March 1, 2008

NIAID Resistance Research Agenda, Shortcomings Highlighted in JID

The National Institute of Allergy and Infectious Diseases (NIAID) has outlined its priorities for research into antimicrobial resistance and antimicrobial research in an article in the April 15 issue of The Journal of Infectious Diseases (JID). An accompanying commentary questions whether NIAID’s agenda is focused on the right pathogens or the right questions.

NIAID currently spends $800 million per year in antimicrobial research, according to the article, co-authored by NIAID Director Anthony S. Fauci, MD, FIDSA. That includes $200 million annually in research to better understand the causes, consequences, and treatments of drug resistance.

The article says NIAID has taken a multi-faceted approach to addressing resistance by funding research, partnering with public and private agencies, and creating a flexible infrastructure to respond to emerging needs. NIAID funding currently supports several key areas, including:

  • Developing rapid, more sensitive and specific diagnostic tests for invasive bacterial infections
  • Determining doses that balance the effectiveness of a drug with its toxicity
  • Studying the structure and physiology of bacterial biofilms to prevent or disrupt their formation

NIAID wrote the article in part to respond to IDSA inquiries about the institute’s resistance research agenda. Antimicrobial resistance is one of IDSA’s key issues and is the subject of the Society’s ongoing “Bad Bugs, No Drugs” campaign.

As part of that campaign, IDSA has identified several resistant pathogens for which antimicrobial research is gravely lacking. In the editorial commentary accompanying the NIAID article, Louis B. Rice, MD, chief of medical service at Louis Stokes Cleveland VA Medical Center and chair of IDSA’s Research on Resistance Work Group, picked up on that theme. He named six antibiotic-resistant bacteria that have become dominant pathogens in health care settings around the world, which he called “the ESKAPE bugs”:

  • Enterococcus faecium
  • Staphylococcus aureus
  • Klebsiella pneumoniae
  • Acinetobacter baumanni
  • Pseudomonas aeruginosa
  • Enterobacter species

Dr. Rice said research into these pathogens is especially important because lessons learned studying them “could be applied to virtually any species that attempts to take their place.”

But it is difficult to tell how much of NIAID’s $800 million budget for antimicrobial research is dedicated to these key pathogens because the funding is spread out across antivirals (including HIV), antibiotics (including tuberculosis), antiparasitics (including malaria), and antifungals, and also includes prevention and vaccine research.

Dr. Rice noted that even after nearly eight decades of use, some of the most basic research questions about antibacterial therapy remain. “For most bacterial infections, minimal lengths of treatment have never been defined,” he said. “The benefit of antimicrobial therapy over placebo for many common infections (such as otitis media or sinusitis) remains murky. The use of combinations of antibiotics is widespread, without conclusive evidence of benefit in most circumstances.” Much more needs to be learned about basic infection-control measures, he added, as well as the best ways to effectively disseminate them.

Following discussions with IDSA leaders, an NIAID advisory council has endorsed in concept clinical trials to answer some of these questions. Furthermore, the IDSA-endorsed Strategies to Address Antimicrobial Resistance (STAAR) Act, a bill currently under consideration in Congress, would strengthen federal coordination of surveillance, prevention, and control, and research activities. IDSA also is advocating for an increase of $100 million in 2009 for clinical research into antimicrobial resistance research at NIAID.

IDSA has mobilized more than a dozen key medical, public health and healthcare organizations to endorse the STAAR Act.  See the coalition’s recent letter to Congress.

Stay tuned for updates on these and other important developments in antimicrobial resistance research.

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