Drug-Resistant Infections: An Emerging Reality

0:00:01 - Announcer

You are listening to the National University Podcast.

0:00:10 - Kimberly King

Hello, I'm Kimberly King. Welcome to the National University Podcast, where we offer a holistic approach to student support, well-being and success - the whole human education. We put passion into practice by offering accessible, achievable higher education to lifelong learners. Today we are talking about antimicrobial resistance and a really interesting discussion coming up, but according to a recent article in the Lancet, as COVID-19 rages on the pandemic of antimicrobial resistance, AMR continues in the shadows. The toll taken by AMR on patients and their families is largely invisible, but is reflected in prolonged bacterial infections that extend hospital stays and cause needless deaths. Moreover, AMR disproportionately affects poor individuals who have little access to second line, more expensive antibiotics that could work when first line drugs fail- A very interesting topic. As I mentioned, we're going to be speaking with Dr. Barral coming up in just a moment. In today's episode we're discussing AMR, or antimicrobial resistance, and joining us now is at National University's Dr. Ana Maria Barral.

Dr. Barral is an educator and scientist dedicated to demystifying science for diverse audiences, particularly underserved communities. With a PhD in medical cell biology from the University of Linköping, Sweden, and ABSC in microbiochemistry from the University of Havana, Cuba, her extensive academic journey has included laboratory research focused on cancer biology, both in academic and industry settings and a pivot to science education, culminating in over a decade of service as a professor at National University. She's the program director of the associate of science and human biology and coordinator of the non-majors general biology and microbiology courses. Her current research interest focuses on science education research, particularly course-based undergraduate research, experiences for which she's received a National Science Foundation grant. In 2023, she received a National University Teaching Excellence Award and wow, this is so impressive. Congratulations and thank you again. We welcome you to the podcast, Dr. Barral. How are you?

0:02:40 - Doctor Ana Maria Barral

Good, thank you so much for having me. I always love to, you know, chat about my passion, which is science and science education. So I have been part of different aspects of science, from academic research to biotechnology, but it was when I started teaching that I really realized oh, this is how I can make a difference. So I'm excited to be here and I'm very excited to talk about anti-microbial resistance, because this is one of my passions, particularly because it's a very current and very serious public health crisis.

0:03:14 - Kimberly King

Absolutely, I love your passion and it is so relevant right now in today's world that we're in 2024. Today, Doctor, we're talking about anti-microbial resistance, AMR. And what exactly is that? What is AMR? Why is it such a concerning issue?

0:03:31 - Doctor Ana Maria Barral

Anti-microbial resistance- AMR means that microbes- and that can include any kind of microbes, so it could be bacteria, fungi, for example they become resistant to drugs. Now become resistant to drugs. What does that mean? The microbe can acquire resistance, so maybe they were damaged or harmed by a drug. Before you know you were using antibiotic and it could treat a bacterial infection. It worked perfectly fine. But now that bacteria will acquire some way to resist the drug and that can be because of change in the DNA, or sometimes bacteria or microbe can swap resistance elements. So now we have an infection that it was treated perfectly fine with a drug in the past and now we can't. We apply the antibiotic or the antimicrobial drug and it doesn't harm the bacteria or the microbes. So what do we do? So that's why the concern that medical practices have to be shifting continuously to be able to treat an infection that was treatable before.

0:04:43 - Kimberly King

Okay, that's so interesting and we were just saying how relevant it is in today's culture about antibiotics and the resistance. So can you provide some examples of current and then emerging resistant infections?

0:04:58 - Doctor Ana Maria Barral

So the big issue with AMR and antimicrobial resistance is that it's a continuous chase, right? So let's say most people have, or a lot of people have heard about MRSA, which is medicine resistant type of staphylococcus aureus. So staph aureus is a bacterium. That is a very common bacterium existing in the skin, but if it penetrates a wound it can cause very serious infections. And this kind of bacterium, staph aureus, I can usually be treated very easily with penicillin or similar antibiotics. Well, with the appearance of this medicine resistance variant, now MRSA infections are harder to treat. We have, instead of I don't know 25 possible antibiotics, we have only five. Those five may be very expensive or they can only be administered in an optimal setting. So that causes, you know, this difficulty is treating the patients for something that was much easier to treat in the past. Now resistance appears continuously, unfortunately. So every year we have the latest superbug or antibiotic or antimicrobial drug resistant infection. So the current one, the big one in, you know, 2023-2024 is a drug resistant gonorrhea infection.

And there is in public health, there is a concern that sexually transmitted disease incidence has increased quite a bit in the past two years. And then you add to this resistant gonorrhea, so it has become a concern.

0:06:50 - Kimberly King

Wow, what are the potential future scenarios if we don't effectively address AMR?

0:06:57 - Doctor Ana Maria Barral

Well, the nightmare scenario is that we are going to go back to, let's say, the 1800s or 1700s or before. So somebody had a wound that got infected and people could die because there are no antibiotics to treat them, in the sense that there are antibiotics, but they are not effective. I'm sorry that I'm often saying antibiotic and antimicrobial, so antibiotic is people are much more aware of antibiotic resistant infection, but the whole concept and the whole issue is applicable to all kinds of microbes.

0:07:35 - Kimberly King

You know what and that really, I wanted to find out a little bit more about that. So we hear about antibiotic resistance, but is that the same as antimicrobial resistance?

0:07:44 - Doctor Ana Maria Barral

Yeah, thank you for you know, to make it a very precise question.

So, antibiotic resistance is a form of antimicrobial resistance, so infectious diseases can be caused by multiple agents. You know we have viruses, of course everybody knows COVID, flu, RSV is a big one these days, etc. Then we have bacteria, then we have fungi, then we have different parasites. So these are all microbes. But most people are very familiar with bacteria Infections which are treated by any with antibiotics. So that is important I think I'm going to talk about that later at some point that virus or viral infections cannot be treated with antibiotics. Thank you, that was my PSA.

0:08:33 - Kimberly King

Thank you for clarifying all of that. So how does overuse and misuse of antibiotics contribute to the development of AMR?

0:08:43 - Doctor Ana Maria Barral

Well, let's say that you have bacteria or microbes or fungi or whatever out there they are surrounding us, the more they are exposed to antimicrobial drugs, antibiotics, etc. It's almost like selecting the fittest. It's like a training camp. So if you have, let's say, a bacterium in livestock and that livestock is being treated with, you know, low level antibiotics just to make them healthy or whatever, that means that the products from that livestock may contain bacteria that become resistant to antibiotics. So the idea is basically we should only use these drugs, particularly antibiotics, only when they are needed, when they are needed and for the disease that they are sensitive to, not, you know, just because, oh, I have a runny nose and a sore throat, let's throw some antibiotic at it. That's not going to work and actually can make things much worse in the long run.

0:09:57 - Kimberly King

And I'm glad you said that it does feel like there is an antibiotic just for, like a runny nose, like you say you know. So what are some of the real world consequences of AMR for individuals and then as a society at large?

0:10:11 - Doctor Ana Maria Barral

Well, I mean I kind of talked about the nightmare scenario that you know, a patient with a minor wound or a simple infection could have a very serious illness or even die because there is no available drug to treat them. But when you kind of expand it to a societal scale, then it means that-I mean, think about what happened with COVID. You will have hospitals overrun with patients that otherwise could be treated with, you know, simple medications, simple drugs now they may require, and a drug that has to be administered intravenously. You know, in a hospital setting it could be extremely extensive. Or you know again, instead of a two week antibiotic treatment at home they may need to be treated for a month in a hospital setting. So the staggering cost you know, both humanly and also in the economical impact of having those very heavy duty treatments, can be harder in society.

0:11:24 - Kimberly King

I can't even... I mean I can't imagine. We just went through COVID, but what are the researchers and then the public health officials doing to combat AMR? Are they promising new treatments or prevention strategies? What's on the horizon?

0:11:40 - Doctor Ana Maria Barral

Well, I feel like I have this soapbox and I don't want to spend a long time on my soapbox, but basically everybody has to, you know, pitch in. So there are multiple things that can be done, should be done, and some are being done, and some we should do more. So, for example, talking about healthcare professionals, doctors, etc. There is this idea of antibiotic or anti-microbial stewardship, which means educating health professionals on being more focused in prescribing and using drugs for patients. So not just, oh, here's again what you were saying, sore throat, etc. There's a sore throat and let’s throw some antibiotics at it. No, so just using it in a more conservative way. Also, we need better diagnostics to figure out which drug would work for which infection. So very often, let's say, a patient comes in with a clear infection but it may take the clinical lab days to figure out oh, this is this kind of infection, it requires this drug that is going to work. And in the meantime, they will use whatever generic stuff they have just to, basically are just throwing darts at the patient, saying, okay, something that works.

So again, knowledge about application, better diagnostics and, at the larger level- so I'm talking now societal level- that could be, for example, livestock, limiting the use of antibiotics in livestock and even going further now at the global scale. Many of these resistant infections come from poorer areas of the world, so they may not have sanitation or hygiene, et cetera, so the use of antibiotics is much less controlled there, because antibiotics are used almost as a prevention instead of having clean water and sanitation and all that. So again, it's a combination of money funding for extending and improving conditions globally, but also education about the use of antibiotics or drug drugs.

0:14:11 - Kimberly King

I love your passion and, again, you are speaking about things that we don't often necessarily talk about or speak about there, with where this is where it's kind of living, and so I love what you're doing to get the word out. This is great information. We have to take a quick break, but more in just a moment. Don't go away. We'll be right back. And now back to our interview with National University's Dr. Ana Maria Barral, and we're discussing antimicrobial resistance and actually, we were just talking about this in the break, really kind of the difference between antibiotic resistance and antimicrobial resistance. It's easy for me to say AMR, you had a point you wanted to make, Doctor.

0:14:58 - Doctor Ana Maria Barral

Yes, so I was at this conference last October. It's like the clinical microbiology conference in San Diego and somebody was talking - these are clinical microbiology people very dedicated to their work - and they were saying how grateful they were to the TV show The Last of Us. So if you are familiar, it's a video game but it was adapted to a TV show and it talks about- It's about this terrible fungal infection that makes people zombies, but in it's just the awareness. So a lot of people were not aware that fungi can cause very serious infections and the scientists were saying, showing slides of the screenshots from the show, I was like we are so grateful for that show because now people ask us about these kinds of infections and indeed, they exist. They may not be as known and as extensive as bacterial or viral infection, but they tend to be serious and more difficult to treat in general.

0:16:09 - Kimberly King

That's great. I like that you brought that, you tie that in, and I didn't realize that it started out as a game first and then it became a movie. So The Last of Us, that's what it was called? Interesting. So what role does education and awareness play in preventing the spread of AMR? That was a perfect lead in, by the way.

0:16:29 - Doctor Ana Maria Barral

Yeah, everybody should know about this because it touches so many facets of life and of course, it's easy to say well, health professionals, doctors, nurses, etc. Or laboratory scientists. But people can do choices in their lives that can contribute to a decrease of AMR, and we have talked about livestock or decreasing meat consumption, that kind of thing that these are all, or buying, let's say, meat from farms that don't use antibiotics, you know, grass fed and antibiotic free, etc. So those are lifestyle choices that people can do. And also when I would say that every patient they are not doctors, they are not health professionals, but they should ask questions when they have a prescription for a drug. Like why is this drug prescribed Is this, you know, not questioning the doctor by just learning about why are they doing that? And just learning about the options.

And also, very important, following the instruction, because one reason why an antibiotic resistant can appear if the patients you know takes the drug three days, four days, I'm feeling better, I don't have to keep taking the medication, which means that if there is one of those microbes that are not dead yet, they may be the beginning of a new antibiotic resistant or antimicrobial drug resistant strain. So it's really important to basically let them die off. Take those 10 days, two weeks of drug that is required so your system is completely wiped out. So we don't give any survivors a chance to expand. But for when one threat resistant appears, it can spread extremely easily.

0:18:40 - Kimberly King

That's great knowledge to know, and often you know we do get them for five to seven days or beyond, and you know, I’m feeling better. So thank you for even explaining that part of it, that there could be some that are holding on and trying to infect, continuing, so thank you. So how can we ensure equitable access to effective diagnostics and treatments for AMR infections globally?

0:19:06 - Doctor Ana Maria Barral

So let me give you an example- how these antibiotic resistant or antimicrobial resistant infections come up, and this is not always the case, but it's very commonly the case. So let's say we are looking at a country that has less developed health care, sanitation, you know. You know hospital conditions, etc. So we have a traveler who either has an accident, a disease, or we have, you know people who go have plastic surgery abroad, it’s cheaper, and then they acquire an infection that over there, in some other country, which is resistant to a drug, and they come back and then it spreads like wildfire. And you know the CDC and all kinds of public health agencies track how this happens. And you see how patient zero arriving to you know one city and then in the next months you have 10 people, 20 people, and then within a year it has turned to the whole country.

So that's why it's so important to address AMR at a global level. So we should really throw money, invest heavily globally- health care system, you know, sanitation, basic infrastructure, clean water, that kind of stuff- but also surveillance, infection control and all kinds of agreements at an international level. And I'm not going to go into economics because that's not my forte, but I do understand that money can be a big issue when either developing or distributing medications to all over the world. So that would require people to think about the world as one instead of a way to make profit from a certain drug.

0:21:17 - Kimberly King

You know it's such a good point about globally and sometimes it is in our own backyard. I just am thinking to be very relevant. You know, with all the rains here in Southern California and the flooding and everything and people have, you know they're out of their homes just because of the way the infrastructure is, so it really does make, you know, cause awareness here in our own backyard and then you think about globally. So, yeah, that's something we really do need to continue to think about. Doctor, how can we incentivize pharmaceutical companies to invest in developing new antibiotics?

0:21:55 - Doctor Ana Maria Barral

Well, I'm going to be very honest with you. I don't know if that is possible except just throwing money at them. So, the problem with you know pharma companies and antimicrobial drugs is that developing a drug is always expensive. You have to do all kinds of tests first. You know chemistry, then you have to do animal tests and then you have to test for toxicity. So it really takes years and approvals, and so it's a big money investment. So if you do that investment for a cancer drug or a drug that lowers blood pressure or treats, I don't know, depression, et cetera.

That means that those are chronic conditions. So the patients are going to take those drugs for years and years, and years and years. When you think about infectious diseases, we are looking at the way it's going to be, and then the patient hopefully gets better and then that's it. It's an acute- tends to be acute infections. So they look at their you know their balance sheet and say, well, is it worth for us to even spend money in this drug that is going to be- it’s not going to provide the same problem. So sorry about that, but I don't know that, besides guaranteeing them like okay, we are going to order from you millions of doses of this thing or we are going to provide you from you.

Good news, is there are alternatives. So right, actually this week or last week there was an article in a very well-known scientific publication called Nature about two, not one, but two anti. One was against the gonorrhea, like I was telling about that antibiotic.

0:23:52 - Kimberly King

Right.

0:23:53 - Doctor Ana Maria Barral

I forgot what it was, but two new anti-microbial drugs that were developed by nonprofits. Well, thank you. So I mean they started as drug candidates from companies but the nonprofit organizations took it and you know they got some funding as nonprofits but they developed the drugs and they are addressing to a resistant infection. So you know, the article was saying well, maybe this is a way out, or one of the ways out to develop new drugs, and the other I will talk to you a little bit later and it has to do with how students can help with that. But there are also some, you know, other approaches, and one that is not directly related to drugs is for the phage therapy. It's basically finding viruses that kill that area, for example. But yeah, I don't personally I don't hold high hopes of pharma companies. You know, changing their tune anytime soon.

0:25:07 - Kimberly King

Wow. Can you explain what role does technology play in tackling AMR? And then also what are some exciting innovations on the horizon? We've talked a little bit, but what about, from the technical side of things, technology?

0:25:19 - Doctor Ana Maria Barral

Well, everybody's talking about artificial intelligence.

0:25:22 - Kimberly King

Yeah.

0:25:24 - Doctor Ana Maria Barral

So AI has this power of you know, taking huge amount of data and make sense out of it. And one of the, let's say, harder parts of drug development is what kind of drug we design. You know, because these days, not like, you are going to a plant and trying to extract something that works- it’s kind of designing, okay, what kind of drug chemically would work for this kind of disease. Well, AI, put you know, went over this huge amount of data. I think it goes to MIT, one of the big name institutions, and they suggested a chemical structure for a normal antibiotic class. So this is something that doesn't exist. They just said, based on the data, we think that if we design something like this, it's going to work for this specific kind of infection. So the use of AI may actually shorten the time they were talking about shortening drug development by six, seven years.

0:26:40 - Kimberly King

Wow.

0:26:41 - Doctor Ana Maria Barral

With this because instead of just trying and testing, and trying and testing, they could say, okay, we are going to try this. So that is a one very exciting development. But the latest I don't know.

0:26:57 - Kimberly King

Yeah, I can't imagine it now. I mean, ai is here and people are jumping on it, but I guess it's just a matter of making sure and really editing everything before you move forward. Can you tell us about Tiny Earth and how National University students are contributing to this global knowledge, and about possible new antimicrobials?

0:27:20 - Doctor Ana Maria Barral

Oh I, can't wait to tell you about it. Long story short and I kind of what I was telling you before, that the development of drugs requires time because the companies, the scientists, have to test many, many, many, many, many candidates to figure out okay, this is worthy. So Tiny Earth is an educational project that is housed in the University of Wisconsin Medicine and she was started by a very famous, very known microbiologist, Dr. Jo Handelsman.

And her idea was to combine scientific teaching like how to make teaching of science more relevant or engaging or interesting with this real life problem, and what it means is that students, college students or even some high school students would take samples mostly soil samples in their environment and they would isolate antibiotics and they would test them against you know, it's a panel of bacteria to you know, to test if they are efficient, and then those best candidates would be sent to the University of Wisconsin-Madison, which has this huge, you know, it's a very highly regarded university. They have a chemistry hub and all kinds of instrumentation and the manpower and the knowledge to analyze and to filter through all those candidates to find interesting candidates. So, basically, funnel a large number of possible drug candidates into this pipeline and I believe they already have like, I don't know if it's less than 10, but I don't remember if it's like six or eight candidates that are kind of ready soon to be tested, to take an over by a company a company to do this. You know, more advanced testing. But I love talking about this because National University has been part of this initiative since 2013.

We were one of the first partners in this initiative and just last year we implemented this process, which, again it's a research project to all microbiology courses at National University, to all the students who take microbiology and those are most recreate, nursing, pre-alliant health, pre-public health, etc. students. They will do a hands-on antibiotic discovery project, and this is from their samples. They can go to the backyard and take soil from the backyard and analyze it. So I think it's just very exciting. Really, microbiology classes have changed since we had implemented this and, needless to say, as part of the course and you know we explain everything how it happened there is also a much higher awareness of the crisis and any biotech business interaction and any biotech stewardship and all that. So many of our students are already working in the health care field and they say, wow, I didn't know this. It's so good for me to understand how this happened. So, anyway, it's one of my favorite projects.

0:31:10 - Kimberly King

What a great way you can tell that you're so passionate, but also for the students to have that ownership into this whole contribution. So thank you. Is there anything else you'd like to add before we wrap?

0:31:27 - Doctor Ana Maria Barral

I just want to thank you once more for the opportunity to talk about this and to enhance the awareness of the topic, and every November so there is a global anti-microbial resistant awareness week in November kind of events and all that. So anybody who's interested to learn more, I recommend that around November, just check out our team, social media, different news organizations, because there is a lot of information broadcast about it.

0:32:01 - Kimberly King

Oh great. Good. Well, we'll definitely have to check back in with you in November, but in the meantime, we appreciate you sharing your knowledge and your passion, and if you want more information, you can visit National University's website at nu.edu. And again, doctor, thank you so much for your time. You've been listening to the National University podcast. For updates on future or past guests, visit us at nu.edu. You can also follow us on social media. Thanks for listening.