Great strides have been made in combating infectious diseases. However, past successes do not necessarily guarantee a bright future, especially in the face of emerging threats, according to speakers at the Infectious Diseases Society of America (IDSA) annual conference plenary symposium in New Orleans on October 26.
About 50 years ago, early success with antibiotics gave way to the realization that resistance had developed and the situation was getting worse. “We risk turning the clock back to a time when simple infections could kill. Modern medicine is at risk. Loss of effective medicine could make routine infections deadly. We need to act now or even drugs of last resort will soon be ineffective,” said Thomas Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, in his talk.
Hospitals need to act as a community, not in isolation. “Even if you practice at the best facility in the world, you are, in many ways, at the mercy of the nursing home down the block, the healthcare provider across town, and the long-term acute care facility that sends patients to you. Patients move and bacteria move with them,” said Dr. Friesen.
Thinking outside of the box when it comes to infection control also applies to bacteria. The human microbiome is a repository of a vast number of bacteria, more of which are friendly rather than pathogenic. Antibiotic therapy that disrupts the human microbiome can lead to the dominance of the pathogens, however.
“Turning the tide on antimicrobial resistance involves finding resistant organisms faster and more completely in hospitals, nursing homes, the community, animals, and food; preventing infections more thoroughly through stewardship, system-wide infection control, vaccination, and improved treatment; stopping infections more quickly by surveillance and reporting, outbreak control, information sharing among hospitals, and improving laboratory capacity; and innovations in antibiotics, diagnosis, infection control, and vaccines,” said Dr. Frieden.
Antiretroviral therapy has also achieved success, but efforts must continue as the face of AIDS and infection with HIV changes. The incidence of HIV declined from 1995 to 2016, partly due to implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR). As a result, life expectancy in sub-Saharan Africa has returned to its level prior to the HIV/AIDS epidemic, and treatment for pregnant women has increased to over 90%. The improved survival rate of infants has resulted in a doubling of the number of the 15-to-24 year olds in sub-Saharan Africa.