Antimicrobial resistance: Combating evolving microbes with data and human behavioral approaches

By Ria Foye

SAN JOSE, Calif. — The ability of pathogenic microbes to resist the arsenal of antibiotic drugs that have successfully held disease at bay for generations is becoming more widespread throughout the world and is a growing threat to public health, according to the World Health Organization.

However, as the problem mounts globally, data-driven approaches such as the use of informatics — the science of information processing and building information systems — and behavioral sciences are helping reverse the trend of pathogens resisting what were once considered miracle drugs. Experts addressing the issue here at the annual meeting of the American Association for the Advancement of Sciences suggest we may be entering what could be the post-antibiotic era.

Resistance occurs when a microorganism evolves to fight off treatments that were once effective in eradicating infection. The overuse or inappropriate prescription of antibiotic drugs by health professionals and use of antibiotic drugs in agriculture to enhance production are big factors contributing to the problem, said Steve Solomon from the U.S. Centers for Disease Control and Prevention, or CDC.

The problem is not only in the hands of healthcare professionals, but also patients who demand antibiotic drugs unnecessarily, Solomon explained during a symposium here on the issue.

“So the question is: Can informatics make a difference? … Concerns about resistance and about improving the way we deal with it have gone on for decades. We’ve done some things well, but clearly whatever we’ve been doing has not been sufficient to turn the tide,” Solomon said.

Solomon, along with other key speakers at the symposium, called attention to the now urgent need for combined data networks in the medical realm. Bringing the digital environment to the examination room — that is by giving both healthcare professionals and patients immediate access to information on antibiotics at the time of diagnosis — could decrease the number of incorrectly prescribed antibiotics.

For this large data infrastructure to be advantageous, clinical, administrative, and even patient-controlled data must be combined to form one large accessible network. Solomon noted, “We give people information … What we’re trying to do is nudge decision making. We need to be letting people know that taking an antibiotic if you don’t need it puts you at unnecessary risk to antibiotic-related adverse events.”

In addition to informatics, surveillance is another critical key to fighting the battle against antimicrobial resistance. By carefully monitoring how physicians prescribe antibiotics and engaging the prescriber, greater awareness and a reduced demand for antibiotics can be achieved.

One initiative taken by the CDC to prevent the spread of antimicrobial resistance has been to set up stewardship programs and intervention practices.

For instance, patients in certain areas of the country, such as California, can access online which hospitals have good antibiotic practices and take this into account when deciding where to go for treatment.

As far as intervention programs, Solomon described a recent study where pediatric practices were enrolled either in a lecture on good antibiotic prescribing with an audit and feedback session or control practices with no intervention.

The findings showed that intervention did, in fact, improve antibiotic prescribing over a twelve-month period. However, after the intervention ended, physicians who participated began to return to their usual, increased antibiotic prescription practices.

Solomon said in response, “Eighteen months after the intervention, everyone was back to baseline. It didn’t stick, so what were we going to do about that?”

As there are many plans in the works to keep antibiotic prescriptions low, one system called Computerized Clinical Decision Support was specifically designed for physicians and allows for an immediate impact on the final prescription decision.

What can be seen is that there is a dire need for methods to fight against antimicrobial resistance. It is not easy to reverse the antibiotic demands of some patients and pulling massive amounts of medical data together is far from an unchallenging task, but, nonetheless a necessary one to tackle antimicrobial resistance.

Ria Foye is a senior at Syracuse University majoring in biology with a minor in forensics. Her work has appeared in The Journal of Young Investigators. Follow her on Twitter @foye_ria or contact her at rsfoyeed@syr.edu.