Interviewing Hans Jørn Kolmos

1. From your point of view, how big is the resistance problem?

He believes that it is an increasing problem, but it should not be the cause of any panic yet. New strategies should be devolved in the use of antibiotics so the increase in antibiotic resistance becomes limited. Antibiotics should not be used to treat infections that we do not know the cause of. Instead a more careful approach in the distribution should be taken. He suggested a simple approach to this issue: three simple steps should undertaken before giving an antibiotic treatment to an infection. First step is to isolate the bacteria. This can be done by evaluating the microorganisms species, its concentration and the origin of isolation. The second step is to conclude whether the isolated microorganism is the cause of infection. This can be done in association with e.g. a prosthesis where an infection has occurred. The third step is to evaluate whether antibiotics can be used against the infection. If the infection occurred in a prosthesis, the bacteria would most likely develop a biofilm. If treated with antibiotics, the infectious bacteria will only be exposed to small concentrations of antibiotics and this will provide time to develop resistance. Under these circumstances, the prosthesis should be removed before given any form of treatment. We should be more retained with the use of antibiotics.

“Nature is smart. Humans have only been here for a few millenniums and microorganisms have been here for billions of years. It would be foolish to believe that we could outsmart nature in only 100 years.” - Hans Jørn Kolmos

2. Does the media highlight antibiotic resistance as a bigger problem than it actually is?

A documentary in danish television called: “When Penicillin doesn’t work anymore.” says that the resistance problem is huge. The documentary shows families experiencing MRSA (Methicillin Resistant Staphylococcus Aureus), and how health care deal with the problem. We asked Mr. Kolmos if the media makes a bigger problem out of it, that it is? He replied that: No, the documentary gave a realistic perspective of the problem.

3. Is there any possibility that we could face a dead end in functional antibiotics if we keep the distribution to this level?

Mr. Kolmos stated there is a potential risk for a multiresistant bacteria. If we kept using antibiotics like we do today, we could potentially get a resistant bacteria, that we could not kill with any of our antibiotic resources.

4. Are there any cases with patients that could not be treated because of an infection caused by multiresistant bacteria?

Mr. Kolmos told us that under the civil war in Libya, the country did not have the resources to treat all the wounded soldiers. Therefore some of them were sent to Denmark. As we treated them, we observed very odd sorts of infections that are not common in Denmark. There were bacterias with other types of resistance than the ones the doctors knew about. The worst were the Gram-negative, ESBL (Extented-Epectrum Beta-lactamase).

He also estimated 30 % of the population are carrier of S.aureus, of these 1-2 % are MRSA. The resistance problem is not just a problem on the hospitals. It is also a part of political debates.

5. Is there any precautions, the ordinary family can contribute with?

He told us that people could get checked if they were carrier of Methicillin Resistant Staphylococcus aureus (MRSA). S.aureus is often found in human nostrils, but if the patient got in contact with the MRSA bacteria, it could outperform the normal flora. The patient would now be a carrier. The MRSA bacteria can be killed by use of antibiotics, but an ordinary family should also take precautions. “Wash your hands, do not sneeze on people, and just be clever about bacteria and how it spreads” - quote Hans Jørn Kolmos.

6. What is the biggest cause to MRSA?

It is hard to isolate a single source that contributes to the development of MRSA, but we know it is a combination of the farming industry and antibiotic distribution.

The media has a tendency to blame the pigs for MRSA. It is actually estimated that only 40% of all pigs are carriers.

7. What antibiotics are used to treat MRSA:CC398, MRSA:USA300 and VISA(Vancomycin-intermediate-S. Aureus)?

Tough question, but Vancomycin can treat both the MRSA:CC398 and MRSA:USA300.

8. Can you see any potential in our project?

It could be a part of a treatment, but it could also be nice to test the bacteriocins on gram-negative bacteria. Bacteriocins could also be used for oral treatment, eg. in the nose, were MRSA is normally found on carriers.