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Who is Most Vulnerable to Antibiotic-Resistant Organisms?


Barry Kreiswirth, PhD, founding director, Public Health Research Institute Tuberculosis Center, professor of medicine at Rutgers University, explains which populations are most susceptible to antibiotic-resistant organisms.

Interview Transcript (slightly modified for readability)

“The question really has to do with who’s really vulnerable to these resistant problems. I guess the good news is that the general population in the community is probably not at risk at all. The concern really is patients who have high risk associated with their disease.

We know, historically, that carbapenem-resistance and the use of colistin is commonly used in immunosuppressed patients, who have been treated for liver transplants, as well as for bone marrow transplant [patients], cancer patients, [and] patients [who] have a reduced immune system. Patients who really are vulnerable are really at the mercy of these resistant organisms, mainly because their own health makes it problematic for them to fight off infections, and the better drugs we have, the better they’ll do. The fact that we’re losing carbapenems, the fact that we’re now concerned about the loss of colistin, [shows that] we don’t have many effective drugs to treat patients who get these resistant organisms.

The drug companies obviously recognize the need for new gram-negative drugs, but drug-discovery takes a long time and we are probably a good two to three years before really even having effective drugs in the pipeline, which could take another 3 to 5 years, before we have new agents to treat these bugs.

In regard to who we think we should be testing, we know that the clinical laboratories and hospitals, especially in areas where carbapenem-resistance is spreading, which is mostly in the northeast, [in] New Jersey and New York have had a lot of experience with these carabapenem-resistant strains, and they use a lot of colistin to treat patients; this is the population where you want to have heightened surveillance, mainly because we use a lot of colistin, it’s important treat, and the idea that we would lose colistin because of resistance is really a clinical concern. In places where these strains are prevalent, yes, active surveillance would be a smart thing to do, just with the idea of learning what the baseline is, and if the baseline is low, that’s good news, but it doesn’t mean [that] we shouldn’t be actively doing the studies and actively doing surveillance just to make sure [that] the problem isn't going to cause outbreaks.”
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