The April 15 issue of The Journal of Infectious Diseases highlights the National Institute of Allergy and Infectious Diseases (NIAID)’s investment in antimicrobial research as well as its antimicrobial resistance research portfolio. The journal also features a commentary highlighting resistance research areas where greater emphasis and funding could be helpful, as well as various articles on antibiotic resistance, including: research noting that a decrease in seasonal antibiotic use may lead to a reduction in antibiotic resistance; and evidence suggesting that community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is underestimated.

In one article, NIAID Director Anthony S. Fauci, M.D. and coauthors note that NIAID has taken a multi-faceted approach to antimicrobial resistance that includes funding research, partnering with public and private agencies concerned about this issue and creating a flexible infrastructure to respond to emerging needs.

The antibiotic resistance facts noted by the NIAID article are frightening:

One in five of the 94,360 Americans who developed an invasive MRSA infection in 2005 died.

About 20 percent of all tuberculosis (TB) cases worldwide are multidrug-resistant, and approximately 10 percent are extensively drug-resistant, according to a survey of international tuberculosis laboratories.

In 2002, 14 percent of Pseudomonas aeruginosa bloodstream infections were multidrug resistant, up from 4 percent in 1993.

NIAID currently invests more than $800 million annually in basic and translational antimicrobial research. Approximately one-quarter (>$200 million) of that amount is devoted to understanding the causes, consequences and treatments of drug resistance across the universe of microbes, such as bacteria (including TB), viruses (including HIV), fungi and parasites (including malaria). Among the research and initiatives NIAID funding supports:

• A new strategy that will reduce the cost of synthesizing the topical antibiotic bacitracin and lead to less toxic derivatives that can be used orally.

• The study of the structure and physiology of bacterial biofilms to prevent or disrupt their formation.

• Photodynamic delivery of drugs to treat infections and cancer; illuminating non-toxic compounds at the site of infection allows conversion to compounds toxic to micro-organisms only where needed.

• Filling in knowledge gaps such as through:
  • developing rapid, more sensitive and specific diagnostic tests for invasive bacterial infections that are or are likely to become resistant to antibiotics;
  • determining doses that balance the effectiveness of a drug with its toxicity; and
  • ascertaining appropriate therapy for bacterial infections that don’t have clear treatment guidelines, such as skin and soft tissue infections caused by community-acquired MRSA.

NIAID also participates in several partnerships to support public health efforts to manage antimicrobial resistance, including those with the federal government’s Interagency Task Force on Antimicrobial Resistance, Medicines for Malaria Venture, St. Jude Children’s Research Hospital, Drugs for Neglected Diseases Initiative and the National Research Council.

The author of an accompanying commentary, Louis B. Rice, MD, chief of Medical Service at Louis Stokes Cleveland VA Medical Center and chair of the Infectious Diseases Society of America (IDSA)’s Research on Resistance Work Group, said, “As the primary federal agency for the federal government’s commitment to research, NIAID is moving in a promising direction to place more emphasis on antibacterial clinical research, and IDSA is encouraged by NIAID’s forward-looking agenda. We continue to stress the need for an increased focus on clinical research for antibacterial resistance and nosocomial infections, while underscoring the need for increased resources to begin to scratch the surface of this problem.”

Dr. Rice’s commentary notes that legislation in Congress, the Strategies to Address Antimicrobial Resistance Act, would strengthen federal coordination of surveillance, prevention and control and research activities in this critical area.

Other articles in the April 15 issue include:

• a report suggesting that yearly seasonal reduction in antibiotic prescriptions during the warm months is associated with a marked reduction in antibiotic resistance rates among pneumococcal acute otitis media;
  
• an editorial noting that the otitis media study provides a start toward estimating how much of a drop in antibiotic use is necessary to reverse the spread of antibiotic-resistant strains; and
• several articles on Staphylococcus aureus. These include:
  • documentation of an increase in nasal colonization of MRSA from 2001 to 2004, while colonization of antibiotic-sensitive S. aureus decreased
  • evidence that it is difficult to distinguish patients with multiple resistant MRSA from those with community-acquired MRSA, and suggesting that community-acquired MRSA epidemic is vastly underestimated; and
  • demonstration that host inflammatory response genes are major factors in S. aureus colonization and infection.

Founded in 1904, The Journal of Infectious Diseases is the premier publication in the Western Hemisphere for original research on the pathogenesis, diagnosis and treatment of infectious diseases; on the microbes that cause them; and on disorders of host immune mechanisms.  Articles in JID include research results from microbiology, immunology, epidemiology, and related disciplines.  It is published under the auspices of the Infectious Diseases Society of America (IDSA).  Based in Arlington, Va., IDSA is a professional society representing more than 8,000 physicians and scientists who specialize in infectious diseases.