By Mr. Ronald W Wolf (Army Medicine)January 18, 2018
An important battle is underway. It involves--rather than armies of people--armies of microbes--bacteria and viruses.
The weapons used in this war are antibiotics and vaccines. For antibiotics in particular, however, increasing resistance to these drugs has been a growing and serious problem for at least 20 years and a topic of discussion for more than half a century by healthcare planners as healthcare quality and safety issues.
Why is this important to the Army? Soldiers--and all other service members--may deploy around the world on short notice to areas where disease is a threat, and potential threats to the health of troops must be identified. Medical experience tells us that soldiers take longer to recover from infections caused by antibiotic-resistant bacteria, those infections can cause death, and the resources involved in treatment are expensive.
Illnesses that were once easily treatable with antibiotics are becoming more difficult to cure and more expensive to treat. For example, infections from common antibiotic-resistant foodborne bacteria, such as Salmonella, are a danger, and these infections can cause life-threatening illnesses.
The Centers for Disease Control and Prevention calls antibiotic resistance "one of the world's most pressing public health problems."
The World Health Organization has cautioned that it is possible that a "post-antibiotic era" may be coming where minor infections--currently easily treated with common antibiotics--may become deadly. A number of national or international organizations are funding research on this medical threat.
Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year because of these infections. Many more people die from other conditions that are complicated by antibiotic-resistant infections.
Soldiers who deploy to areas of the world where antibiotic-resistant bacteria are widespread are at risk for dangerous bacterial infections. Just as importantly, those troops may come home carrying drug-resistant or difficult to treat infections.
Issues with this problem are well documented. Troops returning from Iraq starting in 2003 and through at least 2010 came home with difficult to treat bacterial infections.
During that period, although no American soldiers from the Iraq war died from the bacteria (Acinetobacter baumannii), at least five very ill patients that were in the same hospitals as the infected soldiers themselves became infected and died. Underlying illnesses may have contributed to the deaths of those patients, but that's part of the problem. Individuals who are already ill are especially susceptible to life-threatening complications from antibiotic-resistant bacteria.
Getting a handle on these dangerous organisms is especially critical to protect the safety of soldiers and family members. Bacteria have natural defenses that let them shrug off many antibiotics, and they are also good at adapting to new drugs.
Even sterilizing surfaces in medical treatment facilities is a challenge. Bacteria are extremely resilient and can live on surfaces for days. Even hospitals are a threat for spreading infection because bacteria can lie in wait on bed rails, tables or other surfaces and infect other patients unless disinfection practices are diligent and thorough.
Army Medicine has been focused on this problem for a number of years. In 2009, the Multidrug-Resistant Organism Repository and Surveillance Network (MRSN) was stood up under the Walter Reed Army Institute of Research. WRAIR is the largest and most diverse biomedical research laboratory in the Department of Defense.
The mission of the MRSN is to coordinate analysis and management of antibiotic resistance across the entire military health system. This effort helps military treatment facilities share information, optimize standard practices for infection control and patient safety, identify an outbreak of a pathogen earlier, and make more appropriate antibiotic selections for patients.
More recently, the MRSN became a key part of the DoD's Antimicrobial Resistance and Monitoring Research Program (ARMoR). Managing antibiotic-resistant bacteria and related programs is a triservice effort; ARMoR includes DoD hospital laboratories, clinicians and infection control staff; public health reporting groups; Navy and Air Force public health data collection programs; and national policy groups.
Changes to what are considered effective and prudent use of antibiotics are critical to ensuring safety and health. A shift in the culture of how antibiotics are prescribed by providers and the expectations of patients need to be managed better.
Overprescribing antibiotics by providers when they aren't sure what a patient has or because a patient asks for them, regardless of actual need, have contributed to this problem of antibiotic-resistance. In addition, antibiotics fight bacteria and have no effect on viruses.
Here are some recommendations:
-- Use antibiotics only as prescribed by your provider.
-- Take the appropriate daily dose for the entire course of treatment.
-- Do not take leftover antibiotics. Throw away unused antibiotics.
-- Never take antibiotics prescribed for another person.
-- Practice good hygiene. Wash hands regularly with soap and water, especially after using the toilet, before eating, before preparing food, and after handling uncooked meat.
-- Use hand sanitizers, they are very effective in reducing bacteria and viruses.
-- Ensure your children receive appropriate vaccinations (some protect against bacterial infections, such as diphtheria and whooping cough.)
Effective and prudent use of antibiotics and vaccines are critical to ensuring patients' safety and health which translates to better medical readiness in support of the Army.
Soldiers and their families should work as partners with their physicians to avoid unnecessary use of antibiotics. You can protect yourself by following their advice and using antibiotics only as directed by your healthcare provider.
You can help by remaining informed and learning what constitutes the most appropriate and safe practices to safeguard your health.