Alex Kallen, MD: Stories of Antibiotic Use and Resistance

I have worked with antibiotic resistance since I started my training as an Infectious Diseases Doctor twenty-two years ago. I started by working on methicillin-resistant Staphylococcus aureus (MRSA) initially, but now I work on controlling transmission of lots of resistant organisms. I am lucky enough to work with a stellar team at CDC that is working to implement a strategy to contain new resistance and to devise ways to roll back resistance that is already established.

I think about antibiotic resistance every day -- not only how to prevent it, but also how we treat patients. The challenge of combating resistance is amazingly fascinating work – every day I feel like we get a little closer to understanding the issue more. However, as a practicing clinician I see how resistance affects patients. One patient that I often think about was an otherwise healthy gentleman with a pan-resistant (resistant to all antibiotics) Pseudomonas heart valve infection. He had fevers, but he had been otherwise living a normal life at home; despite surgery and the best antibiotics available, we could not eradicate the infection and he slowly deteriorated and passed away.

The thing that worries me most is the spread of the most resistant healthcare pathogens into the community. Most resistance we come across is found in healthcare settings, but in other parts of the world it is not always. Spread into the community fundamentally changes our ability to control these organisms.

I really want to have us all learn more about the best ways to eliminate resistant organisms from carriers. Are there ways to manipulate the gastrointestinal tract to get rid of these bacteria or vaccines or therapies that could target carriage? I think developing a successful way to do that would be a game changer for controlling resistance.