Antibiotic resistance took the national spotlight in May when scientists confirmed the discovery of a strain of E. coli resistant to colistin, the antibiotic of last resort, for the first time in the U.S. In an interview published in JAMA, Barbara Murray, MD, director of the division of infectious diseases at the University of Texas Health Science Center at Houston and an antibiotic resistance expert, talked about the challenges posed by antibiotic-resistant bugs.
Here are four thoughts from Ms. Murray, pulled from the interview.
1. Resistance to colistin. "Colistin has become the last go-to antibiotic for some of our multidrug-resistant bacteria … When you're left with only one drug and now you see resistance developing in it, it's very concerning."
2. Communicating with patients on antibiotic prescriptions. "The big pressure in an outpatient setting is for respiratory infections — colds, sore throats and sinusitis — and the vast majority of those are viral. I think we just have to tell patients that this is a virus. And it’s not good for you or the world to put you on antibiotics for a viral infection against which antibiotics don’t work."
3. The failure of antibiotic stewardship programs. "When you're dealing with a very sick patient in the hospital, you're not thinking of the public health implications, you’re just thinking of that patient. As clinicians, we tend to just keep changing antibiotics and adding new antibiotics. And I can't say that's wrong. But at the same time, it does drive the selective pressure for resistance."
4. The quick spread of resistance. "It's very difficult to keep things from spreading in the hospital, and that's where the real danger is. In the hospital setting, the bacteria that may acquire the mcr-1 gene [that makes bacteria resistant to colistin] may already be resistant to everything else."