Medical staff walking away in a bright hospital hallway
Part 2

Eradicating HAIs: the challenge ahead

In the second part of our interview Professor Assadian elaborates on the increase of antibiotic resistance and the different possibilities healthcare institutions are offered with in their fight against infections.

Healthcare-associated infections (HAIs) were a problem long before COVID-19 and they will continue to be one when the pandemic is over. In the first part of our interview with Professor Ojan Assadian we talked about the current state of fighting HAIs and his predicaments regarding the future. In the second part of our interview Professor Assadian elaborates on the increase of antibiotic resistance and the different possibilities healthcare institutions are offered with in their fight against infections.

HARTMANN: How much of a factor is the current increase in antibiotic resistance? We are hearing a lot about this. It poses a significant new threat.

Prof. Assadian: Antibiotic resistance was listed by the World Health Organization as one of the top priority health care challenges in the future. For six decades, antibiotics were simply an outstanding class of medication. But to cut a long story short, we have to admit the overuse and inappropriate use of antibiotics in human healthcare and in many other areas, with significant selection and distribution of antibiotic-resistant bacteria. Wonderful antibiotics like penicillin G, now often cannot be used therapeutically for this reason.

Another problem is the widespread closure of many clinical microbiology labs in Europe and North America over the past decade. To use antibiotics appropriately, ideally you should establish the correct diagnosis first and identify the causative organism. Without knowing the resistance pattern or susceptibility of the causative organism, you have to select an antibiotic empirically. Empirically means: I have absolutely no clue whether this will work or not. Let’s give it a try. And if I am wrong, and I underdose the inappropriate antibiotic, it will induce resistance.

However, we now have new antibiotics with smart mechanisms, for example, a Trojan horse drug such as Cefiderocol, which mimics the molecular structure of iron. Bacteria see it as iron which they need for their metabolism, so they actively take it up. Interestingly, this antibiotic is one of the new classes where market approval is not automatically conjunct to an indication like pulmonary infection or soft-tissue infection. It must be used specifically after identification of the microorganism and establishing susceptibility.

My view: New, smart antibiotics will help with the challenge of antibiotic resistance, but we must also work on making antibiotic susceptibility testing available at the point of care.

Accordingly, there is lots of work to be done in that field and this would suggest, that prevention is key. So, let’s look at managing the issue on a day-to-day basis. In healthcare institutions, who plays the central role in preventing infections and what risk is posed by patient’s visitors?

Actually, in health care institutions, the answer is very, very simple: Everybody who works and cares for the patient has to take part in infection prevention and has to understand what he or she is doing. But, of course, in developing or implementing such strategies, the infection prevention and control teams of hospital facilities play a crucial and important role.

Related to the visitors. When there is an outbreak, staff automatically say it was the visitor; and the visitors say it was staff. And if you ask the bacteria, they would say it was a complicated, yet very favourable process.

There are two things to note regarding visitors. First, in recent years many healthcare facilities have made it standard practice to include visitors in hand hygiene, with visual reminders and easy, regular access to alcohol-based hand rubs. Second, COVID-19 has caused a significant reduction in visitors. And if you ask medical staff, the controlled and reduced flow of hospital visitors has been a big help in reducing HAIs. So maybe in the post-pandemic area, we need to reduce and clarify who may visit and how.

Speaking about prevention, how much of a role can digital support tools play? Is there room for them to make a difference?

A lot. Digital tools can play a role in infection prevention, and also in improving diagnostics and treatment. The infection control teams of the hospitals play a crucial role to assess the usefulness of such tools.

Almost all healthcare facilities have some sort of instruments to analyse the prevalent bacterial spectrum and its resistance. It is not rocket science. But at the other end of the spectrum there are Artificial Intelligence (AI) systems able to guide diagnosis and selection of antibiotics. However, so far I have only seen these AI tools used by individuals, not systematically across organizations. We really have to work on that.

What I personally would like to see is the use of an automatic, AI surveillance method, rather than manual collection of data, patient by patient. This really would change many challenges.

Thank you, Professor Assadian for the interesting exchange.

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