iPads: next-​​gen microbial breeding ground

Photo via Thinkstock.

Photo via Thinkstock.

I hope you caught a glimpse of our inter­view with Betsy Hirsch on Tuesday on the impact of antibi­otic resis­tant bac­teria on national health. Bottom line: resis­tance is no good. Infec­tious microbes that evolve to essen­tially spit out the drugs we try to kill them with are pow­erful bugs, even if they are micro­scopic. In fact, according to a new report put out last month by the CDC, they are respon­sible for more than 20 thou­sand deaths each year.

Hirsch is an assis­tant pro­fessor in the Depart­ment of Phar­macy Prac­tice where she is researching how com­bi­na­tions of drugs might do a better job of killing these bac­teria than a single drug alone. The approach brings to mind a comic book sce­nario in which Batman and Superman join forces. Kryp­tonite might get Superman even­tu­ally, but not before he’s had a go at the bad guys. And once he’s dead, sad though it may be, Batman can pick up the slack. Like­wise, Superman is capable of some pretty pow­erful things that Batman, reg­ular guy that he is, could never come close to achieving.

But while devel­oping new antibi­otics and com­bi­na­tions thereof are crit­ical as we attempt to nav­i­gate a future ever more wrought by resis­tant bac­teria, per­haps the most impor­tant super powers we have for pro­tecting our­selves are fore­sight and behavior. Hirsch points out in the inter­view that over– and inap­pro­priate use of antibi­otics are per­haps the two main cul­prits that have gotten us where we are today in this horror story of antibi­otic resis­tance. Going for­ward, our greatest defenses will be infec­tion con­trol and pre­ven­tion, she says. And the first step in con­trol and pre­ven­tion is, undoubt­edly, knowledge.

On Wednesday at IDWeek, the com­bined annual meeting of the Infec­tious Dis­eases Society of America, the Society for Health­care Epi­demi­ology of America, the HIV Med­i­cine Asso­ci­a­tion, and the Pedi­atric Infec­tious Dis­eases Society, Hirsch and her team pre­sented find­ings on how our ubiq­ui­tous devices can serve as fomites for infec­tion, in par­tic­ular resis­tant bacteria.

In a col­lab­o­ra­tive project with assis­tant pro­fessor Steve Leonard and asso­ciate clin­ical pro­fessor Jason Lancaster, Hirsch and her team swabbed the sleek sur­faces of 30 phar­macy prac­tice fac­ulty mem­bers’ iPads for three types of bacteria: methicillin-resistant Staphy­lo­coccus aureus (aka MRSA), vancomycin-resistant Ente­ro­coccus, and Pseudomonas aerug­i­nosa. The team was expecting to see some dif­fer­ences in the level of bac­te­rial col­o­niza­tion on iPads that reg­u­larly visit the clinic (about half of the group also have clin­ical appoint­ments) than on those that stick around the uni­ver­sity more often. No such luck, though.

It turns out both groups had sig­nif­i­cant levels of bac­teria living on them, pro­viding fer­tile ground for trans­fer­ring infec­tion from one person to another. For those iPads that do see the hos­pital, the results show yet another sur­face for clin­i­cians to be wary of when inter­acting with patients, espe­cially immuno­com­pro­mised patients, like people with cancer or HIV, and even preg­nant women.

A few months ago I asked Kim Lewis, another North­eastern fac­ulty member whose research topic of choice hap­pens to be hearty microbes like antibi­otic resis­tant bac­teria, what kinds of pre­cau­tions we should take when pro­tecting our­selves from the mul­ti­tudes of bad bac­teria among us (because, please don’t forget that there are plenty of good bugs out there that we rely on for our good health as well). He told me that our best bet is rub­bing alcohol, rather than the antibac­te­rial soaps you see on the market con­taining the anti­septic tri­closan. The few bac­teria that sur­vive tri­closan onslaught have some­thing called a mul­tidrug resis­tant pump embedded at var­ious points around their cell mem­brane. If these are the only bugs left to sur­vive, then when they repro­duce, their babies will also have MDRs as the pumps are called for short. A slew of bac­teria with MDRs amounts to a antibiotic-​​resistant infection.

So, if you want to keep your iPad clean, I guess the best bet is simply an alcohol wipe. On the other hand, Apple is appar­ently toying with the idea of devel­oping devices with antibac­te­rial sur­faces built right in. This might work some­thing like Tom Webster’s antibac­te­rial paper towels, which are coated with sele­nium nanopoar­ti­cles, cre­ating a rough sur­face upon which bac­teria have a rather dif­fi­cult time growing. If Apple ever does come out with such a design, it would be great to see how they’d hold up to Hirsch’s exper­i­mental protocol.