Trends & Times
4:50 pm
Sun July 27, 2014

Emergence Of Antibiotic Resistance, And What Can Be Done

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"What we are seeing as a more and more growing problem is that there are microbes now that more commonly, particularly in a hospital setting, are resistant to many of the antibiotics that are available," says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases. 

Interview highlights

Antibiotic Resistance And Global Health

"I think it's really quite a substantial threat. It's certainly getting worse. We have really no corporate memory of what it was like, prior to the era of antibiotics, which have been transforming in their life-saving capabilities. Because we've been used to having infections, no matter how serious they are, that somehow or another you can treat. You can find the right antibiotic. But things that you could have easily treated years ago now are having difficulty because of the emergence of antibiotic resistance."

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 Most Concerning Strands

The gram-negative microbes. "We've even had an outbreak here in our own hospital... but where it's not unique to us. It really happens all throughout."

C. difficile. "There have been outbreaks, particularly in nursing and extended-care homes that have become resistant."

Methicillin-resistant staphylococsuss aureus (MRSA). "It's been around a while. It started off as a hospital acquired infection. And now, the thing that gets a bit concerning is that MRSA, or the resistant form is seen in the community. And people are getting infected apart from being in the hospital."

Sexually transmitted infections. "Such as gonorrhea, which is now becoming resistant to many of the common antibiotics that very easily treated them. So there's a whole group of microbes, particularly the ones that I just mentioned, that are of particular concern."

The Emergence of Antibiotic Resistance

"It happens over a period of time from a number of factors. It isn't a unidimensional thing."

Inappropriate use of antibiotics. "There have been recent studies that show that as much as three quarters of the adults who might come into a clinic with bronchitis who have a viral infection are getting treated with antibiotics inappropriately, because you don't treat viral infections with antibiotics. Whenever you treat an infection with an antibiotic, particularly one that you don't need, you do a process that is called selection of strains that ultimately are resistant to the antibiotic. So if you kill of all the good, sensitive bacteria, what you're left with in the community in general, and specifically in a given individual, is a microbe that would be resistant to common antibiotics. So inappropriate use of antibiotics is one."

Poor identification of resistant strains. "And that comes under the category of better diagnostics, to be able to determine that you're dealing with a microbe that is resistant to antibiotics." 

Surveillance. "That is very closed linked to the diagnosis that I said, particularly in hospitals. Because sometimes you have hospital outbreaks that are under the radar screen, and people don't notice it."

Infection control measures. "Which we do in hospitals well. But in some hospitals, not so well. So if someone would come in, either with an already established resistant microbe or if it happens in the hospital, that if you don't have the proper infection control abilities, that could spread to other health care provides who might spread it to the other people in the house, or to even bring it home to their families. It's a whole cascade of events."

Inappropriate use of antibiotics in agriculture. Not to treat a disease in the animals, such as livestock, but for growth purposes. Because it's known that if you treat them with antibiotics, that you can have a greater acceleration of growth of the animal. And that's not an appropriate way to use the antibiotics.

Advice For Consumers

"Don't pressure physician for antibiotics."

"It's unfortunate, but it's the truth. The typical scenario is that a child has a sore throat. There's no bacteria identified, but the child is in some discomfort. The mom says you've got to give the kid, or the adolescent, an antibiotic. One of the most common of infections that are inappropriately treated is when someone gets an upper respiratory infection and then develops a bronchitis or sinusitis. Now, that could be a bacteria. And if it is, and if it's documented, then it's appropriate to treat someone with an antibiotic. But a significant percentage of those upper respiratory tract infections are not bacterial, they're viral and they should not be treated. I think parents being somewhat less aggressive in trying to push the use of antibiotics, when, in fact, the physician might be a little reluctant to do that."

Development of New Antibiotics in Future

"One of the problems that has occurred is that there's really been a lagging in what we call the "pipeline" of new antibiotics."

"For a number of reasons, including the lack of incentive on the part of many of the drug companies with the ability of making the antibiotics. They really put their resources in other areas, and not the antibiotic area. For example, 16 antibiotics were approved by our Food and Drug Administration from 1983-1987,  where as only two new antibiotics were approved from 2008-2012. Now that's getting better now, but we need to reinvigorate the pipeline of new antibiotics being produced. We really need to do better in that regard."

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On Avoiding Infection 

"You aren't going to get antibiotic resistance to microbes that you don't get infected with. One of the ways to avoid the emergence of antibiotic resistance is to avoid the infection in the first place. Now there are a number of ways to do that."

Vaccination. "One of the most efficient and cost-effective way to prevent infection is by vaccination. I had mentioned a bit ago that Methicillin-resistant Staphyloccocus aureus or what we commonly refer to as MRSA, is an important problem, as well as some of the gram-negatives... If someone is in a clinical situation, such as getting ready to go into the hospital for an operation in which one of the complications is an infection of particular surgical site or a particular apparatus that gets put into a person, one of the ways of avoid of having to treat someone with the possibility of a antibiotic resistant infection. "