One of the greatest challenges we face in medicine is the judicious management of our armamentarium of antibiotics as we confront resistant microbes in our community. There continues to be debate in the literature regarding the ultimate best strategy for deciding which antibiotic, by pathogen, one should use now versus a year from now when resistance profiles may have migrated.
The Black Canyon Forecasting Station recently operationalized over 250 pathogen-antibiotic forecast lines for one of our client hospitals. The major challenge of the hospital is how to manage its antibioitic armamentarium with an eye towards the future. In other words, "when will we lose the ability to use a given antibiotic for a given pathogen, and based on this knowledge, should we continue to use it?" Sometimes it's best to holster that "weapon" until a later time when it might be the only option left to you as a physician.
This is a key question from a variety of perspectives- pharmaceutical supply & demand, temporal and financial cost to develop new antibiotics, and patient treatment costs, among many others. What was interesting to us was the disparity between guidance from The Sanford Guide To Antimicrobial Therapy 2011, Epocrates, and current reality in this particular hospital. With antibiotic resistance forecasting now a part of the analysis, these disparities become even more poignant. An example is Pseudomonas aeroginosa, which is horribly resistant to multiple antibiotics, and the forecasts are dismal.
Wiesch et al recently published a nice review of "Population Biological Principles of Drug-Resistance Evolution in Infectious Diseases" (see attached), which reminds us of
The emergence of resistant pathogens in response to selection pressure by drugs and their possible disappearance when drug use is discontinued are evolutionary processes common to many pathogens.
Constant forecasting and real-time monitoring of drug resistance may be our best defense given the research, development, and distribution of new antibiotics is not keeping up with the global problem of resistance.
For those willing to take a leap from reality, look to the Star Trek-themed "frequency-modulated shielding" of a starship (i.e. hospital). A bit of silliness, but a highly relevant analogy when considering the very real threat of encroaching drug-resistant bacteria and the reality of a too-slowly evolving antibiotic armamentarium.
As the Black Canyon Forecasting Station brings this new forecasting capability on-line at the hospital, we note this may be the first time this has ever been attempted...