The war against superbugs starts here in North Carolina

By Daniel Feinstein

http://www.newsobserver.com/opinion/op-ed/article148852079.html

Nearly every day, there are new reports of antibiotic resistance bacteria – superbugs – that are becoming more difficult to treat. Early this year, the Centers for Disease Control and Prevention reported on the death of a woman in Nevada who had a resistant bacterial infection that was impervious to 26 different antibiotic drugs.

The woman was infected with the superbug called CRE – the superbug the CDC labeled the “Nightmare bacteria.” Two years ago, 15 cases of CRE were reported in Charlotte. More recently, the CDC reported on the increasing incidence of a drug-resistant fungal infection in hospitals across the country.

Antibiotic resistance is an extremely complicated problem, but numerous studies have shown that with some diligence, we can turn back the clock and regain the ground we’ve lost to superbugs. While many believe the only way to win this battle is to develop new antibiotics, this is false. Yes, we need new antibiotics, but new drugs alone cannot stop this looming public health crisis.

In numerous studies where antibiotic resistance was curtailed or reduced, this benefit was not the result of new drugs, but rather the more precise use of the antibiotics we already have – something we call antibiotic stewardship.

One of the leading drivers of antibiotic resistance is the misuse of antibiotics, specifically treating viral infections with antibiotics or overusing antibiotics by treating patients with an undefined infections with overly powerful antibiotics, often for an excessive period of time. By giving antibiotics to patients with viral infections or treating a hospitalized patients with a powerful intravenous antibiotic for several days, even after the infection has passed, we inadvertently “select” superbug strains for survival.

Not many are aware that innovative scientists right here in North Carolina play a leading role in the effort to help physicians quickly and precisely select the best antibiotic to kill a specific infection.

In late February, a rapid blood test called the VIDAS Procalcitonin assay became first FDA-approved blood test to help guide antibiotic treatment decisions with the goal of reducing the misuse and overuse of these vital drugs. The PCT test is made by a French company, bioMerieux, which has its U.S. headquarters in Durham.

PCT is a natural human molecule that serves as a biomarker for serious bacterial infections. The human body makes much more PCT when it has a serious bacterial infection, but PCT does not increase in the case of viral infections, making it a fantastic tool for discriminating between bacterial and viral infections.

It currently can take hours if not days to discriminate between viral or bacterial infections. As a result, millions of Americans with viral infections are given antibiotics every day. This misuse promotes resistance.

With the approval of VIDAS PCT, we can now start to reduce this enormous misuse of antibiotics. For example, two-thirds of patients in the U.S. diagnosed with acute bronchitis are treated with antibiotics (“Diagnosis and Treatment of Acute Bronchitis” Journal of the American Family Physician, 2010), yet 90 percent of these cases are caused by viruses!

This is a staggering and irresponsible misuse of these precious drugs. At this rate, our children and grandchildren may live in a post-antibiotic era.

This new approval will help us begin to reverse this trend. The VIDAS PCT test is also very small and could be used in urgent care centers and doctor's offices to prevent prescribing antibiotics to outpatients with viral infections.

In the FDA review of the VIDAS PCT, it was shown that the test led to a 51 percent reduction of antibiotic use in the hospital emergency department, without any adverse events to patients! Many studies have shown that by reducing the overuse and misuse of antibiotics, patients suffer from fewer adverse events, such as antibiotic allergies and C. difficile infections, which often result from prolonged antibiotic use. I can attest to this personally. My hospital, Cone Health in Greensboro, uses VIDAS PCT in our antibiotic management program. On average, we’ve seen a reduction of antibiotic use in our Medical/Surgical ICU of over 4 days per patient.

But as I said, we need both new and rapid medical tests and new antibiotics to defeat antibiotic resistance. RTP companies are leading in both efforts. Cempra Inc., Trana Discovery and others are making great progress in developing new drugs to battle infectious diseases.

Our state is playing a leading role in battling antibiotic resistance and we in North Carolina should be proud of these efforts.

Daniel Feinstein, M.D., is director of the medical surgical intensive care unit at Cone Health in Greensboro.