Antibiotic resistance is a true threat to our health system. While many mBiosphere readers may be familiar with the statistic of 23,000 patient deaths annually due to drug-resistant infections in the US, each of these cases presents as an individual challenge while physicians struggle to control the disease. The ideal future would bring new drugs against novel microbial targets, but the reality is that physicians and their patients need help today.
To help educate physicians and scientists about these individual cases, Dr. Cesar Arias and the editors of Antimicrobial Agents and Chemotherapy have initiated a new section highlighting real-world cases and the decisions made while treating individual patients. Dr. Arias introduced the section in an editorial, and the first two articles are now available – both concern resistant Klebsiella pneumoniae infections. We spoke with Dr. Arias to discuss the importance of these translational research applications.
mBiosphere: Why is it important to highlight these cases?
Dr. Cesar Arias: Antimicrobial medicine is one of the few areas where you can actually go from the basic side, the gene mutations, and explain the patient outcome. However, the basic science and the clinical practice seem to be a little too far apart. Particularly for clinicians, the understanding of the basic concept of antimicrobial resistance and the reasons, especially at the mechanistic level, that are important to make decisions are still very nebulous and obscure.
In this era of resistance, we have to deal with multidrug resistant organisms that are basically resistant to everything we have available. Only that knowledge and the understanding of those basic concepts of resistance and mechanistic insights can help a physician choose an antibiotic for a patient who is in a clinical condition. The objective is to try to present a section and, by using a case, incorporate those basic mechanistic insights of resistance and translate that to effective clinical actions.
How have these two published cases been selected and what sorts of cases do you plan to highlight in the future?
The idea is to select highly challenging cases of common resistant microbial pathogens where there is not much data out there to guide therapy. Those cases need to have some mechanistics and molecular insights to guide the therapeutic decisions. One of the big issues we are facing now is multidrug resistance in Gram negatives, so the first few cases have been on gram negatives because there is that clinical need.
How do the challenge questions hope to engage the readers?
We have incorporated board-like questions to keep it entertaining. We have also incorporated an expert commentary, somebody who has the expertise and the knowledge to make a commentary about the case. They discuss what was done, the outcome, the antibiotic choices. At the end of the day, in a short period of time, clinicians and microbiologists can have a broad idea of what is going on and what decisions need to be made
Who do you hope will read and benefit from these Challenges?
I really target people in training – fellows, residents – but you'd be surprised to see even senior infectious disease physicians are facing a lot of challenges in understanding these new bugs, because they are emerging, so these are completely new concepts. The paradigm of treating these organisms has changed, so experienced clinicians also benefit a lot from these cases. In other words, this is really directed to a wider audience because nobody has experience with treating these bugs, so this section is good for everybody.
How often will these Challenges be posed?
I’m hoping we can end up with a monthly case, so each issue of AAC will have one. [The challenges] will encompass not only bacteria, but also viruses – outside of HIV, because HIV is kind of a different niche – and also parasites and fungi. We hope to bring all the resistant issues of these organisms that everybody is facing and make an interesting and educational section where people can really learn how to treat patients. In other words, make it from the bedside to the bench and then back.
Will these articles continue to be free to read?
We hope that after a few months, this section becomes the go-to for people with problems treating patients and also for educational purposes. I actually use these published cases to teach my fellows in a journal club that I perform every two months. This is the platform I’ve been using for IDWeek for teaching resistance to people, particularly clinicians.
-- Julie Wolf