Don't flush

Not everyone likes to admit it, but we know everyone does it. Everyone poops or poos (depending on where you do it).

But as fast as we may want to flush our stool down the loo, we should perhaps hold onto it. Stool can teach us a lot about what is going on in our bodies.

"There is a huge amount of bacteria in stool and we can possibly identify hidden resistant bacteria," says Achim Hörauf who heads the Institute for Microbiology and Immunology in Bonn.

Good bacteria create chemicals as a defense against bad microorganisms. The same can be achieved synthetically with antibiotics. But common antibiotics aren't working as well as they used to, says Jarne van Hattem, a researcher at Academic Medical Center in Amsterdam.

"When you compare 2005 and 2010, the percentage of resistance to certain types of antibiotics has increased, from one percent to ten percent," says van Hattem.

Van Hattem is the lead researcher in the Netherlands-based probe into bacterial resistance to antibiotics. He says the high usage of antibiotics has caused a rise in drug resistant genes in humans. But that's not the only factor.

"We think the bacteria are getting imported from abroad, for example, by travelers," van Hattem says.

Over the course of their thirty month study, van Hattem and his team want to find out whether antibiotic resistant bacterial infections are indeed hitching rides back home in the guts of travelers, who have visited tropical regions in Africa and Asia.

Sifting through muck

But fear not. The Dutch study doesn't involve vials of blood, sharp needles or mouth swabs. Instead, van Hattem and his team are asking two thousand travelers to voluntarily send in samples of their fecal waste.

The volunteers are being asked to place their stool swabs in special, plastic "safe bags" and to mail them back to the researchers. The researchers will then analyze six samples - two before travel and two upon return, and two further samples a month later.

"If they are negative at all sample points, we will consider them as negative," explains van Hattem.

But if a stool is positive for a type of multi-resistant bacteria, the team will wait to see whether the bacteria clears up on its own and further analyze samples at three, six and 12 months after the traveler's return home.

Bacterial migration?

The team will also use the data to study whether antibiotic resistant bacterial infections can be passed from the travelers to other people in their social or work circles, Van Hattem says.

If the travelers do pass on resistant bacteria strains to friends, relatives or colleagues, the study would provide a source of fresh data on bacterial migration.

The rise of resistance to antibiotics poses a big problem for public health.

"We may die from quite common infections like pneumonia in the future because we don't have antibiotics to treat them anymore," van Hattem says.

However, despite the rising levels of resistance to antibiotics, major drug companies are reluctant to creating new antibiotic medicines.

"The pipeline for new developments over the past ten years is much lower than the proceeding ten years, so we are possibly facing a gap in development," says Hörauf.

Over the counter

Resistance to antibiotics is especially a problem in Africa and Asia.

For instance, in Kenya, antibiotics can be bought over the counter, without a prescription. There are reports that some people use them for toothaches and headaches, even though that is not what antibiotics are meant for.

Increased use of antibiotics leads more to more resistance, van Hattem says.

"And the other thing is when people buy it over the counter, and their complaints disappear, they also stop the antibiotics, so that might leave resistant bacteria in their bodies," he adds.

Van Hattem and his colleagues are still working through the first batch of their tests. The results could lead to different practices.

People who have visited certain countries and are admitted to hospital may have to be isolated, or the architecture of antibiotic treatments may have to change.

"The goal," says van Hattem, "is to prevent the spread of microbacterial resistance."