July 1, 2021 – The harsh realities of antimicrobial resistance – including rising rates of hard-to-treat infections, lack of a strong pipeline of future antimicrobials, and COVID-19 treatments that make people more vulnerable to infections – remain urgent priorities, experts say.
For some patients, the pandemic and antimicrobial resistance (AMR) are closely linked.
âA patient I see now in service really emphasizes how the two interact,â Vance Fowler, MD, said at a June 30 press conference sponsored by the Infectious Diseases Society of America (IDSA). A man in his mid-forties, married with a small child, developed COVID-19 in early January 2021. He was intubated, spent about a month in intensive care and managed to survive.
“But since then he’s been struck by a series of increasingly drug-resistant bacteria,” said Fowler, professor of medicine at Duke University School of Medicine in Durham, North Carolina and chair of the resistance committee. to IDSA antimicrobials.
The patient developed ventilator-associated pneumonia from Pseudomonas while on a ventilator. Although the infection initially responded to standard antibiotics, he has relapsed in recent months. Thanks to these multiple infections, Pseudomonas have become increasingly pan-resistant to treatment.
The only remaining antimicrobial agent for this patient, Fowler said, is “a case study in what we are describingâ¦ a drug that is used relatively infrequently, which is quite expensive, but for this particular patient is absolutely vital.”
A âterrifyingâ personal experience
Tori Kinamon, medical student at Duke University and FDA Fellow on Antibacterial Drug Resistance, joined Fowler at the IDSA briefing. She shared her personal journey of surviving a methicillin-resistant Staphylococcus aureus (MRSA) infection, an infection that sparked her interest in becoming a doctor.
âI had a very frightening and unexpected encounter with antimicrobial resistance when I was in my first year in college,â Kinamon said.
A few days after competing in a Division 1 gymnastics championship, she experienced progressive pain in her left hamstring. The pain worsened, and within days her leg became red, swollen, and painful to the touch.
Kinamon was admitted to hospital with suspected cellulitis and put on IV antibiotics.
âHowever, my clinical condition continued to decline,â she recalls. “Imaging studies revealed a six-inch deep abscess in my hamstrings.”
The limb infection and potentially fatal made her wonder if she would come out of surgery with both legs.
âIn the end, I had eight surgeries in two weeks,â she said.
âAs a 19-year-old varsity athlete, it’s terrifying. And I never imagined something like this would happen to me – until it did,â said Kinamon, who is also a NCAA infection prevention advocate.
When Kinamon’s kidneys could no longer tolerate vancomycin, she switched to daptomycin.
âI think quite often about how having this extra drug in stock had a significant impact on my results,â she said.
Encourage new antimicrobial agents
The lack of new antimicrobials in development is not a new story.
âThere has been a chill that has persisted in the area of ââantibiotic development. Most of the big pharmaceutical companies have left the area of ââanti-infective drugs and most of the research and development is now in pharmaceuticals. small pharmaceutical companies, âFowler said. “And they are struggling.”
One potential solution is the Pasteur Law, a bipartisan bill reintroduced in Congress and supported by IDSA. The bill encourages pharmaceutical companies to develop new antimicrobial agents with funding unrelated to the sale or use of the drugs.
In addition, the bill emphasizes the appropriate use of these agents through effective stewardship programs.
While some institutions diverted resources from AMR out of necessity when COVID-19 hit, “I can certainly say from our experience that at least Duke’s stewardship was alive and well. She was not. relegated to the side, âFowler said.
“In fact,” she added, “if anything, COVID has really underscored the importance of stewardship” by helping clinicians with advice on the use of remdesivir and other antivirals during the pandemic.
Additionally, in some cases, treatments used to keep people with COVID-19 alive may paradoxically put them at a higher risk of other infections, Fowler said, citing corticosteroids as an example.
AMR is not just a problem in the hospital setting. Kinamon reiterated that she contracted the infection in a sports environment.
“Antimicrobial resistance is not just a problem for intensive care patients in hospital. I was healthier and almost escaped death from one of these infections,” a- she declared. virulent, RAM is increasingly becoming a threat to the community, âshe added.
What’s more, consumers are also partly to blame, Fowler noted.
“It’s interesting when you look at the surveys of how many patients have used someone else’s antibiotics” or the antimicrobial agent remains from a previous infection.
âIt’s really surprisingâ¦ this is the kind of antibiotic abuse that directly contributes to antibacterial resistance,â he said.
Reasons for optimism
Promising advances in the diagnosis, treatment and prevention of AMR are underway, Fowler said.
âIt always excites me to talk about it. It’s amazing what technology and scientific discoveries can bring to this discussion and this threat,â he said.
For example, there is a “silent revolution” in diagnostics with the goal of quickly delivering vital actionable data on a real patient in near real time.
Traditionally, âyou start with what should be thereâ while waiting for test results to refine therapy, Fowler said. However, a whole series of new platforms are being developed to reduce the time taken to obtain sensitivity results. This type of technology has “the potential to transform our ability to care for patients, giving them the right medicine at the right time and no more,” he said.
Another promising avenue of research concerns bacteriophages. Fowler is the principal investigator of an ongoing clinical trial to evaluate bacteriophages as an add-on treatment for MRSA bacteremia.
Regarding preventing AMR infections in the future, “I continue to be optimistic about the possibility of vaccines to prevent many of these infections,” Fowler said, adding that the companies were working on vaccines against AMR. those types of infections caused by MRSA or E. Coli, for example.
The man in his forties with multidrug-resistant Pseudomonas infections “is now at the point where he walks in the hallways and I think he will eventually be released from the hospital,” Fowler said.
“But her life changed forever,” he added.
Kinamon’s recovery from MRSA included time spent in the intensive care unit, one month in a regular hospital, and five months at home.
âThis sparked my interest in antibiotic research and development because I see myself as a direct beneficiary of the stock of antibiotics available to treat my infection,â Kinamon said. “Now, as a medical student working with patients who have similar infections. I feel a deep empathy and connection with them because they ask the same questions as I do.”