“That’s probably one of the most important things we do here. Then we have all these other efforts, like octopus arms going in all different directions, depending on what the effort is, but all related to entomology,” Szumlas said.
Products and Services
The Centers of Excellence for Infectious Disease Research (CIDR) and for Military Psychiatry and Neuroscience (CMPN) have a mission focus for the development of products and knowledge that benefit the warfighter. From its mission research, WRAIR and military medical research focus on near-term product development, exemplified in other chapters of this publication and also realized, in part for WRAIR, through the Translational Medicine Division that stands in support of the centers and is comprised of the Pilot Bioproduction Facility (PBF), Clinical Trials Center (CTC), and Regulatory Affairs (for Investigational New Drug applications, in-house Food and Drug Administration compliance, and more). The services of the Pilot BPF and CTC are available to outside organizations through cooperative research and development agreements (CRADAs) and similar mechanisms so that others can take advantage of capacity in the conduct of clinical trials or when pilot lots of vaccines and biologics are needed.
Priority follows funding, according to WRAIR Deputy Commander Col. Peter Weina, and future research, beyond continuing pursuit of old and Second Gulf War-related projects, may be in jeopardy.
“New starts are stagnant right now. WRAIR research and missions are funded by ASA-ALT [Assistant Secretary of the Army for Acquisition, Logistics, and Technology], grants, CRADA partners, and many, many other sources,” he said. “[But] new starts are exceedingly difficult, if not impossible, in the current environment.
“We do have educational efforts that have done well recently due to their immediate and direct relevance to the combatant commander’s mission. Major underappreciated or neglected research is what we address when able; MRSN is a good example and our latest ‘new start’ major effort.”
“We do have educational efforts that have done well recently due to their immediate and direct relevance to the combatant commander’s mission. Major underappreciated or neglected research is what we address when able; MRSN is a good example and our latest ‘new start’ major effort.”
Multidrug-Resistant Organism Repository and Surveillance Network (MRSN)
MRSN is a unique program, even among civilian medical agencies, combining basic and applied research with old-fashioned infection control efforts, Lesho said.
“I co-founded it with WRAIR in 2009, at the direction of the Army, as a unique combination of infection preventionists, scientists, microbiologists, laboratorians, and infection disease specialists to collect multidrug-resistant organisms. When a certain organism is isolated, it is sent to us here and we do sequencing and genomapping, then provide a quick report back to the reporting organization,” he said.
This scanning electron micrograph depicts a couple of clusters of aerobic Gram-negative, non-motile Acinetobacter baumannii bacteria as seen under a magnification of 12,739x. A. baumannii is the etiological agent of nosocomial infections resulting in septicemia, meningitis, endocarditis, pneumonia, and wound and urinary tract infections. MRSN is currently targeting methicillin-resistant Staphylococcus aureus (MRSA), and multidrug-resistant Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii. CDC photo by Janice Carr
“We’re unique from what the CDC [Centers for Disease Control and Prevention] does in that we collect personally identifiable information; the CDC does not. It is both a blessing and a curse, given all the policy and security issues you must have in place. But the military is unique because casualties will pass through four to six hospitals on two continents within weeks of beginning treatment. The second way we’re unique is the CDC has no footprint in highly unstable areas, such as Iraq and Afghanistan. They do get information from Military Health through the National Health Safety Network, which is new, but it is after the fact, while ours is more real time.”
MRSN was the first to detect the presence of superbug genes, which Lesho said typically come from host-nation patients. When a sample arrives from doctors in another country, MRSN confirms what it is and is not, then alerts the reporting facility and sends a report to policymakers, starting with the Army Surgeon General, who create and enforce policy.
“If you have two patients with the same infection – one identified from blood, the other from urine – the question is which patient gave it to the other. Or is it genetically unrelated? We impact empiric therapy when a clinician is faced with a positive culture but doesn’t have all the details yet. When a patient comes in, the doctor wants to start treatment right away, but it will take awhile to get test results,” he said.
“It’s not uncommon for the reporting group to believe they do not have a resistant organism when they do. After that, they go through a hierarchy of characterizations, based on what it is. If it is from theater or a deadly outbreak, we can move on it quickly, determine what it is resistant to in antibiotics, what it’s related to.”
MRSN also translates basic research into clinical usefulness.
“For example, one hospital had an outbreak resistant to every antibiotic we had, so we used state-of-the-art research methods to determine the mechanism and now have a simple test hospitals can use to test for that bacteria. That also is true of the superbug genes,” Lesho said. “Our big focus is on health care-associated infections, which may change from month to month. It’s not in our main mission, but if a hospital asks us for help, we give it.