Antibiotic Resistance

DECEMBER 2019 | FUTUREOFPERSONALHEALTH.COM

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FIGHTING ANTIBIOTIC RESISTANCE

Bill Pullman

Our panel discusses why collaboration is key to solving this global health crisis Inside the scientific and legislative efforts to curb unnecessary antibiotic use

The actor talks about his partnership to shield the world from antibiotic resistance

Why We Need to Start Combating Antimicrobial Resistance Now Imagine a world where antibiotics don’t work. Where a bout of food poisoning, a cut from working in the yard, or a simple bladder infection becomes a matter of life or death.

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his grim reality is rapidly approaching and, in some cases, has already arrived.

This was not the case when I graduated from medical school. From the 1940s through the ‘80s, we had reliably effective antibiotics. During my training, advising on how to treat critically ill, septic patients seemed simple. When paged in the middle of the night, I felt so comfortable with the medical advice I was dispensing that I could hang up the phone and fall right back to sleep.

Today, though, antimicrobial resistance (AMR) keeps me up at night. Medical experts can no longer count on available antibiotics to work in every case and it’s getting worse each year. A 2019 report by the World Health Organization predicts drug-resistant infections may

become the leading cause of death, claiming up to 10 million lives annually (surpassing cancer deaths) by 2050 if AMR is left unchecked.

Evolving bacteria As a clinical microbiologist and infectious diseases physician, I work with bacteria every day. Bacteria exposed to an antibiotic in a lab setting readily develop resistance to that antibiotic by mutating their own genes or acquiring genes from other bacteria — something they are naturally equipped to do. Unfortunately, once bacteria become resistant to an antibiotic, they do not necessarily revert to being susceptible to it when the antibiotic is no longer around.

Humans have taken antibiotics for granted.

Antibiotics have cured infections that previously killed patients, and have enabled us to per-

Robin Patel President, American Society for Microbiology (ASM)

form complicated surgeries and transplants, and cure cancer. But now, because of AMR, we can’t always count on them to work — and we can’t turn the clock back to rid the world of resistant bacteria.

The path forward So what can we do? We need to improve how antibiotics are used in humans and animals by restricting them to only be used when they are needed. We need new antibiotics and we need to reserve newer antibiotics only for appropriate sit-

uations, setting the stage for slower evolution.

We need research to better understand mechanisms of resistance and how we can avoid selecting for resistance, as well as how our interactions with each other, animals, and the environment impact the spread of resistant bacteria. We need innovative, rapid diagnostics that quickly identify whether patients need antibiotics, because, in addition to the potential for selecting for resistance, there are other potential harms to taking antibiotics unnecessarily. Resistant bacteria that emerge in one geographic locale often spread globally and at an amazingly fast pace.

The American Society for Microbiology is playing its part in this global fight. Our international members and public health teams are on the ground in communities, empowering local

microbiologists through training and long-term mentorship aimed at guaranteeing sustained quality microbiology laboratory practices.

Today, some rapid diagnostics capable of identifying bacteria and their resistance factors are available or within reach. Tracking changes in microbial populations (AMR surveillance) is helping detect resistant bacteria and allowing quick action around potential outbreaks across communities.

These surveillance findings are crucial to informing clinical therapy decisions and guiding policy recommendations.

While I note the progress in combating AMR, I acknowledge the long road ahead of us. There are numerous barriers to progress. It is crucial that global stakeholders work together to achieve solutions, and those stakeholders are us, all of us. n

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The world needs new classes of antibiotics Antibiotics are used as our frontline treatment for everyday and life threating bacterial infections; however, these infections are becoming drug-resistant. This is because the bacteria that cause the infections change over time so that they develop the ability to resist the antibiotics used to kill them.

Without effective antibiotics, common illnesses like diarrhoea, routine surgery and cancer therapy can become life-threatening. Drug-resistant infections are claiming the lives of millions and as more antibiotics stop working, more lives across the globe will be put in danger.

At Recce Pharmaceuticals we are working hard to address this problem and aid in the global fight against drug-resistant infections.

Our scientists have discovered a new class of antibiotic that has killed all bacteria it has been tested against, including some of the most dangerous drug-resistant types classified by the World Health Organization.

We are progressing our antibiotic pipeline, which addresses unmet medical needs currently underserved by existing antibiotics.

Is this the first New Class of Antibiotic in over 30 years? www.recce.com.au

The Progress Being Made Against Antimicrobial Resistance Over the past 50 years, antibiotics have revolutionized human and animal health. The continued ability to take advantage of these advances is critical to maintaining optimal health when facing a rapidly rising global population and the need to feed it.

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lowing the emergence of resistant bacteria is widely accepted as the leading global health initiative of the century. As we look ahead to determine what will be required to continue progress in this area, we should be proud of what we have accomplished. Since the U.S. National Action Plan for Combating Antimicrobial Resistance (AMR) was established in 2015, many improvements in antimicrobial stewardship, use, and mitigation of resistance have been realized.

The recently released 2019 Center for Disease Control’s Antimicrobial Resistance Threats Report highlights a number of these improvements in human health, including a decrease in antibiotic prescriptions to outpatient children

of 16 percent since 2011, and a decrease in antibiotic prescribing to all outpatients (adults and children combined) of 5 percent since 2011. Furthermore, important legal changes to the veterinary oversight of antibiotics that took effect in January 2017 have resulted in significant advances in veterinary use of antibiotics.

First, antibiotics that are considered important to human medicine have been completely eliminated for use as growth promoters in U.S. food-producing animals. Second, the U.S. Food and Drug Administration reports that sales of antibiotics used for food-producing animals has dropped by 28 percent since 2009 (with a 33 percent drop between 2016 and 2017).

This represents a 40 percent reduction in feed antibiotic use, an 8 percent reduction in

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injectable antibiotics, a 25 percent reduction in intramammary antibiotics, and a 21 percent reduction in oral/topical antibiotics, all since 2009.

Together, physicians, veterinarians, and farmers have made great progress in improving the way antibiotics are used.

Realizing a safer future While we should celebrate these accomplishments, we all still have significant work to do.

In complex One Health issues like AMR, decisions and policies that are made without a complete and balanced evaluation of the down-stream repercussions on all health sectors can lead to unforeseen consequences on health, welfare, and food security.

My experience as executive director for the National Institute of Antimicrobial Resis-

tance Research and Education (NIAMRRE) has shown that the key to continued progress is a collaborative, open discussion across all One Health fields involved in this issue.

That means human, animal, and environmental health professionals working together to break down walls that hinder communication and meaningful collaboration.

By combining evidence-based approaches with open, balanced discussion, progress toward solving the AMR issue can be accelerated. I encourage you to learn more about how you can participate in that process at the local, state, and national levels, and to visit NIAMRRE. org for additional resources. n Dr. Paul Plummer, DVM, Ph.D., DACVIM (LAIM), DECSRHM, Director, Midwest AMR Consortium; Executive Director, NIAMRRE

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If I asked you what the solution is to the antibiotic resistance crisis, the first thing you might think of is creating new drugs that kill resistant microbes.

What you might not realize, however, is that new clinical laboratory tests for infectious diseases are equally important.

Antibiotics are indispensable for treating bacterial infections like strep throat and pneumonia, but they don’t work — and shouldn’t be used — for viral illnesses, such as the common cold or flu. In the past, however, traditional culture-based tests could take several days to determine whether a patient had a bacterial infection and which antibiotic would treat it effectively. Doctors couldn’t postpone treatment for this long, especially in cases where a delay was potentially life-threatening.

So instead, they would often prescribe antibiotics automatically while waiting for test results to come in. This contributed to rampant antibiotic overuse. To help solve this problem, the scientists who work in clinical laboratories have developed new tests that greatly reduce the time it takes to diagnose infectious diseases.

Most of these new tests are less than a decade old, but thanks to their accuracy and speedy turnaround times, they are already essential tools in the battle against antibiotic resistance. Using these tests will help limit unnecessary antibiotic use while ensuring antibiotics continue to work for the patients whose lives depend on them.

Carmen L. Wiley, Ph.D., President, America Association for Clinical Chemistry (AACC)

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How Bill Pullman and ARMADA Are Shielding the World From Antibiotic Resistance “When you look at solutions, many people think technology just needs to get better,” Pullman said. “But it takes 10 years and a billion dollars to come up with a new antibiotic.”

ARMADA was set up to use a global network of hospitals, physicians, veterinarians, scientists, and citizens to build a database of bacteria and their antibiotic resistance profiles, with the goal of minimizing resistance and preserving our ability to fight infections.

“ARMADA is an acronym,” Pullman said, “but it also suggests a shield of some sort, a protective thing.”

PHOTO: CLAUDETTE BARIUS SMPSP

Why Clinical Laboratory Testing Is Key to Fighting Antibiotic Resistance

Bill Pullman is a famous actor, but the role he most wants to discuss is his work as spokesperson for The Antibiotic Resistance Monitoring, Analysis and Diagnostics Alliance (ARMADA), a nonprofit initiative seeking to combat the growing threat of antibiotic resistance.

“My brother is an infectious disease doctor in Montana,” Pullman said. “He had encountered for the first time infections that he couldn’t cure. He said, ‘I want to help this microbiologist in Seattle.’”

So Pullman got in touch with Evgeni Sokurenko, M.D., Ph.D., founder of ID Genomics, professor of microbiology at the University of Washington, and a member of ARMADA’s Advisory Board.

Scary stats The numbers are frightening — more than 2 million antibiotic-resistant infections occur each year, resulting in 23,000 deaths in the United States alone. It’s estimated that antibiotic-resistant bacteria will claim 300 million lives by 2050.

The Pullman connection Pullman’s family has a strong connection to medicine.

“In some ways, I’m the black sheep going into the arts,” he said with a laugh. “When you see the day-to-day values of what my brothers and sisters are doing — a nurse practitioner, a doctor, a therapist — I wonder, ‘What are you doing to benefit the common good?’

So some of it comes from having some good models, and I’m just doing what I can.”

Anyone else wanting to help can start with shopping for food labeled as using antibiotics responsibly, listening when their physician suggests monitoring an infection, and donating money to the cause.

When it comes to antibiotic-resistant infections, the worst is yet to come. The scientists at ARMADA and citizen advocates like Pullman are sounding the alarm, and we should all be listening. n Jeff Somers

How Industries Are Coming Together to Combat Antimicrobial Resistance What do you believe is one advancement that’s helping combat AMR? Kathy Simmons Chief Veterinarian, National Cattlemen’s Beef Association (NCBA)

Jeffrey Gray Vice President of Research and Global Initiatives, Des Moines University

Widely acknowledged as one of the greatest health risks of our time, antimicrobial resistance could kill 10s (if not 100s) of millions of people by 2050. Solutions will only come if leaders in the human, animal, and environmental health industries come together. We talked to two of those leaders about the collaborative efforts that are underway.

What do you think is the biggest obstacle facing the industry?

Kathy Simmons: A primary obstacle facing beef cattle producers in the fight against antimicrobial resistance is really rooted in problems surrounding communications, public perceptions,

and a significant misunderstanding of the role antibiotics play in our industry. America’s beef producers take cattle health, and the safety of beef and beef products very seriously. The role antibiotics play in our industry is important in protecting both animal health and food safety.

Jeffrey Gray: One important development is novel antimicrobial stewardship programs, some that have had considerable recent impact. These have an excellent possibility of being impactful in the future and can be rapidly deployed as a tool we have at our disposal right now.

How do you see the industry changing in the next 5-10 years?

KS: The beef cattle industry has long been a proponent of innovation and has respected the advancements that occur through scientific research and development. There is a great deal of scientific investigation taking place with scientists

and veterinarians in the area of genomics and gene editing. By utilizing cutting-edge science, it’s likely that cattlemen and women will have the ability to choose breeding animals that are less susceptible to illnesses.

JG: It seems evident that broad resistance management at the local or micro level has proven to have an impact on the antimicrobial resistance in that target population. Scaling up, we lack management plans on a national level. However, what the problem actually calls for is detailed integrated management plans for every type of resistance, or perhaps for problematic bacterial species.

The advancement we may see is future management plans that take all of the pressures at hand into account. n

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Antimicrobial Resistance Threatens Everyone.

All of us need to be resistance fighters.

Join us to make a difference. Drug-resistant infections are a global issue that can affect anyone, of any age, anywhere. We invite you to visit our website to learn, act, and be inspired.

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