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Page 1“Antibiotic Resistance” by Maureen Leonard


by Maureen Leonard Biology Department Mount Mary College, Milwaukee, WI


Antibiotic Resistance: Can We Ever Win?


Part I – Measuring Resistance Katelyn was excited to start her summer job in her microbiology professor’s research laboratory. She had enjoyed Dr. Johnson’s class, and when she saw the fl yer recruiting undergraduate lab assistants for the summer, she had jumped at the opportunity. She was looking forward to making new discoveries in the lab.


On her fi rst day, she was supposed to meet with Dr. Johnson to talk about what she would be doing. She knew the lab focused on antibiotic resistance in Staphylococcus aureus, espe- cially MRSA (methicillin-resistant S. aureus ).


She still remembered the scare her family had last year when her little brother, Jimmy, got so sick. He’d been playing in the neighborhood playground and cut his lip when he fell off the jungle gym. Of course he always had cuts and scrapes—he was a fi ve-year-old boy! Th is time though his lip swelled up and he developed a fever. When her mother took him to the doctor, the pediatrician said the cut was infected and had prescribed cephalothin, an antibiotic related to penicillin, and recommended fl ushing the cut regularly to help clear up the infection.


Two days later, Jimmy was in the hospital with a fever of 103°F, coughing up blood and having trouble breathing. Th e emergency room doctors told the family that Jimmy had developed pneumonia. Th ey started him on IV antibiotics, including ceftriaxone and nafcillin, both also relatives of penicillin.


It was lucky for Jimmy that one of the doctors decided to check for MRSA, because that’s what it was! MRSA is resistant to most of the penicillin derivatives. Most cases of MRSA are hospital-acquired from patients who are already susceptible to infection, but the ER doctor explained that community-acquired MRSA was becoming more common. Th e doctor then switched the treatment to vancomycin, a completely diff erent kind of antibiotic, and Jimmy got better quickly after that.


Katelyn had dropped Jimmy off at swimming lessons just before coming to work at the lab. As she waited in the hallway for Dr. Johnson, she hoped that she would be at least a small part of helping other people like Jimmy deal with these scary resistant microbes. She was surprised when the professor burst out of the lab, almost running into her.


“Hi Katelyn, I’m really sorry but I have to run to a meeting right now—they sprung it on me last minute. Th ere are a bunch of plates in the incubator right now that need their zones of inhibition measured. I’ll be back in a few hours,” Dr. Johnson said as he rushed down the hallway with a stack of folders.


Katelyn dug out her old lab notebook to look up what she was supposed to do. She found the lab where she and her fellow students had examined the antimicrobial properties of antibiotics using the Kirby-Bauer disk diff usion tech- nique. Looking at the plates Dr. Johnson had told her about, she saw they had all been “lawned,” or completely coated with microbes to make a thick hazy layer over the agar surface. She could also see paper disks with letters on them, and some of the disks had clear zones around them where the microbe had been inhibited (Fig. 1). Her notebook explained how to measure the zone of inhibition around the disks (Fig. 2).


NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE


ttle brother, Jimmy, got hi li h h f ll ff h j l


1


We’re looking for undergraduate lab assistants! If yes, e-mail Dr. Johnson to grab a spot today!


(You must have taken Biology 200 Microbiology to apply)


Interested in studying microbial antibiotic resistance?


Do you want to work in a research lab? Are you interested in bacteria?


Have you heard of antibiotic resistance?


Page 2“Antibiotic Resistance” by Maureen Leonard


Plate 1. Plate 2. Plate 3.


S. aureus


PE


CE ME


VA


S. aureus


PE


CE ME


VA


S. aureus


PE


CE ME


VA


PE


CE ME


MRSA


VA


PE


CE ME


MRSA


VA


PE


CE ME


MRSA


VA


Figure 1. Agar plates of S. aureus or MRSA lawns with antibiotic disks placed on them.


NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE


Page 3“Antibiotic Resistance” by Maureen Leonard


Figure 2. Katelyn’s diagram of how to measure a zone of inhibition from her microbiology lab notebook.


x xi


i 1


n


n


Exercise1 Measure the zones of inhibition for each antibiotic on the plates shown in Figure 1 and note the measurements in the spaces in Table 1 below. (Note: Th e Kirby-Bauer method is standardized so that no zone of inhibition is scored as a 0, and all others include the disk as part of the zone.)


Key: PE = penicillin, ME = methicillin, CE = cephalothin, and VA = vancomycin


Plate S. aureus MRSA


1


PE


ME


CE


VA


2


PE


ME


CE


VA


3


PE


ME


CE


VA


An average, or mean (x ), is a measure of central tendency in the data, or what value occurs in the middle of the data set. Th e mean is calculated by adding up all the values for a given set of data, then dividing by the sample size (n).


Average


Standard deviation measures the spread of the data—as in how variable the data set is. Th e standard deviation (s ) is calculated by the following:


Inhibition (clear) zone


Measure in mm


NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE


Page 4“Antibiotic Resistance” by Maureen Leonard


Standard error measures the diff erence between the sample you have taken and the whole population of values. Th e standard error (SE) is calculated as follows:


s (x x) 2


n 1


SE s n


Exercise 2 In Table 2 below calculate and record the averages and standard errors for each antibiotic in S. aureus and MRSA.


S. aureus MRSA


Average SE Average SE


PE


ME


CE


VA


Exercise 3 Now, redraw Tables 1 and 2 into a single, more organized table. Be sure to label the table appropriately.


Standard deviation


Standard error


NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE


Page 5“Antibiotic Resistance” by Maureen Leonard


Exercise 4 Graph the results from Table 2. Be sure to label the fi gure and the axes correctly.


NATIONAL CENTER FOR CASE STUDY TEACHING IN SCIENCE


Page 6“Antibiotic Resistance” by Maureen Leonard


Questions 1. What do you think the experimental question is? 2. What hypotheses can you come up with to answer the experimental question? 3. If your hypothesis is correct, what would the plates look like (i.e., what predictions would you make for each


hypothesis)? 4. Is the experiment you just collected data for an appropriate test of the experimental question you came up with

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