Mari Freitas, MPH: Stories of Antibiotic Use and Resistance

As a Council of State and Territorial Epidemiologists (CSTE) Applied Epidemiology Fellow, I have investigated both outpatient and inpatient antibiotic prescribing. It is very important to track antibiotic prescriptions to see a full picture of how antibiotics impact public health.

The most challenging aspect of antibiotic prescribing is knowing when it is truly needed. We must carefully consider antibiotic prescriptions within the context of the environment and reasons for prescribing to get the full picture—both of which make understanding antibiotic prescriptions more challenging and interesting.

As a student worker at the Minnesota Department of Health (MDH), I was able to aid in the surveillance of invasive methicillin-resistant Staphylococcus aureus (MRSA) infections. Understanding the susceptibility, or the response of bacteria to a variety of antibiotics, is very important for the treatment of infections, but also to track whether infections are increasingly likely to be resistant to antibiotics. Some patients with invasive MRSA infections experience a drastic change in quality of life—from living independently to needing assistance with daily tasks. Learning about these patients and completing surveillance case report forms made me more aware of the effects of antibiotic resistant bacterial infections on the lives of Minnesotans, especially in our vulnerable and elderly populations.

When I first considered a career in public health, I imagined studying and working in the field of chronic disease. However, working at MDH as a student worker and taking a class from Dr. Michael Osterholm opened my eyes to the need for antibiotic stewardship activities and the prevention of infectious diseases. Antibiotic use and resistance are now major interests in my future work in epidemiology. I hope to dive further into this work through my current position at MDH as a CSTE Applied Epidemiology Fellow.

I am most worried that inappropriate antibiotic use and growing antibiotic resistance will usher in a post-antibiotic era as pathogens are more commonly multidrug-resistant. Antibiotics are necessary to prevent and treat all types of infections. Rising rates of antibiotic resistance could impact medicine across the spectrum of care, despite technical advances and infection prevention practices.

I am greatly interested in antibiotic use in settings such as assisted living facilities and nursing homes. Antibiotic use is not easily tracked in these settings. However, getting a full picture of antibiotic use will better aid in stewardship activities as “tracking” is one of the pillars of antibiotic stewardship. Hopefully reporting of this information can happen in the future!