Antibiotics Usage and Developing Antimicrobial Resistance
Personal Connection and Moral Obligation
The fast-growing threat of antimicrobial resistance has been one of my precedencies from the begging of my career. I am so excited and passionate to be part of a project that will be addressing a critical public health concern, in addition this project will be giving me the opportunity to share my personal experiences and will be able to express my views. I have been working in the Microbiology laboratory for more than 25 years, during those years I have personally performed susceptibility testing on thousands of bacterial isolates that was collected from different sources of patient’s samples such as blood, urine, stool, sputum and wounds. Increasingly, I have personally observed and censored those significance shifts and trends in the antibiotics resistant patterns, concurrently I was shadowing many organisms developing drug resistance over the years. Working with bacterial organisms for many years and observing the significant change in their genetic behaviors have built my personal attachment in this area of study and promoted my moral obligation to continually keep spreading the awareness of this serious public health threat.
Though, I have been advocating and participating in many intervention programs that aimed to slow down the pace of those resistant trends, yet, I am very inspired and motivated to be part researches for future discovery of new line of antibiotics that can effectively treat the superbugs and makes a new turning point for the public health.
Networking with Researchers
In addition to my continuous advocacy in pulling the alarm regarding this fast growing public health threat, also I have been reaching out to connect with researchers who are working by our sides in the public health. Fortunately, I was able to connect with one of scientist in the drug discovery research who’ s main work focuses on the discovery of newline of antibiotics that might has the efficacy in compacting these superbugs. I have conducted in- person interview with Dr. Robert H Cichewicz, who is a subject matter expert in the new line of antibiotics discovery research. Robert H Cichewicz, Ph.D., is a professor in the Department of Chemistry and Biochemistry at the University of Oklahoma. Also, he is the head of department of Institute for Natural Products Applications and Research Technologies (INPART).
Dr. Cichewicz’s current research interests focus on translating natural products into therapeutic leads to combat infectious diseases, and other unmet medical needs. Naturally, Gram-positive bacteria use anionic teichoic acid to chelate metals; however his team was able to block that process with cationic polymers that displace metal ions from the teichoic acid sites. Though my background in the clinical microbiology , yet I have expressed my great personal attachment in this area of study and I will be great opportunity in collaborating and building an effective relationship between our areas to help each other reaching our common goal in developing an effective intervention to compact this public health predicament . I am truly thrilled by Dr. Cichewicz researches as it opened a new pathway for me as a doctoral student in public health. In addition, these research studies will build a new hope for public health practitioners to compact the life-threatening superbugs.
Dr. Cichewicz stated that their research lab is focusing on natural products for drug discovery by building resources that can be used for all drug applications. Their researches focus mainly on building a new resource that could aid in finding new antibiotics and new compounds that would improve the applications of current antibiotics. The future direction for their research is to look for a clean drug that is capable to sustain affectivity taking in considerations all the possible smart mechanisms that those organisms are developing over time. Nevertheless, one of the main challenges facing researchers in acquiring an effective new antibiotic is the complexity of the bacterial structure and how they have come up with many tricks to evade and survive under the harsh conditions.
Problem Statement
The global crisis of antibiotic resistance has been attributed mainly to the misuse and the over use of these antimicrobial agents. Although it is very critical to treat bacterial infections without antibiotics, yet the overuse or underuse of these antibiotics has more critical consequences that affect the efficacy and the lifetime of those antibiotics (1). The combination of “overuse of the antibiotics and the intrinsic structure of the organism’s defense system” create the perfect environment to help changing the genetic components of these organisms and allowing them to mutate and to develop the resistant gene to those antimicrobial agents and create the multi-drug resistance organisms (MDRO’s) (2). Multidrug resistant organisms are the product of the emerging resistance of antibiotics; infections due to the MDRO’s are a serious threat to the public health as they are linked with severe clinical implications, increase length of hospital stay, leading to high mortalities and morbidities, impacting great financial burden to the healthcare system (3).
Though there are many studies have been conducted to address the epidemic trends of antimicrobial resistance and their direct critical impact on the public health, yet very limited significant effective measurements has been put in place to minimize the misuse of the antimicrobial agents and its contribution to the fast growth of the antimicrobial resistance.
Several multi-drug resistant bacteria have been increasingly involved in infectious diseases in humans, in our study we have selected three of the highest prevalence gram negative organisms; Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Those bacteria are among MDRO’s that recently gained further global attention by being listed by the WHO as priority antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics (4).
According to the CDC 20 -50 % of antimicrobials prescriptions are either inappropriate or unnecessary, this misuse of antibiotics is very common in both inpatient and outpatient settings. The practice of misuse of antibiotic playing a major role in the fast development of antibiotic resistance, increased risk of patient’s colonization, acquiring infections with multi-drug resistant organisms and create a high opportunity of transmission to other patients (6).
In third world counties where, dispensing antibiotic is over the counter, it is very common to see people practicing the use of antibiotic’s treatment without the doctor’s prescription, this inappropriate use of antibiotics causes major and undesired side effects that leads to developing bacterial-resistant organisms (9). The development of these MDRO’s worldwide is a major concern for us in the public health in the United States as those superbugs might be brought to us through travelers and get spread in our communities by transmitting form one person to another(7).
The fast pace growing of the antibiotics resistance putting the public health in a panic mode and flagging a huge concern to the healthcare system over all (11). The therapeutic failure to infections caused by the multidrug resistance organisms can become deadly and might lead to severe health complications and great financial cost to patients and the healthcare system (13). While we are waiting and hoping for a new miracle antibiotic that can effectively kill the superbugs, we need to make a wiser decision for the better use of the antibiotics we currently have on hand.
In this retrospective study, we will be studying and analyzing the resistance patterns and their association with the antibiotics consumption among our selected microbial pathogens; Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa.
References
1. Islam, J., Ashiru-Oredope, D., Budd, E., Howard, P., Walker, A. S., Hopkins, S., & Llewelyn, M. J. (2018). A national quality incentive scheme to reduce antibiotic overuse in hospitals: evaluation of perceptions and impact. Journal of Antimicrobial Chemotherapy (JAC), 73(6), 1708–1713. https://doi-org.ezproxy.lib.usf.edu/10.1093/jac/dky041
2. Sharma, N., Gupta, A. K., Walia, G., & Bakhshi, R. (2016). A retrospective study of antimicrobial resistance pattern of Pseudomonas aeruginosa isolates from urine samples over last three years (2013-2015). International Journal of Basic & Clinical Pharmacology, (4), 1551. https://doi-org.ezproxy.lib.usf.edu/10.18203/2319-2003.ijbcp20162470
3. Doulgeraki, A. I., Di Ciccio, P., Ianieri, A., & Nychas, G. J. E. (2017). Methicillin-resistant food-related Staphylococcus aureus: A review of current knowledge and biofilm formation for future studies and applications. Research in microbiology, 168(1), 1-15
4. Sharma, N., Gupta, A. K., Walia, G., & Bakhshi, R. (2016). A retrospective study of the changing trends of antimicrobial resistance of Klebsiella pneumoniae isolated from urine samples over last 3 years (2012-2014). Journal of Natural Science, Biology & Medicine, 7(1), 39–42. https://doi-org.ezproxy.lib.usf.edu/10.4103/0976-9668.175060
5. PR Newswire. (2016, May 3). CDC: 1 in 3 antibiotic prescriptions unnecessary. PR Newswire US. Retrieved from http://ezproxy.lib.usf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=bwh&AN=201605031305PR.NEWS.USPR.DC88363&site=eds-live
6. The Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2014. Available via the internet: https://www.cdc.gov/antibiotic-use/community/pdfs/annual-reportsummary_2014
7. Agrawal, C., Biswas, D., Gupta, A., & Chauhan, B. S. (2015). Antibiotic Overuse as a Risk Factor for Candidemia in an Indian Pediatric ICU. The Indian Journal of Pediatrics, (6), 530. https://doi-org.ezproxy.lib.usf.edu/10.1007/s12098-014-1631-0
8. Tillekeratne, L. G., Bodinayake, C. K., Dabrera, T., Nagahawatte, A., Arachchi, W. K., Sooriyaarachchi, A., Woods, C. W. (2017). Antibiotic overuse for acute respiratory tract infections in Sri Lanka: a qualitative study of outpatients and their physicians. BMC Family Practice, 18, 1–10. https://doi-org.ezproxy.lib.usf.edu/10.1186/s12875-017-0619-z
9. Van Houten, C. B., Naaktgeboren, C., Buiteman, B. J. M., van der Lee, M., Klein, A., Srugo, I., & Chistyakov, I. (2018). Antibiotic Overuse in Children with Respiratory Syncytial Virus Lower Respiratory Tract Infection. The Pediatric Infectious Disease Journal, (11), 1077. https://doi-org.ezproxy.lib.usf.edu/10.1097/INF.0000000000001981
10. Bernatz, J. T., Safdar, N., Hetzel, S., & Anderson, P. A. (2017). Antibiotic Overuse is a Major Risk Factor for Clostridium difficile Infection in Surgical Patients. Infection Control and Hospital Epidemiology, (10), 1254. Retrieved from http://ezproxy.lib.usf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsbl&AN=RN613502499&site=eds-live
11. The Centers for Disease Control (CDC) and Prevention released a report, Antibiotic Resistance Threats in the United States, 2013, which presents a snapshot of the burden and threats posed by antibiotic-resistant germs having the most impact on human health, the CDC announced. (2013). Pharmaceutical Technology, (10), 14. Retrieved from http://ezproxy.lib.usf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.350677438&site=eds-live
12. Jibril Mohammed, Yaovi Mahuton Gildas Hounmanou, & Line Elnif Thomsen. (2018). Antimicrobial resistance among clinically relevant bacterial isolates in Accra: a retrospective study. BMC Research Notes, Vol 11, Iss 1, Pp 1-6 (2018), (1), 1. https://doi-org.ezproxy.lib.usf.edu/10.1186/s13104-018-3377-7
13. Llor, C., & Bjerrum, L. (2014). Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Therapeutic Advances in Drug Safety, 5(6), 229. Retrieved from http://ezproxy.lib.usf.edu/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=edo&AN=ejs34217484&site=eds-live
14. Founou, R. C., Founou, L. L., & Essack, S. Y. (2017). Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PLoS ONE, (12). https://doi-org.ezproxy.lib.usf.edu/10.1371/journal.pone.0189621
15. Chatterjee, A., Modarai, M., Naylor, N. R., Boyd, S. E., Atun, R., Barlow, J., Robotham, J. V. (2018). Review: Quantifying drivers of antibiotic resistance in humans: a systematic review. The Lancet Infectious Diseases, 18, e368–e378. https://doi-org.ezproxy.lib.usf.edu/10.1016/S1473-3099(18)30296-2
16. United States: Members of Congress Call for Ending Antibiotic Overuse in Agriculture.” Mena Report, 18 Mar. 2017. General OneFile, http://link.galegroup.com.ezproxy.lib.usf.edu/apps/doc/A486434298/ITOF?u=tamp44898&sid=ITOF&xid=d9b17147. Accessed 20 Jan. 2019
17. Landelle, C., Iten, A., Uçkay, I., Sax, H., Camus, V., Cohen, G., & Harbarth, S. (2014). Does colonization with methicillin-susceptible Staphylococcus aureus protect against nosocomial acquisition of methicillin-resistant S. aureus? Infection Control & Hospital Epidemiology, 35(5), 527-533
18. Kong, E. F., Johnson, J. K., & Jabra-Rizk, M. A. (2016). Community-associated methicillin-resistant Staphylococcus aureus: an Enemy amidst Us. PLoS pathogens, 12(10), e1005837429
19. Igbinosa, E. O., Beshiru, A., Akporehe, L. U., & Ogofure, A. G. (2016). Detection of methicillin-resistant staphylococci isolated from food producing animals: A public health implication. Veterinary sciences, 3(3), 14