Q&A: What makes pathogen reduction a promising strategy to prevent AMR and HAIs?
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Key takeaways:
- Pathogen reduction lowers the risk of transmitting dangerous pathogens to other patients.
- Examples of pathogen reduction include chlorhexidine bathing and nasal application of mupirocin to reduce S. aureus.
Although nearly all health care facilities have antimicrobial-resistant bacteria, researchers are suggesting that pathogen reduction is a promising way to lessen the threat of transmission and risk of resistance.
In a paper published in Emerging Infectious Diseases, Mihnea R. Mangalea, PhD, a microbial ecologist and bioinformatician in the Division of Healthcare Quality Promotion at CDC’s National Center for Emerging and Zoonotic Infectious Diseases, and colleagues explained that decreasing the number of these bacteria in the human microbiome through pathogen reduction is an emerging strategy to prevent infection and transmission of antimicrobial-resistant health care-associated bacteria.
We spoke with Mangalea about what makes pathogen reduction the best strategy and for examples of pathogen reduction that are feasible for most facilities.
Healio: What makes pathogen reduction a promising strategy to prevent antimicrobial resistance (AMR) and health care-associated infections (HAIs)?
Mangalea: A patient’s microbiome acts like a shield to protect them from infections. Colonization of a microbiome with bacterial pathogens, including those that are multidrug-resistant organisms, often precedes HAIs in vulnerable patients. Receipt of antibiotics for an unrelated infection or prophylaxis allows the pathogen to overrun the microbial community, putting the colonized patient at significantly higher risk of infection.
With pathogen reduction — an ounce of prevention is worth a pound of cure. Pathogen reduction reduces the quantity of a pathogen in the microbiome (e.g., in the intestine or on the skin) of patients to prevent infection. Preventing the infection decreases the need for additional antibiotics.
Moreover, pathogen reduction lowers the risk of transmitting the pathogen to other patients, who could become sick and require antibiotics as well.
Healio: What are some examples of pathogen reduction, and how do they prevent infection?
Mangalea: Pathogen reduction approaches work by decreasing the pathogen burden to stop a pathogen’s progression from colonization to infection.
An excellent example of effective pathogen reduction is chlorhexidine bathing of the body and application of mupirocin to the nose to reduce Staphylococcus aureus. Chlorhexidine is an antiseptic that kills certain microbes, including bacteria; as such, its mechanism of action does not overlap with commonly used antibiotics.
Mupirocin is a topical antimicrobial that kills specific microbes (primarily staphylococci and streptococci) by halting bacterial growth; again, with a mechanism of action distinct from most antibiotics used to treat infections.
Most S. aureus infections arise from previous colonization with the pathogen. Implementing pathogen reduction approaches such as chlorhexidine and mupirocin has been shown to be effective in reducing infections in several large-scale clinical trials.
More importantly, chlorhexidine bathing has been shown to reduce infections with MRSA, as well as dangerous infections from other multidrug-resistant resistant pathogens. We also report on some exciting FDA approvals for treating recurrent Clostridioides difficile infections (CDIs) using fecal microbiota products, indicating that microbiome-based therapies are a promising approach for treating recurrent CDIs.
Healio: What makes a good pathogen-reducing agent?
Mangalea: We highlight the preferred attributes for pathogen reduction in this perspective.
These attributes include limiting the spectrum of activity of the reducing agent to narrowly cover the target organism, limiting the distribution of the reducing agent to a single or selected body site, using different mechanisms of action to avoid cross-resistance, using potent agents to prevent selection of resistant mutations and using stable or reproducible agents such as bacteriophage that can maintain pathogen reduction over longer periods of time.
Lastly, pathogen reduction therapies should spare the human microbiome or aim to restore the beneficial populations of microbes that provide colonization resistance.
References:
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