1 00:00:00,000 --> 00:00:08,880 Eighty kilometers from Stockholm, near the town of Uppsala, lies the farm of Anders Kjellarby. 2 00:00:08,880 --> 00:00:16,520 As well as cattle, there's a herd of 180 pigs, and every year the farm produces 4,200 piglets. 3 00:00:16,520 --> 00:00:20,720 There are very tough restrictions, including a maximum weaning age of four weeks and a 4 00:00:20,720 --> 00:00:24,920 complete ban on the use of antibiotics as growth promoters. 5 00:00:24,920 --> 00:00:29,800 Sweden was the first European country to adopt such a ban in 1986. 6 00:00:29,800 --> 00:00:34,920 We had to eliminate the use of antibiotics that boost growth, so to stay competitive 7 00:00:34,920 --> 00:00:38,520 we needed to be stricter in our pig rearing. 8 00:00:38,520 --> 00:00:41,480 We now have to separate them by age. 9 00:00:41,480 --> 00:00:45,920 We have to wash them more thoroughly when we transfer the animals from one compartment 10 00:00:45,920 --> 00:00:50,520 to another. 11 00:00:50,520 --> 00:00:54,000 This means we've had to make certain changes in the pigstyles. 12 00:00:54,000 --> 00:00:59,080 All these measures have worked very well. 13 00:00:59,080 --> 00:01:04,100 From January 2006, the ban on antibiotics as growth promoters has come into effect across 14 00:01:04,100 --> 00:01:05,800 the EU. 15 00:01:05,800 --> 00:01:10,800 Farmers can only use antibiotics, drugs that attack living microbes, to treat diseases. 16 00:01:10,800 --> 00:01:14,560 The measure's not just aimed at improving animal welfare, it's an important step in 17 00:01:14,560 --> 00:01:19,160 combating a real danger to human health, antibiotic resistance. 18 00:01:19,160 --> 00:01:23,400 Many drugs still on sale have become either ineffective or far less reliable than they 19 00:01:23,400 --> 00:01:24,880 used to be. 20 00:01:24,880 --> 00:01:29,240 Excessive and sometimes inappropriate use of medicine has led to a rapid increase in 21 00:01:29,240 --> 00:01:31,640 drug-resistant bacteria. 22 00:01:31,640 --> 00:01:36,160 We're at the Swedish Institute for Infectious Disease Control in Stockholm. 23 00:01:36,160 --> 00:01:41,080 Stefan Normark and Birgitta Henriques are working to better understand how bacteria 24 00:01:41,080 --> 00:01:43,120 become resistant to medicines. 25 00:01:43,120 --> 00:01:48,360 They say it's a natural phenomenon reinforced by other circumstances. 26 00:01:48,360 --> 00:01:53,880 Antibiotic resistance is an evolutionary phenomenon selected by antibiotics, so if you go out 27 00:01:53,880 --> 00:02:00,600 there in the soil and in the water, you find antibiotic resistance. 28 00:02:00,600 --> 00:02:04,840 But some antibiotic resistance traits is very complex. 29 00:02:04,840 --> 00:02:07,320 It has evolved over many, many years. 30 00:02:07,320 --> 00:02:14,160 It's DNA that is picked up and recombined, and then you have mutations on top of that, 31 00:02:14,160 --> 00:02:16,280 and then you create new features. 32 00:02:16,280 --> 00:02:22,480 So we make evolution to go much more rapid with antibiotic selection, much more rapid 33 00:02:22,480 --> 00:02:27,360 than what is naturally occurring. 34 00:02:27,360 --> 00:02:31,360 Together with other European scientists, the team in Stockholm is working to discover an 35 00:02:31,360 --> 00:02:38,240 elusive code, namely how resistance is genetically transferred to bacteria. 36 00:02:38,240 --> 00:02:43,240 Pneumococcus express pili is a bacteria that causes pneumonia and septicemia, and it's 37 00:02:43,240 --> 00:02:46,320 a major killer of children under five years old. 38 00:02:46,320 --> 00:02:50,000 It's also resistant to many penicillin-based treatments. 39 00:02:50,000 --> 00:02:54,720 Resistance can come about in one of two ways, either through a mutation in chromosomes or 40 00:02:54,720 --> 00:02:58,320 a change in the bacteria's DNA structure. 41 00:02:58,320 --> 00:03:03,520 In the latter case, the bacterium can receive the resistance gene from a dead bacterium, 42 00:03:03,520 --> 00:03:10,160 from another living bacterium that transfers small pieces of DNA called plasmids, or from 43 00:03:10,160 --> 00:03:15,200 a virus that transfers the resistance gene from one bacterium to another. 44 00:03:15,200 --> 00:03:19,360 Since the bacterium is resistant, it can defend itself against antibiotics molecules 45 00:03:19,360 --> 00:03:21,400 in four ways. 46 00:03:21,400 --> 00:03:26,720 The antibiotics molecules might simply be unable to enter the strengthened bacterium, 47 00:03:26,720 --> 00:03:34,280 or the molecules enter but are forced out again, the so-called pump effect. 48 00:03:34,280 --> 00:03:43,840 They might be neutralized by surrounding enzymes, or disintegrated by other enzymes. 49 00:03:43,840 --> 00:03:49,920 So how can scientists get around these defenses and destroy the bacteria? 50 00:03:49,920 --> 00:03:54,680 Staffan and Birgitta are just two of around 30 European scientists working on the GRACE 51 00:03:54,680 --> 00:03:55,680 project. 52 00:03:55,680 --> 00:04:04,800 It's aimed at combating resistance in respiratory diseases like bronchitis and pneumonia. 53 00:04:04,800 --> 00:04:08,360 We think that the lower respiratory tract infections are very important, and specifically 54 00:04:08,360 --> 00:04:13,880 for the antibiotic resistance development, in that you try to treat a lot of lower respiratory 55 00:04:13,880 --> 00:04:16,240 tract infections with antibiotics. 56 00:04:16,240 --> 00:04:20,840 And it's very important that you really have the right diagnosis, and that you really have 57 00:04:20,840 --> 00:04:25,240 the right indications for using antibiotics. 58 00:04:25,240 --> 00:04:29,880 This hospital near Antwerp in Belgium is at the centre of the GRACE project. 59 00:04:29,880 --> 00:04:34,480 Scientists are now able to better identify MRSA bacteria, which can cause a number of 60 00:04:34,480 --> 00:04:39,200 respiratory infections and can resist antibiotics such as penicillin. 61 00:04:39,200 --> 00:04:43,520 The complex process, including taking samples from the patient's throat and amplifying their 62 00:04:43,520 --> 00:04:50,120 DNA, allows researchers to obtain a photograph of the genetical identification of the MRSA 63 00:04:50,120 --> 00:04:51,200 bacteria. 64 00:04:51,200 --> 00:04:56,160 It takes just six hours, compared with up to four days in conventional microbiology. 65 00:04:56,160 --> 00:05:01,000 Instead of receiving a short-term prescription, the patient is isolated, so he or she cannot 66 00:05:01,000 --> 00:05:03,320 transmit the bacteria to others. 67 00:05:03,320 --> 00:05:06,120 Dr. Man Gosens is the GRACE project coordinator. 68 00:05:06,120 --> 00:05:11,480 We're looking at human genomics, and the reason why we're doing this is because we know that 69 00:05:11,480 --> 00:05:16,560 some patients, irrespective of antibiotic treatment, will have a worse outcome, may 70 00:05:16,560 --> 00:05:21,000 even die of this infection, for instance in the lungs. 71 00:05:21,000 --> 00:05:25,520 And so therefore some patients are genetically at risk, there are genetic risk factors. 72 00:05:25,520 --> 00:05:31,800 What we're trying to do now is to identify the genes that are associated with an increased 73 00:05:31,800 --> 00:05:38,000 worsening of the disease with respiratory infections, and therefore try to prevent 74 00:05:38,000 --> 00:05:42,000 patients' worsening from these kinds of infections. 75 00:05:42,000 --> 00:05:46,720 Another way of fighting resistance is developing new antibiotic compounds. 76 00:05:46,720 --> 00:05:51,440 The Centre for Protein Engineering at the University of Liège is involved in the UR-INTEFAR 77 00:05:51,440 --> 00:05:52,440 project. 78 00:05:52,440 --> 00:05:57,720 They're looking for new ways to weaken penicillin-resistant bacteria. 79 00:05:57,720 --> 00:06:02,320 Professor Bernard Jory and his colleagues have created a 3D representation of one of 80 00:06:02,320 --> 00:06:09,480 the enzymes forming the bacteria's protective coating. 81 00:06:09,480 --> 00:06:13,840 We're studying this enzyme because it's resistant to antibiotics. 82 00:06:13,840 --> 00:06:18,400 We've isolated its gene, we've produced large quantities of the enzymes. 83 00:06:18,400 --> 00:06:24,160 We can carry out a thorough study of its properties. 84 00:06:24,160 --> 00:06:28,840 At the same time, we've passed the enzyme to the crystallographers to create crystals 85 00:06:28,840 --> 00:06:32,360 and use these to make three-dimensional structures. 86 00:06:32,360 --> 00:06:37,120 The 3D structures give us the enzyme's cartography. 87 00:06:37,120 --> 00:06:42,640 Now we're trying to understand why this enzyme became resistant, obviously by comparing the 88 00:06:42,640 --> 00:06:50,880 resistant enzyme with the one which was sensitive to the antibiotic. 89 00:06:50,880 --> 00:06:55,200 There is another line of attack against antibiotic resistance, information. 90 00:06:55,200 --> 00:07:00,040 The Swedish Strategic Programme for the Rational Use of Antimicrobial Agents was founded in 91 00:07:00,040 --> 00:07:01,560 1995. 92 00:07:01,560 --> 00:07:07,080 One of its aims is informing people in Sweden and further afield about the dangers of over-prescription 93 00:07:07,080 --> 00:07:10,560 and over-consumption of antibiotics. 94 00:07:10,560 --> 00:07:15,080 The information to the public is one of the most important things that you could do. 95 00:07:15,080 --> 00:07:24,600 You should educate people, mothers, parents, about what is an antibiotic, what does it 96 00:07:24,600 --> 00:07:31,680 do, when should you use it and when should you not use it, so that the expectations from 97 00:07:31,680 --> 00:07:37,760 the patients when they go to a doctor is not wrong. 98 00:07:37,760 --> 00:07:43,000 A recent poll suggested only about 40% of EU citizens knew antibiotics were useless 99 00:07:43,000 --> 00:07:45,320 against a virus such as the common cold.