The MRSN’s laboratory, organism repository, and network of Army hospitals coordinate with other military medical facilities and plan eventual expansion to all U.S. military hospitals. They’re working closely with the Defense Health Agency to unify and standardize MRSN activity across the MHS.
Lesho pointed to several unique aspects of the organization in both military and civilian sectors. One is the identifying information they collect. “We don’t just collect the organism,” he said. “We collect the organism, the actual bacterial isolates, and we collect all the clinical and demographic information associated with that organism. That’s needed to track the pathogen and the spread across the military evacuation system, where patients are rapidly transferred across several continents, many hospitals, in a very short period of time.”
Another unique feature is the repository, and a third is how the organisms are characterized – as a combination of the clinical situation and an applied state-of-the-art research process.
When they receive a sample from a hospital lab, they not only confirm the pathogen’s identity, but also conduct complete genome sequencing (deciphering the organism’s genetic information) and multiple “high-level molecular tests to help us figure out where the organism evolved from, what makes it so resistant and what makes it so virulent,” Lesho said. “After we’re done with that, we preserve these pathogens in our repository for future use, for other investigators, or for look-back situations to develop vaccines and antibiotics.”
“It’s not limited to E. Coli giving resistant genes to E. Coli; E. Coli can give genes to Acinetobacter.”
The information gathered about the organisms is maintained not only for research, but also for clinical action in treating a particular patient as well as monitoring possible outbreaks in a facility. Lesho said information about the bacterial isolate from a patient is provided to the hospital that submitted it, informing them whether the organism is genetically identical to organisms from other patients at the same location.
Mosquito-borne diseases, such as dengue fever, malaria, and chikungunya, are research focuses for WRAIR. Photo by James Gathany
“We do genetic fingerprinting and we feed that right back,” Lesho said. “So if the hospital suspects or is wondering if they’re having an outbreak, that’s the first type of information we send them, saying, ‘yes, you are having an outbreak, [the isolates] are all related,’ or ‘no, this is not an expansion of one strain so you’re not having an outbreak.’”
Lesho characterized MRSN research as “genome-scale epidemiology.” He explained that the way in which bacteria become resistant is often due to a highly mobile genetic element that they acquire in the environment and share. And they can share between species, he said. “It’s not limited to
E. Coli giving resistant genes to E. Coli; E. Coli can give genes to Acinetobacter.”
Lesho said these highly mobile genetic elements pose special challenges for detection and even more challenges for infection prevention and control measures because they are easily transmitted between patients and among bacteria. “You can’t detect or fully characterize or understand these mobile genetic elements without sequencing the entire genome of the pathogen at a very high resolution. So that’s where we’re bringing in a state of the art to it, and that requires specialized sequencing.”
Beyond establishing a pathogen’s genome sequence, it must also be assessed in the context of everything else that’s been sequenced in order to be valuable information. Lesho identified a promising upcoming advance as development of a bioinformatics sequencing pipeline database, “to make it faster and more convenient to compare that sequence to everything else that’s been sequenced, and determine if there’s anything unique or special in that sequence.”