Infection Prevention Imperatives for the New Year

Antibiotic Stewardship

Addressing antibiotic resistance is shaping up to be a big issue for 2009. Infectious disease experts warn that new drugs are urgently needed to treat six drug-resistant bacteria that cause most HAIs and increasingly escape the effects of antibiotics. The “ESKAPE” pathogens — Enterococcus faecium, Staphylococcus aureus, Klebsiella species, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species — are still flourishing more than four years after the Infectious Diseases Society of America (IDSA) first drew attention to the growing shortage of effective antibiotics. As the crisis of antibiotic resistance continues to grow, the latest IDSA report examines the trickle of new antibiotics in the research and development pipeline and proposes steps to tackle the shortage.

“The six bad bugs we call the ESKAPE bacteria are among the biggest threats infectious diseases physicians face today,” says Helen Boucher, MD, of Tufts Medical Center in Boston, lead author of the new report, published in the Jan. 1 issue of Clinical Infectious Diseases. “We desperately need new drugs to fight them. But we also need cooperation among industry, academia, and government to create a sustainable R&D infrastructure that will fill the pipeline to meet today’s needs and keep it filled with drugs that tackle tomorrow’s infectious diseases threats.”

The Food and Drug Administration (FDA) has approved a small number of new antibiotics in the last several years, most of them active against MRSA, however, resistance to them is already beginning to emerge. There remains a paucity of drugs for the Gram-negative pathogens Acinetobacter, Klebsiella and Pseudomonas that are becoming increasingly resistant to antibiotics. Only one new drug was approved for Gram-negative infections last year, and resistance already exists to other drugs in its class.

“More than four years after our first report, the bad bugs are getting worse, and we still don’t have the drugs we need,” Boucher says. “We need new tools to fight the ESKAPE bugs now. But there will always be bad bugs. We need industry, academia, and government working together so we are never again left with no drugs for bad bugs.”

Warye agrees that the declining arsenal of antibiotics is high up on a list of priorities for infectious disease experts to address. “I think antibiotic stewardship is beginning to be elevated on people’s radar in terms of something in which they need to be more involved,” Warye says. “Of course, while infection preventionists don’t actually prescribe these antibiotics, they realize they must work with pharmacists, physicians and others to spread the word about the need for antibiotic stewardship. I think infection preventionists have a role to play in determining what antibiotic stewardship actually means. In a conversation recently with Dr. Jarvis related to the C. diff study, he said he examined what antibiotics stewardship looked like in different organizations, and there was an incredible number of variations on the theme. So I think defining what a good antibiotic stewardship program looks like is probably something in which APIC will play a larger role down the road because it’s a critical underlying factor in all the problems we face.”

In its new report, the IDSA outlines steps Congress should take to make antibiotics a more attractive business proposition. The IDSA also urges Congress to pass the Strategies to Address Antimicrobial Resistance (STAAR) Act, a bill designed to improve research, surveillance and prevention of resistant organisms.