With challenges to address the problems of viral diseases and multidrug-resistant bacteria becoming more urgent, investigators at Walter Reed Army Institute of Research (WRAIR), a unit of U.S. Army Medical Research and Materiel Command (USAMRMC), are at the forefront of research and intervention to meet these challenges, benefitting not just military health care, but all of medicine.
According to Col. Emil Lesho, D.O., director of WRAIR’s Multidrug-resistant Organism Repository and Surveillance Network (MRSN), a number of international and domestic health organizations list antibiotic-resistant bacteria as one of the top, if not the greatest, threats to global public health, both military and civilian.
Lesho characterizes the state of the problem of multidrug-resistant organisms in the U.S. Military Health System (MHS) as “very problematic, very concerning, but currently stable.”
“Antibiotic-resistant bacteria threaten our ability to provide basic, safe, effective patient care – not only causing infections, but making medical procedures we tend to take for granted very difficult,” Lesho said, “because without antibiotics, you can’t do elective surgery; you can’t do cancer therapy; you can’t do transplants; you can’t do joint replacement.”
“The reason why the incidences and the prevalence are not continuing to increase is because the activity in Iraq and Afghanistan, at least for the time being, has markedly decreased,” he explained. “The problem really began, or really peaked, after Operations Enduring Freedom and Iraqi Freedom. Highly resistant bacteria were fairly rare even at the tertiary care centers before that, and afterwards there was a huge increase.”
A scanning electron micrograph of two red-colored Klebsiella pneumoniae bacteria being surrounded by a blue human white blood cell, or neutrophil. Klebsiella can cause pneumonia, bloodstream infections, wound- or surgical-site infections, and meningitis. NIAID image by David Dorward, Ph.D.
“Antibiotic-resistant bacteria threaten our ability to provide basic, safe, effective patient care – not only causing infections, but making medical procedures we tend to take for granted very difficult,” Lesho said, “because without antibiotics, you can’t do elective surgery; you can’t do cancer therapy; you can’t do transplants; you can’t do joint replacement.”
Lesho characterized the current outlook as not very promising in terms of winning the war on these pathogens, a situation he attributes to “a confluence of factors.”
“Drug companies are disincentivized to develop antibiotics for many reasons, so there’s a dry pipeline – there are no new antibacterials coming out,” he said. Additionally, “The bacteria are emerging new resistance mechanisms and sharing those with other bacteria at a rapid rate.”
Lesho identified the most problematic organisms as Escherichia coli along with those organisms known by the “ESKAPE” acronym – Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species. These pathogens are frequently linked to health care-associated infections, but are increasingly found in the community and highly prevalent in long-term care facilities.
One response to address the threat was the establishment of MRSN in 2009. As co-founder, Lesho identified the overall mission as “collecting and characterizing these multidrug-resistant organisms and providing actionable feedback to the individual units, and aggregate reports across the enterprise to enhance countermeasures, to help predict or prevent transmission of these pathogens.”