The rapid emergence of antimicrobial resistance has threatened to render our antibiotic therapeutics arsenal useless and represents a major public health crisis. An increase in both the kinds of bacteria that are resistant, as well as the mechanisms by which they become resistant, have been observed in the last several years. The emergence of antimicrobial resistance among the common bacteria that are found in the respiratory and digestive tracts has important public health implications since these organisms are among the most frequent causes of infection seen in children and adults in the United States and throughout the world.
The presence of antibiotic resistance has been shown to result in increased severity of disease and deaths related to infection, as well as leading to an increased cost of medical care. Our antibiotic resistance research seeks to better understand antimicrobial resistance and change clinical practice accordingly.
Overall, this line of research aims to understand the mechanisms of antimicrobial resistance and ultimately reduce and/or prevent resistance of common bacteria to antibiotic drugs.
For example, one project aims to understand the effect that continuous preventive antimicrobials may have on the development of resistance. An earlier study looked at the effectiveness of antibiotics used to prevent recurrent urinary tract infections and renal scarring in young children. In any situation in which antimicrobials are used for prevention of infection, the risk for development of antimicrobial resistance must be weighed against potential benefits. We are using various types of research methods to close the gaps in our understanding of antimicrobials resistance – including clinical trials, pharmacoepidemiology studies, and observational studies – to help clinicians and parents make informed decisions.
So far, we have observed an increase in cases of methicillin-resistant Staphylococcus aureus (MRSA) in a retrospective study of 33 children’s hospitals from 2002 to 2007. We have also studied the mechanisms of antimicrobial resistance in children. A case control study conducted at CHOP found a strong association between production of extended-spectrum beta-lactamase (ESBL) and fluoroquinolone (FQ) resistance in patients with pediatric bloodstream infections caused by E. coli and Klebsiella species.
What’s Next: Our next project in this line of research involves investigating how antimicrobial prophylaxis impacts the development of antimicrobial resistance.
Funding: Thrasher Foundation
Please contact Theoklis Zaoutis, MD, MSCE, CPCE Director and CHOP Division Chief, Division of Infectious Diseases, for more information about this line of research.
Antibiotic Resistance Published Research
Mechanisms of Antimicrobial Resistance
Gerber JS, Coffin SE, Smathers SA, Zaoutis TE. Trends in the incidence of methicillin-resistant Staphylococcus aureus infection in children's hospitals in the United States. Clin Infect Dis, 2009. 1;49(1):65-71.
Kim JY, Lautenbach E, Chu J, Goyal M, Nachamkin I, McGowan K, Coffin S, Zaoutis T. Fluoroquinolone resistance in pediatric bloodstream infections because of Escherichia coli and Klebsiella species. Am J Infect Control, 2008. 36(1):70-3.