Confronting the challenge of antimicrobial resistance

NIAID describes research efforts aimed at reducing antimicrobial resistance

Drug resistance is making many diseases increasingly difficult--and sometimes impossible--to treat, according to Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. “Extensively drug-resistant tuberculosis and invasive methicillin-resistant Staphylococcus aureus (MRSA) infections are just two recent examples of this problem that pose serious threats to domestic and global health,” he adds. In a new report in the Journal of Infectious Diseases, now available online, Dr. Fauci outlines NIAID’s commitment to addressing this urgent public health issue.

The innate ability of microbes to evade containment and destruction by drugs through rapid reproduction and genetic mutation is exacerbated by the overuse and misuse of existing antimicrobial drugs, Dr. Fauci and his coauthors note. Other factors contributing to the upswing in drug resistance include a dearth of rapid diagnostic tests that would allow physicians to better gauge whether a given infection is drug-susceptible or drug-resistant, and a paucity of clinical trial data to guide therapeutic strategies.

NIAID is meeting the complex challenge of antimicrobial resistance through a multifaceted research approach that includes partnerships with other federal agencies, academia, industry and non-governmental organizations, the authors report. In fiscal year 2007, NIAID invested more than $800 million to support basic and translational research on antimicrobials, more than $200 million of which was devoted to understanding the causes, consequences and treatments of antimicrobial drug resistance.

Basic research projects under way at NIAID or in NIAID-supported labs across the country include the following:

• Investigations of mechanisms of resistance and how these traits are acquired and passed on by microbes

• Research on factors that contribute to the virulence of pathogens such as MRSA

• Efforts to better understand and ultimately prevent biofilms--slimy coatings made by communities of bacteria that are impervious to the effects of antibiotics

• Creation of computer-based virtual microbial metabolic pathways that allow quick identification of potential drug targets
  
  

Facilitating the translation of basic research findings into better diagnostics, new therapies and novel strategies to slow the emergence of antimicrobial resistance is also an area of emphasis for the Institute, write the authors. The following are examples of the many applied and translational research programs supported by NIAID:

• Numerous clinical trials, including is assessing the need for antibiotics in children with acute middle-ear infections; and two trials designed to test off-patent oral antibiotics for treating uncomplicated community-associated MRSA

• Preclinical development of vaccine candidates to prevent staphylococcal infections