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TEACHER GUIDE 1

Ior haIf a cenlury, anlibiolics have given us a overfuI vay lo lreal infeclions lhal once vere
Iife lhrealening. Yel, lhe groving number of anlibiolic-resislanl bacleria is ulling lhis goIden
era of medicine al risk. Nov, ve !nd ourseIves in a race lo revenl bacleriaI infeclions from
once again becoming one of humanily's ma|or kiIIers.
Rise of the Superbugs
ACTIVITY AT A GLANCE
PURPOSE: To show how populations of bacteria
become resistant to antibiotics via the process
of natural selection and human misuse
OVERVIEW: Students follow the story of a
teen who develops an infection related to injuries
resulting from a bicycle accident. They analyze
graphs of cultures that doctors grew to track how
the infecting bacteria responded to antibiotics.
The graphs show that, over six days, the teens
population of bacteria becomes increasingly
resistant to two antibiotics. Students deduce that
the teen picked up some bacteria resistant to the
initial dose of antibiotics at the hospital. Those
bacteria then grew to dangerous levels. Students
conclude the activity by making a recommendation
regarding the next course of action.
LEVEL: Grades 912
TIME: 2 class periods
CORE CONCEPTS
Bacteria can be resistant to different kinds
of antibiotics.
After being exposed to antibiotics, a population
of bacteria can become resistant to antibiotics
through the process of natural selection.
MATERIALS
Student sheet for each student
Student sheet for Going Further activity (optional)
STANDARDS CONNECTION
Life Science
58: Reproduction and Heredity; Populations
and Ecosystems; Diversity and Adaptations
of Organisms
912: The Cell; Biological Evolution; and Matter,
Energy, and Organization in Living Systems
Health
Standard 1: Comprehend concepts related
to health promotion and disease prevention.
Standard 3: Practice health-enhancing behaviors
and reduce health risks.
Standard 4: Analyze the inuence of culture,
technology, and other factors on health.
PROGRAM CONNECTION
efore lhe advenl of anlibiolics, bacleriaI infeclions couId be Iife lhrealening. Wilh lhe
discovery of anlibiolics and lhe deveIomenl of melhods lo mass-roduce lhem, many
bacleriaI infeclions became easiIy lrealabIe. ul lhe bacleria have foughl back. Any ouIalion
of organisms faced vilh a chaIIenge lo ils survivaI has lhe olenliaI lo adal via lhe rocess of
naluraI seIeclion. Ior examIe, many insecls have become resislanl lo inseclicides and many
ccniinuc!

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TEACHER GUIDE 2
BEFORE WATCHING
Whal is an anlibiolic` Whal lyes of diseases
do lhey lreal` Have you ever laken anlibiolics` If
so, vhich kind(s)`
An cnii|iciic is c su|sicncc inci ccnirc|s inc grcuin
cj |ccicric, ciincr |q |i||ing incm cr inni|iiing incir
c|i|iiq ic rcprc!ucc. 1ncq crc usc! ic ircci |ccicric|
injcciicns, sucn cs |ccicric| pncumcnic, sicpn, cn! ccr
injcciicns. |xcmp|cs inc|u!c |cciirccin, ccpnrc!inc,
ciprc!cxccin (ciprc), crqinrcmqcin, nqsiciin,
pcnici||in, cn! icirccqc|inc.
Whal do you lhink il means for a disease lo be
resislanl lo a drug, such as an anlibiolic` Lisl
some issues reIaled lo lrealing a disease caused
by bacleria lhal are resislanl lo anlibiolics.
|ssucs inc|u!c. Nci |cing c||c ic ccnirc| inc injcciicn,
puiiing inc pciicni ci scricus ris|, giting rcsisicni
|ccicric inc cppcriuniiq ic pcss incir rcsisicncc cn
ic cincr |ccicric in inc pciicnis |c!q, cn! cn incrccsc!
ris| cj sprcc!ing inc rcsisicni |ccicric ic cincrs in inc
ccmmuniiq.
AFTER WATCHING
Hov is lhe emergence of anlibiolic-resislanl
bacleria an examIe of naluraI seIeclion`
1nis ucsiicn is cxp|cinc! in inc cnsucr ic siu!cni
sncci ucsiicn 11.
Discuss vhal our Iives vouId be Iike if mosl
bacleria adaled lo lhe resence of anlibiolics and
became resislanl lo lhem.
Ask vhy anlibiolic-resislanl bacleria are such
a big robIem in hosilaIs.
Hcspiic|s ircci sic| pccp|c. As c rcsu|i, incq nctc
c |crgcr num|cr cn! !itcrsiiq cj !isccsc-ccusing
micrccrgcnisms incn is iqpicc||q jcun! in inc
ccmmuniiq. |urincrmcrc, ncspiic|s rcgu|cr|q usc
mc!icincs inci |i|| !isccsc-ccusing micrccrgcnisms,
crcciing cn cntircnmcni inci jctcrs micrc|cs rcsisicni
ic incsc mc!icincs. |inc||q, uni|c inc s|in is cn
cxcc||cni |crricr cgcinsi micrccrgcnisms, ii is cjicn
|rc|cn in ncspiic|smcnq pciicnis crritc uiin cpcn
ucun!s, cn! ii is cjicn punciurc! |q ncc!|cs cn! cui
uiin mc!icc| imp|cmcnis cs uc||.
Discuss hov human behavior heIs resislanl
slrains of bacleria arise. Ask vhy lhe overuse and
misuse of anlibiolics is risky, bolh for lhose vho
overuse or misuse lhem and for lhe overaII heaIlh
of lhe ubIic.
veeds have become resislanl lo herbicides. SimiIarIy, some lyes of bacleria have resonded
lo lhe increasing resence of anlibiolics by becoming resislanl lo lhem. So bacleriaI infeclions
may once again become Iife lhrealening.
This rogram foIIovs lhe case of an American leenager and his doclor ballIing againsl an
anlibiolic-resislanl bacleriaI infeclion. Anlibiolic resislance is lhen Iaced in a ubIic heaIlh
conlexl by examining lhe Iarge-scaIe !ghl againsl anlibiolic-resislanl lubercuIosis infeclion
in Ieru. The rogram oinls oul lhal even vhen lrealmenls are avaiIabIe, lhe deIivery of lhose
lrealmenls resenls yel anolher sel of chaIIenges.
This aclivily examines one rocess by vhich slrains of anlibiolic-resislanl bacleria can arise.
PROGRAM CONNECTION (continued)
PROCEDURE
1. Dislribule lhe sludenl sheel. Have sludenls
read aboul lhe leen vilh lhe anlibiolic-resislanl
infeclion on lhe sludenl sheel and ansver
queslion 1.
|i is nc|pju| ic cssign inis rcc!ing pricr ic c|css cn! ic
rcticu inc ccnccpi cj nciurc| sc|cciicn.
2. Have sludenls vork individuaIIy, in airs, in
leams, or as a cIass lo comIele lhe sludenl sheel.
Siu!cnis ic|c cn inc rc|c cj cpi!cmic|cgisis, i!cniijqing
cnii|iciic-rcsisicni injcciicns cn! rcccmmcn!ing inc
|csi ccursc cj irccimcni. 1c !c inis, incq cnc|qzc
ccniinuc!
FOR MORE INFORMATION
pbs.org/rxforsurvival
2005 WGBH Educational Foundation
and Vulcan Productions, Inc.
TEACHER GUIDE 3
indeendenl. Some genes lhal confer anlibiolic
resislance are carried in Iasmids. acleria in a
ouIalion can exchange Iasmids. This exchange
can lransfer anlibiolic-resislanl genes belveen
bacleria, incIuding bacleria of differenl secies.
efore beginning lhis Going Iurlher aclivily, you may
vanl lo reviev Iasmids, reslriclion enzymes, and
geI eIeclrohoresis.
GOING FURTHER
Have sludenls anaIyze lhe rovided eIeclrohoresis
geI holograh and idenlify lhe oinls al vhich
Lva's bacleria acquired anlibiolic-resislanl genes. The
handoul enlilIed Idenlify lhe Genes Carrying Anlibiolic
Resislance sles sludenls lhrough lhis anaIysis.
acleria have bolh chromosomaI DNA and Iasmids,
vhich are circuIar unils of DNA. IIasmids can become
incororaled inlo lhe chromosomaI DNA or remain
Wrole lhoughlfuI resonses lo sludenl sheel
queslions and suorled concIusions vilh dala
resenled in lhe grahs.
LxIained hov lhe deveIomenl of anlibiolic
resislanl-bacleria iIIuslrales lhe rocess of naluraI
seIeclion.
CorreclIy recommended lhal doclors lreal Lva
vilh anlibiolic .
Demonslraled an underslanding of hov our
use of anlibiolics romoles lhe deveIomenl of
anlibiolic resislanl-bacleria and lhal lhese bacleria
ose a serious lhreal lo gIobaI heaIlh.
ASSESSMENT
Sludenls' resonses lo lhe queslions on lhe sludenl
sheel shouId incororale lhe oinls discussed in lhe
ansvers (incIuded in lhis seclion). In addilion, consider
lhe foIIoving vhen assessing sludenl vork:
Suorled lhe leam by conlribuling lo lhe
discussion, Iislening lo olhers' ideas, vorking
logelher lo anaIyze lhe grahs, and heIing lhe
leam deveIo a consensus.
Inderslood hov dala are resenled on a grah
and inlerreled grahs correclIy.
CouId arlicuIale vhen lhe bacleria acquired
resislance lo anlibiolics A and C and hov lhe
roorlion of anlibiolic-resislanl and non-resislanl
bacleria changed over lhe six days.
grcpns sncuing inc rcic cj grcuin cj |tcs |ccicric,
unicn ucrc cc||ccic! ci !ijjcrcni iimcs !uring inc
ccursc cj inc injcciicn. Scc inc Asscssmcni scciicn jcr
cnsucrs ic inc ucsiicns cn! jcr |cq !iscussicn pcinis.
|n sicps 211, siu!cnis cnc|qzc inc grcpns sncuing
inc grcuin cj |tcs pcpu|ciicn cj |ccicric, !ctc|cp cn
cxp|cnciicn cj ncu ncr cnii|iciic rcsisicncc !ctc|cpc!,
cn! rcccmmcn! c irccimcni sircicgq. A ccmp|cic
cxp|cnciicn sncu|! mcniicn inci inc grcpns sncu
uncn inc |ccicric ccuirc! rcsisicncc ic cnii|iciics A
cn! C cn! ncu inc prcpcriicn cj cnii|iciic-rcsisicni
cn! ncn-rcsisicni |ccicric cncngc ctcr inc six !cqs.
Siu!cnis sncu|! rcccmmcn! inci |tc |c irccic! uiin
Anii|iciic B. 1nc jc||cuing cxp|cnciicn summcrizcs
inc |cq pcinis.
|igurc 4 sncus inci inc pcpu|ciicn cj |tcs |ccicric
nc! nc iniiic| rcsisicncc ic Anii|iciics A, B, cr C.
1ncrcjcrc, snc ccuirc! ncr rcsisicncc in inc ncspiic|.
|tc |cccmc injccic! uiin |ccicric rcsisicni ic
Anii|iciic A !uring ncr tisii ic inc ncspiic|
cn Mcn!cq cjicrnccn. |igurc 5 sncus inci inc
pcpu|ciicn !cc|incs cs Anii|iciic A |i||s inc
susccpii||c |ccicric. Bui inc pcpu|ciicn cj |ccicric
rcsisicni ic Anii|iciic A incrccscs in inc icsi iu|c.
Bq ncur ninc, incir num|crs incrccsc !rcmciicc||q.
1ucs!cq mcrning, |tc icc| inc |cji-ctcr Anii|iciic
A. 1nis !csc |i||c! inc rcmcining |ccicric susccpii||c
ic Anii|iciic A, |ccting cn|q c pcpu|ciicn cj |ccicric
rcsisicni ic Anii|iciic A. 1nc grcpn |inc in |igurc 6
sncus inci, |q 1ucs!cq ctcning, inc pcpu|ciicn
cj |ccicric ucs ccmp|cic|q uncjjccic! |q Anii|iciic A.
|igurc 4 sncus inci, iniiic||q, c jcu |ccicric in inc
pcpu|ciicn cj |tcs |ccicric crc rcsisicni ic
Anii|iciic D. Sincc |tc nctcr ic|cs Anii|iciic D, inc
prcpcriicn cj incsc rcsisicni |ccicric !ccs nci cncngc
ctcr inc ucc|incq nctc nc pcriicu|cr c!tcnicgc
ctcr inc unrcsisicni |ccicric. |igurcs 48 sncu |tcs
Anii|iciic D-rcsisicni pcpu|ciicn is inc scmc cccn
iimc, incrccsing cn|q s|igni|q cjicr |cing grcun in c
icsi iu|c jcr 24 ncurs.
|igurcs 6 cn! 7 sncu |tcs pcpu|ciicn cj |ccicric
|cccming rcsisicni ic Anii|iciic C. Sincc incrc ucrc
nc Anii|iciic C-rcsisicni |ccicric cn 1ucs!cq ctcning,
|tc musi nctc ccuirc! incm cjicr tisiiing inc ncspiic|
cn 1ucs!cq ctcning. |tc sicric! ic|ing Anii|iciic C
1nurs!cq. Bq Sciur!cq, |tcs |ccicric| pcpu|ciicn is
mcsi|q Anii|iciic C-rcsisicni |cccusc nccr|q c|| cj inc
Anii|iciic C-susccpii||c |ccicric nctc |ccn |i||c!.
PROCEDURE (continued)
TEACHER GUIDE 4
ANSWERS TO RISE OF THE SUPERBUGS STUDENT SHEET
1. (a) Whal mighl exIain vhy Lva's infeclion is nol
resonding lo lrealmenl by anlibiolics`
Scmc |ccicric mcq |c rcsisicni ic inc cnii|iciics.
(b) Whal informalion aboul lhe infeclion vouId
you vanl in order lo !nd a vay lo lreal il`
|i ucu|! |c gcc! ic un!crsicn! unci |in!s cj
|ccicric crc prcscni cn! uncincr incq crc rcsisicni
ic cnii|iciics.
3. LxIain hov lhe grahs in Iigures 13 describe
lhe bacleriaI grovlh over lhe 24 hours.
No anlibiolics: 1nc num|cr cj |ccicric incrccscs
uic||q.
Anlibiolics and suscelibIe bacleria: 1nc num|cr
cj |ccicric !cc|incs uic||q cs inc cnii|iciic |i||s incm.
Anlibiolics and some resislanl bacleria: |irsi,
inc num|cr cj |ccicric jc||s cs inc cnii|iciic |i||s
inc susccpii||c |ccicric. 1ncn, |cccusc inc rcsisicni
|ccicric nctc |ccn rcprc!ucing, c pcini is rcccnc!
uncrc inc num|cr cj susccpii||c |ccicric |cing |i||c!
cuc|s inc incrccsc cj inc rcsisicni cncs. As inc
pcpu|ciicn cj rcsisicni |ccicric ccniinucs ic grcu,
inc curtc sicps !rcpping cn! |cgins ic risc.
4. Hov viII Dr. Hincaie use lhe lhree slandard
grahs`
1ncsc sicn!cr! grcpns sncu inc pciicrn cj grcuin
in |ccicric uncsc rcsisicncc ic cnii|iciics is c|rcc!q
|ncun. Kncuing incsc grcuin pciicrns, nc ccn
cnc|qzc inc grcuin pciicrns jrcm |tcs |ccicric in
cr!cr ic i!cniijq cnii|iciic-rcsisicni cn! cnii|iciic-
susccpii||c |ccicric.
5. Were anlibiolic-resislanl bacleria resenl in lhe
lissue samIes laken vhen Lva !rsl arrived al lhe
hosilaI on Monday` (Iigure 4) Hov can you leII`
Ycs. 1nc s|igni risc sicriing crcun! ncur 12 sncus
inci incrc ucrc c smc|| num|cr cj |ccicric rcsisicni
ic Anii|iciic D in inc pcpu|ciicn cj |tcs |ccicric
uncn snc "rsi crritc!.
6. y Salurday, vhich anlibiolics vere lhe bacleria
resislanl lo`
Anii|iciics A, C, cn! D.
7. Al vhal oinl did lhe ouIalion of bacleria shov
resislance lo:
Anlibiolic A Wncn |tc ucs ci inc ncspiic| cn
Mcn!cq cjicrnccn, snc pic|c! up scmc |ccicric
rcsisicni ic Anii|iciic A. Bq ic|ing inc |cjictcr
cnii|iciics cn 1ucs!cq mcrning, snc |i||c! mcsi cj inc
|ccicric susccpii||c ic Anii|iciic A, c||cuing incsc
rcsisicni ic ii ic !curisn. 1nc pcpu|ciicn cj rcsisicni
|ccicric incrccsc! !rcmciicc||q ctcr inc ucc|.
Anlibiolic Nc |ccicric ucrc rcsisicni.
Anlibiolic C Wncn snc rciurnc! ic inc ncspiic|
cn 1nurs!cq ctcning.
Anlibiolic D |tc nc! scmc |ccicric rcsisicni
ic Anii|iciic D ctcn |cjcrc ncr ccci!cni.
8. LxIain lhe difference in lhe grovlh rales of
bacleria grovn in lhe resence of Anlibiolic A
on Monday versus on Tuesday.
|tc nc! nc |ccicric rcsisicni ic Anii|iciic A cn
Mcn!cq cjicrnccn. (|igurc 4) Yci, cjicr ncr tisii ic
inc ncspiic|, |tc nc! ccuirc! scmc |ccicric rcsisicni
ic Anii|iciic A. |igurc 5 sncus inc pcpu|ciicn cj
|ccicric !ccrccsing ci "rsi cs inc susccpii||c |ccicric
!ic, |ui incn grcus cs inc rcsisicni |ccicric incrccsc in
num|cr. On 1ucs!cq mcrning, |tc icc| scmc |cjictcr
Anii|iciic A. |igurc 6 sncus inci, |q 1ucs!cq, c||
inc surtiting |ccicric crc rcsisicni ic Anii|iciic A.
(|igurcs 7 cn! 8)
9. LxIain lhe difference in grovlh rale of lhe
bacleria resislanl lo Anlibiolic C from Thursday
lo Salurday.
As cj 1ucs!cq, |tc ncs nc |ccicric rcsisicni ic
Anii|iciic C. Hcuctcr, |igurc 7 sncus inci cn
1nurs!cq, incrc crc c jcu |ccicric rcsisicni ic
Anii|iciic C|tc musi nctc pic|c! scmc up uncn
snc tisiic! inc ncspiic| cn 1ucs!cq. |igurc 7 sncus
inc pcpu|ciicn !ccrccsing unii| ncur 20, in!icciing
inci mcsi |ccicric crc sii|| susccpii||c ic Anii|iciic
C. Hcuctcr, |igurc 8 sncus inci |q Sciur!cq inc
prcpcriicn cj Anii|iciic C-rcsisicni |ccicric ncs
incrccsc!. Sincc 1nurs!cq ctcning, Anii|iciic C
ncs |i||c! mcsi susccpii||c |ccicric. |igurc 8 sncus
inc |ccicric| pcpu|ciicn !ccrccsing ci "rsi,
cs inc rcmcining susccpii||c |ccicric crc |i||c!.
1ncn inc num|cr cj Anii|iciic C-rcsisicni |ccicric
incrccscs rcpi!|q.
10. Hov is lhe grovlh of lhe bacleria resislanl lo
Anlibiolics A, C, and D an examIe of naluraI
seIeclion`
|ntircnmcnic| ccn!iiicns !cicrminc unicn in!iti!uc|s
in c pcpu|ciicn crc inc "iicsi. |n inis ccsc, inc
cntircnmcni jctcrc! |ccicric inci ucrc rcsisicni
ic Anii|iciics A, C, cn! D, c|| cincrs ucrc |i||c!.
Sincc cn|q rcsisicni |ccicric ccniinuc! ic |rcc!,
sccn inc cniirc pcpu|ciicn !critc! jrcm incsc iniiic|
|ccicric cn! ucrc rcsisicni. 1nus, inc cntircnmcni
sc|ccic! jcr rcsisicni |ccicric, i||usirciing inc prcccss
cj nciurc| sc|cciicn.
11. Whal advice aboul lhe nexl anlibiolic lo lry
can Dr. Hincaie give lo Lva's doclors based
on lhese resuIls`
1rcci |tc uiin Anii|iciic B.
TEACHER GUIDE 5
RELATED RX FOR SURVIVAL
WEB SITE FEATURES
(see pbs.org/rxforsurvival)
Why Global Health Matters: Learn why we should all
be involved in global health initiatives.
Deadly Diseases: Learn about some of the diseases
that are humanitys most feared killers.
Global Health Champions: Learn about men and
women who have profoundly changed global health
outcomes and saved lives in many parts of the world.
Get Involved: Find meaningful ways to take action.
Dispatches from the Field: Hear rst-person accounts
from people on the frontlines of health care.
LINKS
Alliance for the Prudent Use of Antibiotics
tufts.edu/med/apua
Learn about the efforts to promote the
responsible use of antibiotics at home and
abroad.
Antibiotics: The Untold Story
prairiepublic.org/features/healthworks/antibiotics/
index.htm
Examine our dependence on antibiotics as the
most common treatment for illness.
Evolving Ideas: Why Does Evolution Matter Now?
pbs.org/wgbh/evolution/library/11/2/e_s_6.html
Relates how evolving bacterial resistance
helps us understand disease treatment and
prevention.
Evolution of Antibiotic Resistance
pbs.org/wgbh/evolution/library/10/4/l_104_03.html
See resistant bacteria survive, divide, and
multiply in this animated NOVA feature.
National Library of Medicine
nlm.nih.gov/medlineplus/antibiotics.html
The NLMs Antibiotics page contains detailed
information and recent articles on antibiotics.
BOOKS
Antibiotics: Actions, Origins, Resistance Christopher
Walsh. Cambridge: Harvard University Press, 2003.
Describes how antibiotics combat infection and
disease at the molecular level.
The Coming Plague: Newly Emerging Diseases
In a World Out of Balance Laurie Garrett. New York:
Farrar, Straus & Giroux, 1994.
Tracks diseases that travel the world, which are
spreading faster and farther than ever before.
The Other End of the Microscope: The Bacteria Tell
Their Own Story Elmer Koneman. Washington, DC:
American Society for Microbiology Press, 2002.
Tells the story of some bacteria upset at
their continued mistreatment at the hands
of humans.
Revenge Of The Microbes: How Bacterial Resistance is
Undermining the Antibiotic Miracle Abigail A. Salyers,
Dixie D. Whitt. Washington, DC: American Society for
Microbiology Press, 2005.
Details the consequences of turning one
of our best weapons against disease into
a powerful enemy.
Infections and Inequalities: The Modern Plagues Paul
Farmer. Berkeley: University of California Press, 2001.
Examines how economic disparities are often
indicators of who will be treated and survive.
RESOURCES
2005 WGBH Educational Foundation and Vulcan Productions, Inc.
Rx jcr Surtitc|A G|c|c| Hcc|in Cnc||cngc is a Co-Iroduclion of lhe WGH1NVA Science Inil and VuIcan Iroduclions, Inc. Iroduced in associalion vilh }ohns Hokins
Ioomberg SchooI of IubIic HeaIlh.
1
WGH LducalionaI Ioundalion and VuIcan Iroduclions, Inc. AII lhird arly lrademarks are ovned by lheir reseclive ovners and
used vilh ermission. Ma|or funding for Rx jcr Surtitc|A G|c|c| Hcc|in Cnc||cngc is rovided by lhe iII & MeIinda Gales Ioundalion and The Merck Comany Ioundalion.
Rise of the Superbugs
On Monday, Eva went to the emergency room following a
fall from her bike. Fortunately, her only broken bone was a
nger. But she suffered scrapes and cuts, including some
deep cuts on her legs. After spending several hours in the
emergency room having her wounds cleaned, stitched, and
bandaged, Eva returned home.
Tuesday morning, one of the deeper cuts on Evas legs was
red and felt warm. She had a few pills of an antibiotic left
over from her bout with strep throat that previous winter.
Thinking it might help to prevent infection, she took them
according to the prescription instructions.
Throughout Tuesday, the cut on Evas leg became
increasingly red, swollen, and painful. Eva felt awful and
returned to the hospital on Tuesday night. Her cut had
become infected. The doctors cleaned and restitched her
leg and prescribed a daily dose of Antibiotic A, a stronger
version of the same antibiotic Eva had taken at home just
that morning.
By Thursday, Evas infection had spread to the point where it was too painful to walk. In addition, Eva felt ill. She
returned to the hospital and this time was admitted. The doctors immediately administered a different kind of
antibiotic, Antibiotic C, directly into Evas bloodstream through an intravenous tube.
Friday, Eva felt better, and her leg became less painful and swollen. But on Saturday, it was clear that Eva had
taken a turn for the worse. The infection on her leg continued to spread, and she had become feverish. The
medical staff involved with Evas case held a meeting to plan the next steps in Evas treatment.
1. Ansver lhe foIIoving queslions:
(a) Whal mighl exIain vhy Lva's infeclion is nol resonding lo lrealmenl by anlibiolics`
(b) Whal informalion aboul lhe infeclion vouId you vanl in order lo !nd a vay lo lreal il`
Streptococci, the bacteria that cause sore throats and tonsillitis, are usually
present in the body. These bacteria cause no harm until the immune system
is weakened in some way, such as by a virus or malnutrition.
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Stephen Schudlich WGBH Educational Foundation
STUDENT SHEET 1
RISE OF THE SUPERBUGS
3. LxIain hov lhe grahs Iines in FIGURES 13 shov hov lhe number of bacleria changes over lhe 24 hours.
No anlibiolics:
Anlibiolics and suscelibIe bacleria:
Anlibiolics and some resislanl bacleria:
4. Hov viII Dr. Hincaie use lhe lhree slandard grahs`
FIGURE 3. Antibiotics and
a population with some
resistant bacteria. 1nc icsi iu|c
ccnicins |ccicric| grcuin mc!ic
cn! cnii|iciics ic unicn scmc cj
inc |ccicric crc rcsisicni.
FIGURE 2. Antibiotics and
susceptible bacteria. 1nc icsi
iu|c ccnicins |ccicric| grcuin
mc!ic cn! cnii|iciics |ncun ic
|i|| inc |ccicric usc! in inc icsi.
FIGURE 1. No antibiotics.
1nc icsi iu|c ccnicins |ccicric|-
grcuin mc!ic, unicn c||cus
inc |ccicric usc! in icsiing ic
un!crgc un|imiic! grcuin.
2. Read lhe foIIoving slory aboul a doclor vho lesled lhe bacleria causing Lva's infeclion.
Dr. Hincapie, a conscientious intern interested in sports injuries, had followed Evas case since she arrived
at the emergency room after her bike crash on Monday. On each visit, he had taken samples of uid and tissue
from Evas wounds. He wanted to analyze them to see how the cells in her immune system changed
as she healed.
As Evas condition worsened, he realized that the samples he had collected might hold clues as to why her
infection was not healing and what new treatments might work. Dr. Hincapie thought that bacteria that were
resistant to the antibiotics she had been given might be causing Evas worsening condition. To test this idea, he
grew cultures of bacteria from each of Evas visits. (FIGURES 48) Dr. Hincapie compared the resulting graphs to
standard graphs. (FIGURES 13) To make a standard graph, researchers grow 10,000 (10
4
) bacteria in a test tube
under known conditions. They measure the growth over 24 hours and graph the results. The standard graphs Dr.
Hincapie used in his comparisons are:
In any population, the individuals are not identical to each otherjust look around the classroom! There
is always variation in a population. In bacteria, this includes variation in resistance to antibiotics. Some
bacteria may be resistant to antibiotics while others are susceptible. While antibiotics kill most bacteria,
some will be resistant and survive. Because the conditions determine which individuals in a population are
the most t to survive, this is an example of natural selection.
Scottish researcher Alexander
Fleming accidentally discovered
penicillin in 1928. He observed
that a mold growing on one of
his Petri dishes had killed all the
bacteria growing nearby.
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STUDENT SHEET 2
RISE OF THE SUPERBUGS
KEY FOR THE RESPONSE TO FOUR ANTIBIOTICS
|ccn scmp|c |cgins uiin 10,000 (10
4
) |ccicric. Hcur zcrc rcprcscnis
inc |ccicric in |tcs ||cc! ci inc iimc mcniicnc! in inc ccpiicn cj
cccn "gurc. 1nc jc||cuing 24 ncurs rcprcscni inc grcuin cccurring
in Dr. Hinccpics icsi iu|cs. 1c un!crsicn! uncincr cr nci |tcs
|ccicric crc rcsisicni, scc ncu inc pcpu|ciicn cncngcs ctcr 24 ncurs.
FIGURE 8.
Sciur!cq mcrning cjicr
spcn!ing |ri!cq in inc
ncspiic| cn! ic|ing
Anii|iciic A sincc
1ucs!cq cn! Anii|iciic C
sincc 1nurs!cq nigni.
FIGURE 7.
1nurs!cq ctcning cjicr
rciurning ic inc ncspiic|
c scccn! iimc cn! |cing
c!miiic!. |tc nc! ic|cn
Anii|iciic A sincc 1ucs!cq
mcrning. 1nc !ccicrs
prcscri|c! Anii|iciic C.
FIGURE 6.
1ucs!cq nigni cjicr
rciurning ic inc ncspiic|.
|tc nc! ic|cn Anii|iciic
A. 1nc !ccicrs prcscri|c! c
ncu !csc cj Anii|iciic A.
FIGURE 5.
Mcn!cq ctcning jusi
|cjcrc |ccting inc
ncspiic|, |cjcrc cnq
cnii|iciics ucrc ic|cn.
FIGURE 4.
Mcn!cq cjicrnccn
cjicr crriting ci inc
ncspiic|, |cjcrc cnq
cnii|iciics ucrc ic|cn.
Ising lhe slandard grahs (FIGURES 13), Dr. Hincaie
can nov anaIyze lhe resuIls of lhe bacleriaI cuIlures he
grev from Lva's lissues over lhe course of her infec-
lion. Lxamine FIGURES 48, and ansver queslions 511.
5. Were anlibiolic-resislanl bacleria resenl in lhe
lissue samIes laken vhen Lva !rsl arrived al lhe
hosilaI on Monday` (FIGURE 4) Hov can you leII`
6. y Salurday, vhich anlibiolics vere lhe bacleria
resislanl lo`
7. Al vhal oinl did lhe ouIalion of bacleria shov
resislance lo:
Anlibiolic A:
Anlibiolic :
Anlibiolic C:
Anlibiolic D:
8. LxIain vhy lhe number of bacleria is so differenl
on Monday aflernoon (FIGURE 4) comared lo
Tuesday (FIGURE 6), afler groving for 24 hours
in lhe resence of Anlibiolic A.
9. LxIain vhy lhe number of bacleria is so differenl
on Thursday (FIGURE 7) comared lo Salurday
(FIGURE 8), afler groving for 24 hours in lhe
resence of Anlibiolic C.
Antibiotic A
Antibiotic B
Antibiotic C
Antibiotic D
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STUDENT SHEET 3
RISE OF THE SUPERBUGS
10. Hov is lhe grovlh of lhe bacleria resislanl lo Anlibiolics A, C, and D an examIe of naluraI seIeclion`
11. ased on lhe resuIls of his lesling, vhal advice shouId Dr. Hincaie give lo Lva's doclors aboul lhe nexl
anlibiolic lo lry`
In bacleria, lhe genes for anlibiolic resislance are oflen carried on Iasmids (smaII circIes of DNA) ralher lhan
in lhe main bacleriaI chromosomaI DNA. IIasmid DNA can be reared and vieved using geI eIeclrohoresis.
Dr. Hincaie vanled lo delermine vhich gene vas resonsibIe for lhe anlibiolic resislance he observed in lhe
bacleria causing Lva's infeclion. Iirsl, he isoIaled Iasmid DNA from each of Lva's originaI samIes. Then, he
searaled lhe Iasmid DNA samIes using geI eIeclrohoresis. Here's a holograh of his geI.
Dr. Hincaie recognized lhal lhe lvo Iarger ieces of DNA
21OO base airs and 18OO base airsvere from Iasmids found
in bacleria lhal cause infeclions. The brighlness of a iece of DNA
on a geI reveaIs lvo lhings: Iarger ieces of DNA are brighler
lhan smaIIer ieces and Iarger amounls of DNA aear brighler
lhan smaIIer amounls. Knoving lhis, vhich bands on lhis geI do
you lhink conlain a gene for resislance lo:
Anlibiolic A:
Anlibiolic :
Anlibiolic C:
Anlibiolic D:
WELL
NUMBER SAMPLE
1
2
3
4
5
6
DNA size marker
Monday, immediately after arriving at the hospital
Monday evening, just before leaving the hospital
Tuesday night after returning to the hospital
Thursday evening, after being admitted to the hospital
Saturday morning
WELL NUMBER
1 2 3 4 5 6
GOING FURTHER: Identify the Genes Carrying Antibiotic Resistance
2100 bp
1800 bp
1500 bp
1200 bp
1000 bp
900 bp
800 bp
700 bp
600 bp
517/500 bp
300 bp
Some bacteria exchange genetic material using a tiny
tube that connects them together. In this way, a drug-
resistant bacterium can pass its resistance on to others.
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Iroduced in associalion vilh }ohns Hokins Ioomberg SchooI of IubIic HeaIlh.
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STUDENT SHEET 4
RISE OF THE SUPERBUGS