July 18, 2018

Cardo and Hicks with IDI members at workshop

Antibiotics keep us safe from infectious diseases—except when they don’t. With antibiotics in popular use for decades, some organisms they target have adapted and rendered the drugs less effective. At least two million people in the U.S. each year become infected by antibiotic resistant bacteria, and another 23,000 die from those infections. Patients dealing with chronic conditions caused by cancer and other diseases are especially vulnerable. A major contributor to the rise of resistance is improper use of antibiotics, including use when none are warranted, or use of the wrong drug or dosage for a particular bacterial infection. Proper use of antibiotics, or stewardship, is the first step in the battle against resistance.

Protecting patients and stopping outbreaks is among the top priorities for the Centers for Disease Control and Prevention (CDC), which sent representatives to visit The Ohio State University on Wednesday, June 27, for a full day of programming related to antibiotic resistance.

The university’s Infectious Diseases Institute hosted the events, beginning with a public talk by Denise Cardo, MD, director of the CDC’s Division of Healthcare Quality Promotion (DHQP). Cardo described the multi-pronged approach the CDC employs to reduce the impact of antibiotic resistance, including preventing infections and their spread, tracking data to stay ahead of outbreaks, improving antibiotic use, developing new drugs and diagnostic tests, and collaborating with a wide range of national and international partners. “We need all of those approaches,” said Cardo. “We want to think about the patient holistically to protect them.”

In a series of roundtable workshops, Cardo and colleague Lauri Hicks, DO, captain in the U.S. Public Health Service and director for the CDC’s Office of Antibiotic Stewardship, learned about and provided feedback on the work Ohio State is doing to advance interdisciplinary research in antibiotic resistance. Researchers presented ideas from current and upcoming studies—from how social media is used to understand behaviors that contribute to (or prevent) disease, to research on antibiotic resistant microbial communities in chronic diseases like cystic fibrosis.

CDC guests also learned of the collaboration between Ohio State’s Veterinary Medical Center and Wexner Medical Center that recently established one of the first antibiotic stewardship programs in a veterinary medical center in the U.S. Roger Fingland, chief medical officer at the Veterinary Medical Center, explained the value of accessible guidelines for veterinary medicine students and faculty when prescribing antibiotics to companion, equine and farm animals. “It’s a tremendous advantage to us in veterinary medicine and a testimonial to what collaboration can do at a university,” said Fingland. “It’s phenomenal to have people from different areas in the health sciences coming together to do this.”

CDC guests walked away impressed with Ohio State’s dedication to One Health, a movement recognizing that the health of humans is directly connected to the health of animals and the environment. “The integration I see here at Ohio State is the way to move forward,” said Cardo, noting that “the questions asked in one area impact the others.”

The visit culminated in an evening workshop that brought together dentists and orthopaedic surgeons from the central Ohio community to address differences in their recommendations on the proper use of antibiotics - recommendations that have historically been at odds with one another.  Attendees discussed risks associated with antibiotic prescriptions for dental patients who may undergo orthopaedic surgery, which can lead to life-threatening complications, including C. difficile infections in the intestine. Increased communication between dentists and surgeons, facilitated through this workshop, is a positive first step in reducing antibiotic resistance-related illness. Dr. Hicks shared her experience engaging dentists and surgeons on this topic, and noted this was the first time that the two communities were brought together in the same forum, leading to truly insightful outcomes that can benefit both professional communities and the patients they serve.

Debbie Goff, PharmD, FCCP, infectious diseases specialist at the Wexner Medical Center and clinical associate professor in the College of Pharmacy, and Julie Mangino, MD, and internal medicine clinical professor, served as lead faculty hosts for the workshop. Goff stated the event was “beyond successful” and that this topic, if left unaddressed, ultimately leads to confusion about infections. “The patient is stuck in the middle: 'Which doctor should I listen to?’”

This is important work, given that infection rates for deadly illnesses like C. difficile remain high. “Stewardship is critical. It cannot be an afterthought—it has to be embedded in how we practice medicine,” says Cardo. “We’re not against antibiotics, but we need to decrease unnecessary use that causes a lot of problems.”

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