the cells of our body in a number of different ways, which makes it a Bodacious for us so you can use things like antibiotics that Target these Differences so they can kill bacteria but leave ourselves alone. So there's quite a number of bacteria living on the human body all the time. The main sights are on the skin, especially the armpit in the groin areas like that. The oral cavity is many many different bacteria within the oral cavity and then the primary site where you find the bacteria the human body is the is the gut the small and large intestine. We're both sitting here now with lots of bacteria in our bodies, but we were both perfectly healthy. It's a revelation recently that we discovered that the bacteria on a human body. Not only are they not causing us any harm. Some of them are actually beneficial for us. There's lots of different examples of that. There's been studies showing that when a person is stressed their gut microbiota changes as a result of the stress. There's I've been other studies linking the microbiota in the gut with obesity. So they've done some studies in mice where they've got mice. Jim free which is sterile and they've put the microbiota of a dead mouse in one and the microbiota of a fat mouse in the nether then fed them both the same diet the mouse with the microbiota from the fatness just put on more weight right there. So you can see that how the micro world is key at how we digest our food. Yeah that's been shown as well in humans. There's been cases where people getting treated for crusty Joy these difficile disease. They get a fecal transplant from a close member of the family and it's been shown that people who get that. I've started to put on weight because they've got the microbiota from an obese person. It's been shown that in breast milk. There are things that the baby can't digest but they're they're specifically for the gut microbiota become established. You can see how long this symbiotic relationship between us and bugs has been bugs in our gut to produce vitamins that we do not produce like vitamin K. They obviously As a natural Shield to other pathogenic organisms. So if you think about it a pathogen is trying to get into your body, but the house is full because it's bacteria are everywhere and they can't get a foothold. There's lots of different examples currently in the literature showing the benefits of the microbiome as well. And obviously when it gets unbalanced or there's a shift it can cause some diseases like asthma and inflammatory bowel diseases and stuff like that. That is fascinating. We've established that we're full of bacteria anyway, but there are some types of bacteria that if you were to ingest them, then you are likely to contract some sort of disease. I'm thinking like E.coli that sort of thing. So types of E, coli salmonella campylobacter, neisseria gonorrhea, sexually transmitted diseases and so forth. Those are what we would call maybe obligate pathogens. There are other types of pathogens that we call opportunist. Thick so these are the bacteria that live on us normally not causing us any harm but given the opportunity you can cause disease so classy example, that would be staphylococcus. Aureus it lives on our skin quite harmless lie, but if we have a cat or something then when the staphylococcus aureus gets into the cat, it starts to cause disease and start to cause infection, right and they are lots of examples of that where we have endogenous infections happening in the body and that happens a lot in health care a lot of Vance's of Health Care over the years intensive care treatments like lines being put in four trips Etc catheterization all make the human body susceptible to opportunistic infections. And so it's a big problem in hospitals. Yeah, and that usually happens with endogenous bacteria on the body. Is that what we would call a hospital-acquired infection? Yeah, it will it will be so say that whether acquired it from yourself or from the environment within the hospital people within People all surfaces within the hospital as well. So we've treated bacteria with antibiotics, which you mentioned very briefly. Can you explain how they work? So antibiotics are chemicals? Yeah chemicals have a unique three-dimensional shape and how antibiotics work they encounter a bacteria. And as I mentioned previously there certain things that are bacterial cell has that a human cell in our body? And tough and there are a number of examples for example bacteria have what they call a cell wall and ourselves do not a cell wall is something on the outside of the bacteria that gives it rigidity and strength to exist within the environment. What an antibiotic would do it will come in and bind specifically to a bacterial structure due to its shape. So for example, we could be two different bacteria, but we're two different bacteria because we have a different shape face. So if an antibiotic would come into the room now, it could bind specifically Lie to my face because it's shaped that way and as a result it binds to my face. I can't breathe and I die but you don't because your face is a different shape, which is bounce off May and it just doesn't bind tightly and you'll be fine. So that's in essence what happens with an antibiotic. It comes into the bacterial cell binds to something and that binding inhibits the function of whatever is just bound to and that results in either the cell dying or at the very least not dividing. So for example, everybody's heard of maybe the antibiotic called penicillin. Yes penicillin acts on the cell wall of bacteria. What it does is it goes into the cell wall and it prevents the cell wall from form incorrectly as a result the cell wall of bacteria in the presence of penicillin is structurally weak. And so they pop like a balloon you imagine like a balloon when the structure our integrity of the balloon is compromised. It pops. Yes and back to you. They're just do the exactly the same things. The bacterias are under pressure. The cell wall is weak. And they explode and that in essence. It's how antibiotics well there are lots of antibiotics are they said that Target the cell wall, there are targets within the cell in the bacterial cell which are unique to bacteria. So as a result, the antibiotics have no effect by and large and ourselves and there are dozens and dozens of different types of antibiotics is that right? There's lots of different types of antibiotics. There are only a couple of Target sites within a bacterial cell and to be Optics initially I discovered they produced by That microorganisms. So people may know the penicillin was discovered from a mold from a fungus and there are other antibiotics that are have been discovered from other bacteria and they produce it of course because the bacteria are producing antibiotics because they're in competition with other bacteria within the environment for space and nutrients Etc. Yeah, so that chemical warfare going on so many very recently within the evolutionary period of the world as it has been that mankind have used these antibiotics for that. Benefit what has happened recently not recently. But in the past then clever chemists take the natural antibiotics and change them chemically prolonging their usefulness and changing the characteristics or maybe they have a broader spectrum of activity or better pharmacokinetics within the body, you know, so maybe last better in the body or penetrate into a body site better. That's what basically we do it done in the past antibiotics have been discovered and we've changed their chemistry prolonging their usefulness the main Of course that that discovery of antibiotics has slowed down. Well, yeah, let's let's come onto that. So we've used antibiotics for around World War Two. There's a World War II we were when we were knowingly using antibiotics can look back in history and ancient civilizations using things like garlic and honey, which they used for treating wounds Etc. And only now we're realizing that those substances do actually have an antibacterial properties, you know, but only real robot. Oh, we found chemicals and new Use them specifically knowingly that they treat infections but we've been using things unknowingly for a very very long time and we're going back and looking at those compounds now trying to find new antibiotics. A lot of research has been going on in Cardiff with honey, Manuka Honey, especially we are creating and using more and more antibiotics more effective antibiotics, but unlike I suppose viruses and immunizations You know how we eradicated smallpox from the world for example bacteria don't go away. Do they remember that bacteria have been using antibiotics to kill themselves other bacteria for billions of years. And so they used their used to becoming resistant. So that's the game. They've been playing for a while. So this is nothing new for the bacteria and it's just a process of evolution. Really. I remembered a joke. It's a a lion with the best. Into this room. I don't have to outrun the lion. I just have to outrun you. It's about adapting and bacteria a very good at adapting fast as well fairly fast bacteria divide quickly. And so they're able to produce mutants it within a population and then those mutants can be selected for by the antibiotic when we divide as human beings. We have to duplicate our genome and that takes a long time. So imagine you had to copy an essay for example, and you Week to do it the copy you would do would be pretty good right if you had to copy an essay in 10 minutes and they might be a few typos in there. Yeah in the genetic code we would call those mutations. Yeah. So when you have a bacterial this dividing all the dr. cells are not identical that are mutants in there. Those mutants have a price to pay because they might be not as fit as the other so they might die and they might struggle to survive that diversity means that when there's a change in the environment the bacteria population can adapt to it quickly. Lee so the change in the environment, you know in humans could be that we start getting predicted by lions and we gets and only those that can run fast get selected for yeah, like the film Zombieland. I don't know if you've seen the film Zombieland, but the first rule of zombies. Yes, it's cardio if not a reference. I was expecting. Yeah, so but I'm a big zombie farm and and the first rule is cardio and so it selects for people who can run fast. And so that's the same thing that's happening in the bacterial population when you use an antibiotic it selects for those bacteria. Have developed resistance. And as a result, you get the entire population then is that of resistant bacteria? Yeah, but what bacteria can do as well that we can't is that they can transfer their DNA from one individual to another what we call horizontal Gene transfer. So we get our genetics from our parents and we pass it on to our children if we were bacteria, I could give you the gene for the resistance despite transferring horizontally to you and as a result of that the adapt quickly. Yeah bacteria can adapt quickly and become resistant to antibiotics very quickly. So that is created a problem called antimicrobial resistance is now that's basically what we've just outlined is that the bacteria are mutating to become not consciously, but the mutant bacteria that are resistant to antibiotics. Yeah, they did that they just they're just adapting they want to survive and we as a human population as Humanity have used antibiotics extensively. I mean if you think about Of the dollar modern Healthcare is based on the use of antibiotics. There's like organ transplantation cancer treatment limb replacement with artificial knees Etc. All that stuff can happen because of the use of antibiotics. Well any sort of general surgery, I any invasive procedure, you know, there was a time where a cut on your finger could be a life-or-death situation giving birth could be a life-and-death situation and the use of antibiotics has meant that people surviving these things and Able to survive, you know, very Advanced invasive treatments. When you going into intensive care ward in the hospital. You see all these patients with all these machines in them keep them alive. But as a result that all susceptible to infection and these patients can be kept alive with antibiotics and then hopefully kept alive to treat what they are being treated for with all these invasive procedures. I saw David give a talk at a conference where he showed a video clip of bacteria on yes. What was that work desk? That was eager. We commonly use egg as a medium to grow bacteria and the lab it was a big a plate and it had no one up antibiotics in the egg on the periphery and it was getting more and more concentrated as it got into the center. It was just a Time Lapse video showing bacteria growing coming up to the antibiotic and stopping. And then the mutation happened between in one bacteria and you can you saw that bacteria then this flourish and spread to the new environment. So I'll put a link to that video in the episode description of this podcast. And I do really really recommend that you watch it not to frighten yourselves, but just to be kind of aware of the problem that we're talking about and some of the steps that we as individuals can take to help combat this but I wanted to ask how did health organizations I suppose worldwide as well as the NHS in the UK. UK how do they combat this problem? That is the million-dollar question. I feel that it's important to remember that the bacteria don't see boundaries. And so whatever we do. It has to be a worldwide response. That's the first thing there are lots of things that we can do to help slow the progress of antimicrobial resistance and there's lots of people who need to be involved in that. So things like increasing public awareness of the issues are just this very podcast for example is something positive. About raising public awareness of the issue. So that patients for example don't demand antibiotics when they go see a doctor for a cough or a cold or something like that. Yeah, we don't want to misuse of the use of antibiotics and if we use a lot of antibiotics, then we're putting this great what we what evolutionary biologists we call a selection pressure the bacterial population. So you want to keep the use of antibiotics antibiotics down or within reasonable limits. Another thing we need to do then worldwide is to improve hygiene and sanitation stopping people from getting sick in the first place. Yeah, increasing vaccination rates and things like that. We need to look at the use of antibiotics in agriculture. They used heavily in agriculture for various reasons, which is not my area of expertise. But I know that when they use in agriculture again, the antibiotics are getting into nature and I'll have an impact on obviously selecting for bacteria. Yeah for resistant bacteria within the environment that bacteria can then come in and affect us all. The genes from the environment as I've said can be transferred to bacteria that affect us. Yeah, so we need to look at that. We need to look at maybe new technologies in my area for Rapid Diagnostics or maybe getting results and tests and much more quickly and not in days but in hours and then really going on with the work that we do in the hospital is surveillance. Yeah surveillance is key in my opinion to maintaining the usefulness of antibiotics as long As possible and to reduce am I want to ask about that. So how does the work you do kind of inform this strategy when a healthcare professional gives you an antibiotic. They don't pick an antibiotic out of thin air. They base their decision on guidelines and they should be following guidelines local guidelines saying for this type of infection in the first instance use this antibiotic and those guidelines are based and should be based on good solid evidence so things that we know that if you use this antibiotic in the past this really worked Experts decide that yeah, and so what we do what I think is really important in surveillance is that we look at the type of infections. We sample them. We see what the bacteria causing the infections what the antibiotics they're susceptible to so that gives us a body of data that we can be used to review the guidelines when they come up for review. I'm always remembering my driving instructor when I was learning to drive long ago, and he always told me to look look ahead and the best time to see a problem is in the Distance so you have time to do something about it. Obviously when you're driving it slowing down or stopping but with surveillance what it is, we're looking ahead and we can see in the distance maybe some issue developing with resistance. And so we have the time to maybe suggest to doctors. Okay, maybe we prescribe another antibiotic hear something like that. Well, I don't want to see his patients all of a sudden not getting Optimum treatment and coming back on Revere ones there infections have not been resolving properly. You know and all of a sudden we think oh, wow, there's a big resistance problem here sneaked up as always a surprise to us, you know, I mean that's fascinating and obviously the work that you and your colleagues and counterparts around the world is doing is ensuring that people can live healthy lives. We're not afraid of infection from cuts and scrapes and stuff like that. We can have surgery we're living longer what would happen if we were to just stop and everyone was like right just prescribe any old antibiotic kind of worst-case scenario. It would be really scary. I mean, it's really scary. Now if you if you stop and think about it very soon. I don't want to say a timeline but if everybody was prescribing any antibiotic Willie or they are some place in the world where you can get antibiotics without prescription, so it is happening in some places. Yeah. Well, which is really scary and those are the areas of the world where we're finding highly resistant multi drug-resistant bacteria that situation where superbugs are. Will be a common place in this country if we started down that path and then you know life expectancy will drop and infectious disease people dying from infections. Not treatable infections would be the number one cause of death in the country at the moment. It's cancer but in a recent government report only report 2016. They said if antimicrobial resistant rates carry on the way, they are then by 2020. It will be the number one killer infectious diseases by antimicrobial. Since wow, it's a scary situation now really and then there's a lot of work in healthcare to really combat this now. All we can do at the moment is maintained the usefulness of our antibiotics that we currently have. Yeah. Hope that you want to be Optics are coming in the pipeline but it takes a long time. It costs a lot of money the key Battleground that moment is surveillance. So we look where we're looking at a bug and we say, right? Okay, we've been giving this this antibiotic to treat it resistance is Raising, right? So, let's give it this Earth antibiotic now. Yeah. Keep that going. Until another answer presents itself nanotechnology or something that made miniature robots that can go inside the robot e to kill bacteria something like that that hasn't happened yet. But you know, it could happen in a space where the film because we're using chemicals to kill bacteria. And this is nothing new to the bacteria. This is what they do if any scientists that their finds a different tack then I'm sure they'll win the Nobel Prize for it. It's a big problem and it's a big Drive within the research Community to find that answer. Sir, yes. Yeah, I can imagine well in the UK, obviously we rely so heavily on the NHS and the research organizations within and around the NHS to keep us healthy and well from problems like bacteria, but other any actions that individuals can take to help so you mentioned for example not going to your GP and demanding that you get antibiotics if you have like a cough. Yeah, I mean, that would be the main one is that yeah, that would be the main one, you know following the Declined so if you do get antibiotics that you take them as the doctor recommends. Yeah, you don't store them and just give them out to your members of family, like all my store this penicillin. I might give it to somebody else just take them yourselves as the as the doctor recommends get vaccinated. There's a big debate in the country at the moment vaccinations. Yeah. I think Wales is a slot or the UK is this loss this measles free. Yeah Status, which is mid-august 2019. Yeah. I've just lost measles free. Yeah, so in my opinion that's a very sad thing so vaccinations are very important on another note. I would say, you know, don't be afraid of getting your hands dirty in the environment as well as important that you get your kids out there and playing in the mud and stuff like that to build up their immune systems, you know? Yes, we have our own kind of antsy bacteria resistant as I've mentioned, you know, the good bacteria that's out there the bacteria don't cause us harm, you know that the back as you're developing as a youngster educates your immune system and get Ready for the big bad. Well, so don't keep your kids wrapped up in Cotton wool get that hands dirty build up their immune systems. I would say easy steps that everyone can take really but it would contribute if everyone did it. I'm sure we've contributed hugely. As I said, it's a global effort this thing and everybody has to has to do their part in trying to combat this big problem. That was really fascinating David. Thank you so much. Thanks again to David Thomas their biomedical scientist at the University Dental hospital for Wales. What a fascinating discussion. I never really knew how much work goes into keeping the mutations of bacteria at Bay and all the working surveillance and future work that can go on that dab. It mentions with nanotechnology and all that sort of stuff that that we may see in our lifetimes. Hope you caught the references to both the Zombie Land and Inner Space. I think David and I are Kindred Spirits as far as films go. And don't forget this winter. If you have a cough or a cold, please don't ask your GP or pharmacist to prescribe you antibiotics because they simply won't work and they just make the problem that much more likely if you have antibiotics at home and you've taken half a course and you thought I'll keep the rest of them. Just throw them away. Don't save them for the rest of your family only take medicine that you've been prescribed self. And when you're taking it follow the instructions, it's as simple as that if you have a topic that you'd like us to cover. Cover someone that you'd like us to interview, please get in touch. You can contact me by emailing news at Wales dot NHS dot u k or via social media. I'm on Twitter @ CV and score, uh be or on Facebook at Cardiff and Vale, uh be don't forget to like And subscribe to this podcast where you can and why not leave a review. It'll just help us to reach that many more people spread the good word about the NHS until next time. I've been bring kentish and this was how Healthcare happens
Alexander Fleming discovered penicillin in 1928. Nearly a century later, antibiotics are one of the biggest weapons in the healthcare arsenal with dozens of different types being prescribed to thousands and thousands of people across the world every day. But are we becoming over-reliant on their use and what would happen if they just stopped working? To answer this question and to see what the NHS, and Cardiff and Vale UHB specifically, is doing to combat the continual mutation of bacteria which is making them resistant to the drugs we use to treat them, we chat to Dafydd Thomas. Dafydd is a biomedical scientist who specialises in bacteria and who is based at the University Hospital of Wales and the University Dental Hospital. We talk about the science behind the prescribing decisions that healthcare staff make, what would happen if antibiotics stopped working, and how we can all take individual action to help in the fight against bacteria. I mention this video, which shows the speed at which bacteria mutate to overcome the chemicals in antibiotics and which was the inspiration for this episode when Dafydd used it as part of a presentation he gave at a conference in early 2019. 