Managing Antibiotic Resistance at Penn
Antibiotic drugs were developed in the late 1940s to kill bacteria. At first, the drugs were very effective, killing nearly all bacteria most of the time. However, within a few years doctors noticed that infections that had once been cured within days were taking weeks to go away. Researchers soon discovered that some of the bacteria in these infections had become resistant to normal antibiotics. And even worse, because the antibiotics were eliminating competing germs, the surviving “antibiotic-resistant” bacteria were thriving.
For a time, higher doses and longer treatment times worked to kill antibiotic-resistant bacteria, but these tactics eventually failed as newer, hardier strains of bacteria emerged. Today, some strains of bacteria are resistant to almost all antibiotics.
Investigating Antibiotic Resistance
Several causes for antibiotic resistance have been discovered. One cause of resistance involves mutations––natural changes in the bacteria’s genetic information––that make it possible for bacteria to withstand an antibiotic’s attack. A second avenue for resistance occurs when already resistant germs transfer genetic information to other bacteria, rendering them resistant.
In addition to investigating sources for resistance, researchers wondered what makes antibiotic resistance more likely to happen. The answer, surprisingly, was that the more an antibiotic is used, the greater the chances that it will encounter resistant bacteria.
Penn Comprehensive Antibiotic Stewardship Program
Bacterial infections are especially dangerous for people who have recently had surgery, with weakened immune responses, burns or trauma. Thus, with the rise of antibiotic resistance, the Hospital of the University of Pennsylvania created a comprehensive antibiotic stewardship program to manage the use of these drugs in the hospital. The goals of the program are to find ways to prevent antibiotic resistance, to preserve the effectiveness of antibiotics within the hospital, and to make antibiotic use safe for all patients. Now employed throughout the University of Pennsylvania Health System, the program provides a number of measures to meet these goals.
Through ongoing education, Penn clinicians and staff refine their knowledge of antibiotics, the germs they affect and the diseases associated with these bacteria. Guidelines for infection control and antibiotic dosing are put in place and are distributed throughout the system. Computer programs provide up-to-date information about antibiotics and their side effects for physicians, nurses and pharmacists. The availability of certain antibiotics within the hospital is regulated to prevent inappropriate use. All of these strategies are dependent upon close collaboration between departments, physicians and other health care providers throughout Penn.
Studies show the program works. When compared to standard practices at most hospitals, researchers found that the antimicrobial stewardship program at Penn improves the appropriateness of antimicrobial use and its effectiveness as treatment. In general, cure rates have risen and the number of infections resistant to antibiotics has declined.
Against the setting of this good news, the continuing emergence of antibiotic-resistant bacteria outside the hospital is worrying. But here, too, Penn researchers are at work, helping physicians in the community better understand appropriate antibiotic use and the dangers of antibiotic resistance to public health.
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