Diabetes Fuels Antimicrobial Resistance, Study Finds

Diabetic Infections Drive Antibiotic Resistance

With nearly 530 million people worldwide living with diabetes, the risk of developing infections is significantly elevated.Furthermore, uncontrolled blood sugar levels can create an environment were bacteria, notably Staphylococcus aureus ( S. aureus), thrive and evolve resistance to antibiotics. This troubling link between diabetes and antibiotic resistance (AMR) was recently highlighted in a study published in the journal science Advances.

Researchers at the University of North Carolina (UNC) investigated how S.aureus evolves resistance in diabetic mice compared to non-diabetic mice. They infected both groups with S. aureus and treated them with the antibiotic rifampicin. After just four days, bacteria treated in diabetic mice had evolved resistance, with the mutation rapidly overtaking the entire infection. In contrast, no rifampicin-resistant bacteria were observed in the non-diabetic models.The study revealed that the diabetic environment, characterized by excess glucose and a weakened immune response, provides a fertile ground for S. aureus to evolve and spread resistance.

“The lack of innate immune control and excess glucose availability lead to unrestricted growth of the pathogen,” explained Dr. Brian Conon, associate professor at UNC, told Technology Networks. “the large numbers of bacteria increase the likelihood of resistance mutations occurring and importantly, once a resistant mutant is present, the excess glucose allows it to rapidly outgrow and take over the infection, whereas the same resistant mutant remains fairly well restricted in a non-diabetic background.”

S. aureus is particularly well-suited to exploit this environment. Its four dedicated glucose transporters allows it to efficiently utilize excess glucose, while its virulence factors are further enhanced in high-glucose environments.

These findings emphasize the critical need to prevent diabetic infections and highlight the importance of controlling blood sugar levels. “insulin was able to stop resistance from taking over,” Conon noted. “This may have more implications for the treatment of infection in diabetics, particularly patients with difficult-to-control blood sugar. In these instances, using multiple antibiotics might potentially be advisable to restrict the evolution of resistance.”

The UNC team plans to further investigate the link between diabetes and AMR, considering other antibiotic-resistant bacteria such as Enterococcus faecalis, Pseudomonas aeruginosa, and Streptococcus pyogenes. They also aim to explore other conditions, like chemotherapy and transplantation, which can also impact immune function and perhaps contribute to AMR.

Reference: Shook JC, Genito CJ, Darwitz BP, et al. Diabetes potentiates the emergence and expansion of antibiotic resistance. Sci Adv.11(7):eads1591.doi: 10.1126/sciadv.ads1591

About the Interviewee:

Dr. Brian Conon is an associate professor at the University of north Carolina (UNC) Chapel Hill. Conon earned a BSc at the University of Galway before completing a PhD at University College Dublin. He did his postdoctoral training under Dr.Kim Lewis at Northeastern university before starting his own lab at UNC Chapel Hill in 2016. Conon is deeply committed to developing a better understanding of how antibiotics work in the infection microenvironment and using the resulting knowlege to develop new therapeutic strategies to improve antibiotic efficacy and curb the development and spread of antibiotic resistance.Conon is currently PI on multiple awards from NIAID and is a Burroughs wellcome Fund Investigator in the Pathogenesis of Infectious Disease.

What are some of the key differences in antibiotic resistance development between diabetic and non-diabetic mice as observed in your study?

Archyde News Exclusive: Interview with Dr. brian Conon on Diabetes and Antibiotic Resistance

Diabetes and the Rising Threat of Antibiotic Resistance

In a groundbreaking study published in Science Advances, researchers at the University of North Carolina (UNC) explored the link between diabetes and antibiotic resistance (AMR), shedding light on a significant public health concern. We sat down with the study’s lead, Dr.Brian Conon, Associate Professor at UNC Chapel Hill, to discuss their findings and the implications for global health.

Dr. Conon, your study highlights a troubling connection between diabetes and antibiotic resistance. Could you walk us through your key findings?

Dr. Brian Conon: Absolutely. We found that diabetic mice infected with Staphylococcus aureus (S. aureus) evolved antibiotic resistance much faster and to a much greater extent than non-diabetic mice, even when treated with antibiotics. The diabetic environment, characterized by high glucose levels and a weakened immune response, seems to foster the evolution of resistance.

Essentially, the lack of immune control and excess glucose allow the bacteria to grow unchecked, increasing the likelihood of resistance mutations. Once a resistant mutant appears, high glucose levels help it rapidly outgrow and take over the infection.

That’s alarming, given the global diabetes epidemic. What does this mean for people with diabetes?

Dr. Brian Conon: It underscores the critical importance of infection control and good blood sugar management in people with diabetes. Our study suggests that maintaining healthy blood sugar levels can help prevent the evolution of antibiotic resistance. It also implies that using multiple antibiotics simultaneously might be advisable in certain cases to prevent resistance.

S. aureus appears notably adept at exploiting the diabetic environment. Why is that?

Dr. Brian Conon: S. aureus has four dedicated glucose transporters that allow it to efficiently utilize excess glucose. Moreover, its virulence factors are enhanced in high-glucose environments. These traits make it well-suited to take advantage of the conditions found in diabetic infections.

Your work has significant implications for global health.What’s next for your research?

Dr. Brian Conon: We plan to investigate other antibiotic-resistant bacteria like Enterococcus faecalis, Pseudomonas aeruginosa, and Streptococcus pyogenes to see if they respond similarly to the diabetic environment. We’re also looking into other immune-compromising conditions like chemotherapy and transplantation to better understand how they might contribute to AMR.

Dr. Conon,thinking ahead,what steps can be taken to mitigate this growing threat?

Dr. Brian Conon: A multi-faceted approach is needed. Better diabetes management, judicious use of antibiotics, and rigorous infection control practices are crucial. Moreover, supporting research into new antibiotics and alternative therapies could prove vital in our fight against antibiotic resistance.

Thank you, Dr. Conon, for your time and insights. Your work highlights a stark reality that demands global attention and action.

Reference: Shook JC, Genito CJ, Darwitz BP, et al. Diabetes potentiates the emergence and expansion of antibiotic resistance. Sci Adv.11(7):eads1591.doi: 10.1126/sciadv.ads1591