University Times

Antibiotic resistance — when bacteria develop resistance to drugs designed to cure or prevent infections — is one of the world’s most pressing public health problems, according to the federal Centers for Disease Control and Prevention.

And CDC officials cite overuse of antibiotics as the worst offender in spreading resistance.

To fight the resistance menace, UPMC Health System has created an Antibiotic Management Program to promote appropriate use of antibiotics. The program was launched Oct. 14 at UPMC Montefiore and is expected to begin at UPMC Presbyterian this month, said program director David L. Paterson, a professor in the medical school’s Department of Medicine.

The program is modeled after similar ones at Johns Hopkins and the University of Pennsylvania Health System. If UPMC’s program proves to be effective, it may be instituted throughout the health system, Paterson said.

Under the UPMC Antibiotic Management Program, clinicians must consult with program personnel before the hospital pharmacy will allow them to prescribe antibiotics especially likely to produce resistance. But Paterson said he and the program’s other, full-time faculty members and researchers — Pitt School of Medicine assistant professors Blair Capitano and Brian Petoski — should not be seen as interfering gatekeepers or cost-controlling bureaucrats.

“Our aim is to educate and advise doctors,” Paterson said. “We don’t want to interfere in the relationship between clinicians and patients. Our role is to help doctors to choose the best antibiotic or antibiotics for each individual case.

“We want to be guides, and we’re in a good position to do that because this is what we do every day: We familiarize ourselves with different antibiotics, doses and durations of treatment. Whereas doctors who have to keep up with the latest developments in treating hearts and lungs, bellies and legs — they just don’t have time to go into details regarding antibiotic therapies.”

Petoski, a clinical pharmacist in the Antibiotic Management Program, said: “The hope is that if we ensure the appropriateness of therapy and act as guides to clinicians, we can decrease resistance and regain some susceptibility [among infectious bacteria] to some of these antibiotics, or at the very least decrease this growing trend of resistance.”

Besides advising doctors about antibiotic use, the program is stressing the old rule of washing hands before touching patients. “The most common way of spreading resistant germs within a hospital is by hand contact,” Paterson noted. See story on page 9.

Complementing the Antibiotic Management Program’s clinical activities will be a research effort involving Paterson, Petoski, Capitano, two data analysts and a lab assistant. “It’s almost a unique opportunity,” said Paterson. “When we see a strain of bacteria in the hospital that is particularly resistant to antibiotics, we’ll potentially have the capability of working out in the laboratory why, at a molecular level, that resistance occurred. We’ll be equipped with detailed knowledge of how long the patient had the infection, what drugs they were prescribed, how long they were taking them and in what doses.”

Bacteria are Nietzschean. What does not kill them makes them stronger — and more resistant to antibiotics.

“That’s why it is vital to prescribe the right antibiotic in the right dosage, for only the period of time necessary to kill the bad bacteria,” said Paterson.

“The way that antibiotics used to be promoted by the pharmaceutical industry, and also by infectious disease doctors, was that we should use the most powerful antibiotic to kill the broadest spectrum of bacteria. We need to educate physicians about the latest thinking, which is that it’s better to use the narrowest possible antibiotic treatment to kill only the bacteria that are causing illness.

“Each of us is full of bacteria,” Paterson pointed out. “It’s all over our skin, in our noses, our intestines and stomachs. When you use what we call the ‘big gun’ antibiotics, you kill not only the nasty bugs but also the flora of natural bacteria that protect us against the proliferation of antibiotic-resistant bacteria.

“With seriously ill patients, we’ll still use the big guns first to deal with major infections,” Paterson added. “But even with those patients, we would prefer to get them onto more narrow antibiotic agents as soon as it’s safe to do so.”

Antibiotic resistance is a global problem, and epidemiologists have traced the spread of individual strains of resistant bacteria from one continent to another.

But the deadliest strains are less likely to be found in the community than in sophisticated health care institutions such as UPMC Health System hospitals.

“It’s an unfortunate by-product of us being good at keeping people alive, the fact that the really super-resistant germs are going to occur in hospitals,” Paterson said. “We know that the level of resistance rises the more complex the surgery is, and the more powerful the immunosuppressive or anti-cancer drugs are that you’re using.

“Let’s look at the example of a life-saving liver transplant. When patients develop an infection after the transplant, which they often do, we give them powerful antibiotics that kill good as well as harmful bacteria, leaving resistant ones behind. If the patient gets another infection, it’s likely to be with an antibiotic-resistant clone.”

— Bruce Steele