Year in Review: MHS stepped up measures against antibiotic resistant bacteria
The wars in Iraq and Afghanistan saw a rise in antibiotic-resistant bacterial infections. In 2016 the Military Health System stepped up efforts to identify and study such bacteria and share information gathered with the larger health-care community. (U.S. Air Force photo by Master Sgt. Christopher Stewart)
THe past year brought significant advances in identifying bacteria that can resist current antibiotics. Military Health System officials say the effort has been of the utmost importance.
“If the rise of antibiotic-resistant bacteria continues unchecked, we will be at a point where we really don’t have antibiotics to treat simple things,” said Army Lt. Col. Paige Waterman, director of Translational Medicine at the Walter Reed Army Institute of Research (WRAIR) in Silver Spring, Maryland. “For common infections, we take for granted an antibiotic will be available and the infection cured. If, however, bacteria are too resistant, we will be faced with simple infections that are now untreatable.”
Waterman is an infectious disease doctor by trade and added this predicament has implications beyond simple infections.
“Imagine having no antibiotics to treat infections in people receiving chemotherapy or commonly needed joint replacements,” said Waterman. “What good would available antibiotics be if all that’s circulating are resistant bacteria? The next question asked is if we can even do any surgery or chemotherapy, when patients are known to be at greater risk for infection.”
These concerns and a 2014 presidential executive order prompted the MHS to expand its efforts to stop the resistance. The military enhanced surveillance for resistant bacteria, improved stewardship of new and existing antibiotics, and developed new diagnostic tests and treatments. All of this was done with international efforts in mind, given the worldwide footprint of the military.
As a result, the Multidrug Resistant Organism Repository and Surveillance Network (MRSN) at WRAIR was the first to discover a gene from a human patient within the United States that is resistant even to a last-resort antibiotic. Colistin is often the final line of defense to treat patients with multidrug resistant infections. The colistin-resistant gene was discovered in samples sent to the MRSN.
Waterman’s colleague, Army Lt. Col. Kate Hinkle, also an infectious disease doctor, is the director of the network. She said the MRSN is just one part of the larger Department of Defense effort against antibiotic-resistant bacterial infections. That effort began during the wars in Iraq and Afghanistan.
“Those wars have been a real wake-up call for the DoD in terms of antimicrobial resistance,” said Hinkle. “We saw wound infections with very resistant bacteria coming back from those wars. The initial goal was to collect bacteria samples, provide an early alert to medical facilities, and set up a repository to be able to hold onto and study these bacteria and understand them better over time. That mission remains the same today.”
The information is also being shared with the larger scientific community. Researchers discovered more about some common types of bacteria, such as methicillin-resistant Staphylococcus aureus, better known as MRSA infections, and E. coli. It can also provide timely assistance with potential outbreak situations.
“These are also common problems in all hospitals,” said Hinkle. “All of the military treatment facilities around the world are sending us the resistant bacteria collected during routine medical care only. We’re able to study the antibiotic susceptibility of each bug, which provides direct information to clinicians caring for patients, as well as do genetic molecular analyses to figure out what is causing the antibiotic resistance and how it might be transmitted.”
In addition, researchers at the MRSN use the information they’ve gathered to help with outbreak investigations. Such study spurred changes in infection control practices and provided health care personnel with more information on some of the circulating strains within facilities.
“Telling hospitals whether patients did or did not share genetically identical bacteria helps them better understand what they need to do to interrupt an outbreak, such as preventing the spread of that bacteria from one part of the hospital to another,” said Hinkle. “Our current turn-around time from receiving the bacteria to getting information back to the hospitals can be as few as 48 hours – a remarkable feat. It used to take weeks. There are no other large repository and reference labs that can provide that quick and clinically relevant turnaround.”
The MRSN was originally started just to serve Army medical clinics and hospitals, but has been expanded to accommodate all of the services. Waterman said now the network is the cornerstone of the overall stewardship efforts for the military. The National Action Plan for Combating Antibiotic Resistant Bacteria requires the MHS to submit lab data from bacteria and antibiotic use information. To be successful nationwide, that information has to be valid and communicated. Some facilities have already uploaded some of this information, with the plan to ultimately include all hospitals.
“The lab data provided is of high quality because the MRSN has confirmed it,” said Waterman. “We are all working together to look at the information we collect so that we find ways to make a difference in our use of antibiotics.”