The very act of using antibiotics contributes to antibiotic resistance. Bacteria are exposed to an antimicrobial agent and develop genetic strategies to survive repeated exposures. But what if using antibiotics in a certain sequence could revert resistant strains to the wild type? Researchers from California and Washington DC tested that theory and discovered some promising results.
You can read the PLOS ONE study and the Scientific American article to learn more.
Over at her new blog Germination, Maryn McKenna discusses a recent study in Clinical Infectious Diseases about livestock-associated MRSA and infections in farmers. For those clinical laboratory scientists who work in labs that serve a rural population, this is a must-read.
–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.
Once again Maryn McKenna–blogging with National Geographic now–breaks down the Anglo-Saxon remedy for eye infections that set the antibiotic community ablaze last week. In short: effectiveness is one thing; getting it to market is another. You can read the full post here.
Last week, I attended the Illinois Summit on Antimicrobial Stewardship at Northwestern Memorial Hospital. While the target audience was physicians, nurses, pharmacists, and administrators, as a clinical laboratory scientist I found the presentations (with a few caveats, which I’ll get to in a moment) quite informative.
The morning sessions covered the relationship between antibiotic use and resistance patterns; interpretations and implementation of the national guideless for stewardship; and using behavioral science to increase compliance with stewardship programs. Participants spent part of the afternoon in small groups to discuss designing and implementing a stewardship program.
A few notes:
-50% of antibiotics for upper respiratory infections aren’t needed; 50% of antibiotics for inpatients aren’t needed, either
-antibiotics are the only drug where use in one person impacts it effectiveness in another
-based on the literature, antibiotic stewardship programs have at least a transient effect on antibiotic effectiveness—eventually, resistance numbers begin to climb again
-hospital antibiograms are the most widely available measure of resistant organisms, but we aren’t using them as effectively as we could. For example, we typically report that, say, “62.5% of E. coli isolates are resistant to ciprofloxacin,” but we don’t say where those isolates come from. Are they urinary tract infections or upper respiratory infections? What’s the rate of resistance for infected wounds?
-a weighted antibiogram might make empirical treatments for effective. For example, “what % of urinary tract infections are resistant to ciprofloxacin?”
-it’s important to note that the IT department, hospital information systems, and laboratory information systems play a huge role in stewardship programs
-stewardship programs depend on the “5 D’s” Diagnosis, drug selection, dose, duration, and de-escalation of use
-diagnostic uncertainty—driven by lack of early organism identification—drives a significant amount of antibiotic use
-when combined with stewardship, rapid bacterial identification methods such as MALDI-ToF platforms decrease parameters such as length of patient say, time to treatment, etc.
-we can use peer pressure to drive improvements. No one wants to perform worse than the doctor next door
-our efforts might be moot, anyway; other countries take a much laxer stance on antibiotic use
While the laboratory in general and clinical microbiology departments specifically were mentioned during the presentations, I must say they were only mentioned in the context of how little perceived impact we have on stewardship. (“Well, we know the laboratory isn’t going to give us any useful information for another three days…”) It wasn’t until I participated in the small group sessions in the afternoon that attendees at my table admitted that the laboratory is an important piece of the stewardship puzzle. We have mountains of data we can assimilate (antibiogram creation, anyone?). We can bring in new technologies to make identifications faster. We can work closely with the infectious disease doctors to help guide treatment. That brings up a good point—if microbiology labs aren’t in-house, then creating an antibiotic stewardship program becomes that much harder because results can be delayed.
If you’d like to see the powerpoints from the presentations, you can do so by clicking the “downloadable content” tab at Northwestern Memorial Hospital’s antibiotic stewardship page.
–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.
Researchers may have made some headway in the fight against antimicrobial resistance. A paper published online in Nature today (abstract only unless you’re a subscriber) discusses a new method to grow bacteria that have previously been uncultivable. In doing so, researchers have discovered a new antibiotic they’re calling teixobactin that is active against gram-positive organisms (specifically, a precursor of peptidoglycan present in the cell wall). Initial tests suggest bacteria can’t form a resistance to this mode of action.
Maybe there’s something to the expression “throw some dirt on it and get back in the game” after all.
NPR and the Washington Post discuss this paper and its findings today, as well. It’s too soon to be excited, but I admit I’m cautiously optimistic.
–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.
Over on Superbug, Maryn McKenna (are you following her yet? No? If you’re into infectious disease, you should) discusses a recent report on the global ramifications of antimicrobial resistance. In it, the authors project by 2050, 10 million deaths a year will be attributed to infections caused by six resistant organisms. (Those are: Klebsiella pneumoniae, E. coli, MRSA; HIV, TB and malaria.) These deaths will cause an estimated loss of 100 trillion dollars of lost gross national product.
So what can laboratory professionals and pathologists do to help stop these predictions from coming true? For starters:
What else can labs, microbiologists, and pathologists do to stem the tide of antibiotic resistance?
–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.
Last week, the White House published a National Strategy for Combating Antibiotic Resistant Bacteria and President Obama signed an executive order that orders the implementation of the strategy. The report covers a lot of information, but two goals stuck out as being especially pertinent for laboratory professionals.
By 2020:
Both of these goals require the cooperation of clinical laboratories including (but certainly not limited to) infrastructure upgrades, data collection, and procedural changes. In an era when laboratories have less resources than ever before, will this stretch microbiology departments too far? Based on available resources, are these goals attainable?
If you’d like a comprehensive overview of the government’s strategy, check out Maryn McKenna’s excellent post on Wired’s Superbug blog.
–Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.
The World Health Organization assessed worldwide antibacterial resistance and recently published their findings. The report notes that a post-antibiotic era isn’t a dystopian fantasy but, in fact, a real possibility in the 21st century. Dire? Yes, but if you’ve been following the news, unsurprising.
The press release is here.
You can download or order the report here.
You can read a summary of the report here.
Linking to a few articles by Maryn McKenna because you need to read them.
In this blog post, Ms. McKenna writes about a man from New Zealand who died from a bacteria completely resistant to all antibiotics.
In this article, she imagines the post-antibiotic world. In a nutshell: it’s a scary place.
-Kelly Swails
Lablogatory 