Slowing the Threat of Antibiotic Resistance

According to the US Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, about 2 million Americans contract an antibiotic-resistant bacterial infection each year, and about 23,000 of these patients die.

In a recent Association of Health Care Journalists (AHCJ) webcast, 2 experts discussed the growing challenge of antibiotic resistance, and highlighted current and emerging strategies to reduce this major public health threat.

“People like to talk about preventing antibiotic resistance,” said Michael Bell, MD, CDC’s deputy director of the Division of Healthcare Quality Promotion, “but this is not our goal.” Primarily, we want to slow it down, he emphasized.

Dr. Bell explained that clinicians themselves can employ effective strategies to help reduce the likelihood of antibiotic resistance. These include approaches to prevent infections occurring in the first place (for example, by removing indwelling catheters as soon as possible) and appropriate antibiotic use.

At the national level, CDC and other federal agencies have also performed a tremendous amount of work to improve understanding of the problem of antibiotic resistance, stressed Michael Craig, MPP, senior adviser for antibiotic resistance coordination and strategy, Division of Health Quality Promotion at the CDC Center for Emerging Zoonotic and Infectious Diseases.

In the US, the National Action Plan for Combatting Antibiotic-Resistant Bacteria was implemented in 2015, outlining steps to address this public health threat on a national issue, he said.

However, Craig also described an increasing investment to better understand this problem at the international level, stressing that antibiotic resistance is not just a US phenomenon, but “a global issue that potentially impacts everyone on the planet.”

Some new innovations also focus on the One Health approach to combating antibiotic resistance in the United States, said Craig, and aim to understand more about the impact of antibiotic use in the animal health sector, and its consequences for human health. Dr. Bell stressed recent progress in this area, in the US Food and Drug Administration’s 2017 directive to prevent the use of antibiotics for growth promotion in farm animals.

Discussing new and emerging innovations in the pipeline to help combat the threat of antibiotic resistance, some new antibiotics are in clinical development, said Craig. However, Dr. Bell emphasized that new drugs alone are not enough to protect Americans, so “just inventing a new antibiotic is not the silver bullet.”

He noted interesting research that focuses on “good” bacteria, and on the importance of having a healthy microbiome with the correct balance of bacteria. By better understanding the microbiome, we can begin to measure how antibiotic use impacts and disrupts its bacterial populations, he said.

Speaking to Contagion^®, Dr. Bell also highlighted additional microbiology research areas to watch in the field of antibiotic resistance.

For example, there is new interest in using bacteriophages instead of antibiotics he explained. Bacteriophages are viruses that prey on bacteria and hijack the bacterial cellular equipment. They are widespread in the environment, and are found wherever bacteria are present, and are thus potential options to help combat antibiotic-resistant bacteria.

Environmental hygiene is also an important research focus, said Dr. Bell, especially because patients in health care settings are susceptible to dirty environments. Related to this is the basic issue of splashing, he noted. This may include sinks that splash on health care workers, or even toilets that make a significant splash—both can be a source of pathogenic bacteria that health care workers can transmit to patients, even after handwashing.

In an environment where health care workers are trying to prevent transmission of agents such as norovirus, Clostridium difficile, or antibiotic-resistant organisms from fecal flora, “the last thing you want is a massive splashy flush every time someone uses the toilet.” Opportunities to change the environment and make it more conducive to success in reducing the problem of antibiotic resistance are therefore interesting areas of research right now, said Dr. Bell.

Another specific area to watch is biofilm research, he added. Biofilms are layers of slime that contain collections of microorganisms and can grow on many different wet surfaces. Biofilms are everywhere, Dr. Bell stressed. Dental plaque is a biofilm, he said, and biofilms are also the reason why sinus infections are so difficult to treat. And because these layers provide a stable environment that protects microorganisms against environmental stressors, biofilms may thus protect bacteria against killing by antibiotics.

Because biofilms continue to challenge clinical medicine, understanding their role in human health is critical, said Dr. Bell. For example, “what can we do to make an intravenous catheter less prone to having a biofilm on it? Can we tell whether a biofilm is brand new and still easy to treat? Or is it so mature that the only thing to do is to remove that catheter?” This area of science is moving forward, he concluded, and may prove very interesting.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.