In 2013, antibiotic resistance was responsible for 2,000,000 infections and more than 20,000 deaths in the United States. Recently, the World Health Organization released a global action plan calling for better strategies to contain the spread of antibiotic resistant microorganisms and create innovative ways to fight them. In yesterday’s plenary session, “Antibiotic Resistance: A Public Health Crisis,” Victoria Fraser, MD, emphasized that government legislation, research institutions, and hospital facilities must collaborate to control this crisis and find a creative way to stop the resistance.
Fraser, the Adolphus Busch Professor of Medicine at Washington University in St. Louis, specializes in healthcare epidemiology and has studied nosocomial infections, including the risk factors, outcomes, and costs of these infections.
Antibiotic resistance affects patients everywhere, from hospitals to long term care facilities, to the community at large. “People think that antibiotic resistance is going to be fixed by just developing more antibiotics or newer or more powerful antibiotics,” Fraser said. “That is the biggest challenge because there are not a lot of new drugs in the pipeline.” She went on to say that clinicians, laboratorians, and other healthcare professionals must work on a comprehensive, multipronged approach: reducing unnecessary and inappropriate use of antibiotics, making sure antibiotics are administered at the right dose for the right period of time, and improving rapid diagnostic tests so patients with viral infections are not treated empirically with antibiotics.
Demand from patients and families for antibiotics regardless of the type of illness is an ongoing problem, Fraser noted. When the audience was polled asking if they had ever taken antibiotics for a likely viral illness, almost 60% admitted that they had.
Fraser called for new behavioral research and coalitions of patients and providers to promote education. “Antibiotics have consequences,” she said, “and inappropriate use of antibiotics drives resistance but also complications—drug reactions, antibiotic-related fever, kidney failure, and abnormalities in liver function, to name a few.” She stressed that antibiotics are not completely benign medications. Patient education needs to include information on disease prevention strategies, such as vaccination and hand hygiene.
Fraser discussed several studies examining the effect of antimicrobial stewardship programs, which are now required by CMS and The Joint Commission. These programs have evolved from restricting the ordering of antibiotics to providing education and guidance on appropriate utilization, and they have resulted in improvements in clinical outcomes.
What role do clinical laboratories play in this fight? Clinical laboratories and industry are very important players in the task of optimizing rapid diagnostic tests, Fraser said. Careful evaluation and validation of new diagnostic tests in conjunction with close partnerships with clinicians on useful susceptibility reports can encourage correct prescribing of antibiotics. Clinical laboratories are also essential for helping with antibiograms, reporting data on resistance, and helping with disease surveillance.
An important area of discovery and research is new technology that will quickly identify an organism’s susceptibility to antibiotics. Simply identifying the pathogen isn’t enough; information about whether it is a resistant pathogen is needed to guide therapy and inform infection prevention policies. “This is a tremendous area of research and innovation,” Fraser said.