Bacteria Going Rogue

Q&A with Monica Farley

Don Morris

Monica Farley is principal investigator for the Georgia Emerging Infections program, an Emory professor of medicine in infectious disease, a physician at the Atlanta VA Medical Center, and a faculty researcher at the Emory Antibiotic Resistance Center. Here's what she says about the looming threat of antibiotic resistance.

What's the biggest challenge for doctors? 

Antibiotic resistance is changing the playing field. Isolating bacteria and testing them for antibiotic resistance can sometimes take too long if someone is sick and needs treatment. Twenty years ago, if someone had a suspected staph infection in a cut on their leg, we could assume it would be treatable with cephalosporin or something similar. Now we have to assume it will be MRSA, and it means we have to treat many more infections with vancomycin—a compromise, because it doesn’t work as fast as the drugs we would have used in the past. This phenomenon is threatening the advances we have made in the past fifty years.

Can you explain antibiotic stewardship?

Because development of new antibiotics is slower than we need it to be, we want to preserve the value of antibiotics that are still effective. That means: Don’t use antibiotics against viral infections. Choose the narrowest spectrum antibiotics—don’t expose other organisms to selective pressure if we don’t have to. It means the right dosing and shortening courses of antibiotics for pneumonias and other common infections. Every day an antibiotic is in use against an organism that causes disease; we have to balance its effects against others that may become resistant.

What happens in hospitals?

A recent study of health care–associated infections, which the Emerging Infections Program (EIP) was involved in, found that 50 percent of people in hospitals on any given day were on antibiotics. There’s a danger from health care providers going from patient to patient, carrying bacteria on their hands or on items. Experts at Emory have been looking at this systematically, in collaboration with Georgia Tech. They have a studio mock-up of a hospital room so they can ask: What changes to the environment reduce contamination?

What's the outlook?

It’s now a rarity to encounter isolates for which there are no effective treatments. But without action, it could happen in the next decade. A report from the British government predicted a potential for ten million deaths per year by 2050. This was a main driver for the creation of Emory’s Antibiotic Resistance Center.

How can the Antibiotic Resistance Center help?

We’d like to strengthen the connection between clinical and basic researchers. When the clinical lab takes a culture from the patient’s throat, urine, or blood, it usually stops there. They report what they found back to the clinic, but we don’t learn more about those bacterial isolates. What we are planning to establish is an investigational clinical microbiology lab that will allow us to routinely and serially collect isolates and perform detailed characterization of the mechanisms of resistance, tying that to clinical and demographic information. Did this patient have a stroke? Does he have diabetes? Was there antibiotic exposure? It’s very powerful to be able to say that we’re seeing this mechanism of resistance in certain populations, or in people who have particular medical problems. Our objective is to tighten the pipeline of communication.

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