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The Up-Hill Battle of Antibiotic Resistance in the World of Infection Prevention

Hospital-Associated Methicillin-resistant Staphylococcus aureus (MRSA). The bacteria shown is strain MRSA252, a leading cause of hospital-associated infections in the U.S. and U.K. Credit: NIAID

When the news that a woman in Pennsylvania was found to be carrying a unique strain of E. coli was published, it seemed like it took a minute for people to realize the implications of such a discovery.

The Department of Defense researchers published their findings that hiding within her urine was an E. coli strain that was resistant to colistin, an antibiotic of last resort. The CDC released an alert to U.S. healthcare facilities and one of the first recommendations involved infection prevention. Shortly after, research teams in Lithuania and Argentina reported their findings of seagulls that tested positive for the colistin-resistant E. coli in their droppings. The teams suspected that the birds picked up the bug from eating garbage that included sewage or medical waste.

While these cases are interesting, what do they have to do with infection prevention and control in healthcare? Antibiotic resistance has been the slow burn in healthcare for years and we’re all hoping these headlines mean people are starting to catch on.

Infection preventionists (IPs) have been preparing and working to prevent the growing threat of antibiotic resistance for decades. Infectious disease physicians have been continuously preaching antibiotic stewardship and antibiograms have been passed around resident orientations to little fervor. Simply put, during my years as an IP and infectious disease epidemiologist, multi-drug resistant organisms (MDROs) were the ugly stepsister.

Flashier diseases like Ebola and Zika grab the headlines and that’s when our departments are looked to for leadership, advice, and training. It was a pretty remarkable experience to see the rapid attention and resources infection prevention and control got once Ebola hit U.S. soil. These are undoubtedly good things, but what is more concerning is that Ebola is a rare disease, while MDROs are alarmingly pervasive and a more threatening reality for patients.

Public framing and hysteria brought Ebola to the forefront. But where is this sense of urgency for organisms so resistant that we have no means of treating them? The case in Pennsylvania received fleeting public attention but it has long been the concern and fear of those working in healthcare and biology.

IPs have been working for years on MDRO surveillance and isolation. We work with physicians, nurses, environmental services, public health, and microbiology departments to screen patients, maintain databases, and try to isolate as soon as possible.

During my experience in pediatric infection control, it was amazing to see the number of community-acquired MRSA cases grow over the years. MRSA has become almost a common trend in healthcare, something no longer novel and attention-grabbing to most. Disneyland associated measles came and went, but there was always MRSA and VRE lingering in the background – a constant reminder of the real threat in infection control.

As an IP, it is concerning that MDROs receive so little public attention. There have been times when it feels like we are all shouting from the rooftops to garnish attention on this impending reality. Colistin-resistant E. coli and CRE are officially here but where is the consistent international news coverage to stop over prescribing antibiotics and work to mitigate growing microbial resistance?

Some may say that food safety is America’s soft underbelly, but in the opinion of this IP, antibiotic resistance is the real soft underbelly and on a global scale. Pulling from T.S. Elliot, this is the way the world ends, not with a bang like Ebola, but with the soft whimper of a world without effective antibiotics.

Saskia Popescu, PhD, MPH, MA, CIC, is an infection prevention epidemiologist and biodefense researcher whose work primarily focuses on the role of infection prevention in global health security and biodefense efforts. She holds a PhD in Biodefense from George Mason University, a Master’s in Public Health in Epidemiology, a Masters of Arts in International Security Studies, and a Bachelor’s Degree in Classical History, with a specialization on disease in ancient Rome, from the University of Arizona. She is a certified infection preventionist and fellow of the Johns Hopkins Center for Health Security Emerging Leaders in Biosecurity Initiative. She can be reached at

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