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The Struggle against Superbugs: Combating Antimicrobial Resistance in the Clinic and the Community

The Struggle against Superbugs
Reported by
Kathleen McGowan

Posted August 27, 2007

Presented By

Presented by The Center for Interdisciplinary Research to Reduce Antimicrobial Resistance (CIRAR), Columbia University, and the New York Academy of Sciences


Powerful antibiotics that control or eliminate bacterial infections are one of the true marvels of modern medicine, but their remarkable power is under threat. Drug-resistant strains of infectious bacteria are widespread and becoming increasingly common. This emerging menace was the subject of a June 21, 2007, meeting at the Academy.

Sara Cosgrove of Johns Hopkins University School of Medicine began by discussing projects that Johns Hopkins and other hospitals have adopted to control antimicrobial resistance at the institutional level. Kitty Corbett of Simon Fraser University presented a detailed example of an attempt to curb antimicrobial resistance at the community level—a recent mass media campaign in Colorado that successfully reduced antibiotic use citywide for acute respiratory infections. Past President of the Infectious Disease Society of America Martin Blaser talked about this issue from the policymaking perspective, describing the IDSA's efforts to put this problem on the national agenda.

Web Sites

Center for Interdisciplinary Research on Antimicrobial Resistance
The Web site of this program of the Columbia University Medical Center includes background information on the success of previous interventions to reduce antimicrobial resistance, as well as notes from presentations given on such subjects as infections in the neonatal intensive care unit (PDF, 844 kB) and modeling the spread of resistance (PDF, 217 kB).

Association of Professionals in Infection Control and Epidemiology
Read reports detailing the prevalence of drug-resistant staph in hospitals and estimating the cost of healthcare-associated infections (PDF, 3.23 MB). The Web site also provides links to a range of guidelines for infection control and isolation procedures.

Centers for Disease Control
Basic and technical information about combating drug resistance can be found at the CDC's Antibiotic and Antimicrobial Resistance site, including basic information on methicillin-resistant Staphylococcus aureus and profiles of other antimicrobial-resistant organisms. The site also indexes CDC surveillance reports about specific drug-resistant pathogens.

Infectious Diseases Society of America
Browse to access a range of policy-related information on antimicrobial resistance: extensively drug-resistant tuberculosis (PDF 43.6 KB), the use of antibiotics in agriculture (PDF 33.5 KB), and recommended procedures (PDF, 34.3 KB) to limit the spread of antimicrobial resistance. The most comprehensive resource is the 2004 white paper "Bad Bugs, No Drugs," including patient stories. Also see the Strategies to Address Antimicrobial Resistance Act, legislation introduced to Congress on September 27, 2007.

National Institute of Allergy and Infectious Disease
This Web site includes information on past and present Annual Conferences on Antimicrobial Resistance, as well as reports such as the Summit on the State of Anti-Infective Development (PDF, 89.5 KB).

Virtual Museum of Bacteria
A wealth of information about bacteria, including a "species filing cabinet" that includes images, fact sheets, and consumer guides for a range of common pathogens.

Journal Articles

Strategies to Reduce Antibiotic Resistance in Healthcare Settings

Cosgrove SE. 2006. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin. Infect. Dis. 42: S82-9.

Cosgrove SE, Patel A, Song X, et al. 2007. Impact of different methods of feedback to clinicians after postprescription antimicrobial review based on the Centers For Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults. Infect. Control Hosp. Epidemiol. 28: 641-646.

Cosgrove SE, Qi Y, Kaye KS, et al. 2005. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp. Epidemiol. 26: 166-174.

Improving Antibiotic Use in Diverse Communities

Corbett KK, Gonzales R, Leeman-Castillo BA, et al. 2005. Appropriate antibiotic use: variation in knowledge and awareness by Hispanic ethnicity and language. Prev. Med. 40: 162-169.

Gonzales R, Corbett KK, Leeman-Castillo BA, et al. 2005. The "minimizing antibiotic resistance in Colorado" project: impact of patient education in improving antibiotic use in private office practices. Health Serv. Res. 40: 101-116. Full Text

Harris RH, MacKenzie TD, Leeman-Castillo B, et al. 2003. Optimizing antibiotic prescribing for acute respiratory tract infections in an urban urgent care clinic. J. Intern. Med. 18: 326-334. Full Text

Articles by panelists

Aboelela SW, Larson E, Bakken S, et al. 2007. Defining interdisciplinary research: conclusions from a critical review of the literature. Health Serv. Res. 42 (1 Pt 1): 329-46.

Aboelela SW, Saiman L, Stone P, et al. 2006. Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature. Am. J. Infect. Control 34: 484-494.

Aboelela SW, Stone PW, Larson EL. 2007. Effectiveness of bundled behavioural interventions to control healthcare-associated infections: a systematic review of the literature. J. Hosp. Infect. 66: 101-108.

Larson EL, Saiman L, Haas J, et al. 2005. Perspectives on antimicrobial resistance: establishing an interdisciplinary research approach. Am. J. Infect. Control 33: 410-418.

Moreno-John G, Fleming C, Ford ME, et al. 2007. Mentoring in community-based participatory research: the RCMAR experience. Ethn. Dis. 17: S33-S43.

Patel SJ, Larson EL, Kubin CJ, Saiman L. 2007. A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations. Pediatr. Infect. Dis. J. 26: 531-537.


Sara E. Cosgrove, MD, MS

Johns Hopkins University School of Medicine
e-mail | web site | publications

Sara E. Cosgrove is an assistant professor of medicine in the Division of Infectious Diseases at Johns Hopkins University School of Medicine. She also directs the antibiotic management program and is an associate hospital epidemiologist at The Johns Hopkins Hospital. Her research investigates the epidemiology and outcomes of antimicrobial resistance in the hospital setting, develops tools and programs to promote the rational use of antibiotics and prevent hospital-acquired infections. She works to develop tools and programs to encourage the safe and rational use of antimicrobial drugs.

Cosgrove received her undergraduate degree from Columbia College, her medical degree from Baylor College of Medicine in Houston, Texas, and her master of science degree in epidemiology from Harvard School of Public Health. She completed her postgraduate training in internal medicine at The Johns Hopkins Hospital and underwent subsequent training in infectious disease at Beth Israel Deaconess Medical Center in Boston.

Kitty Corbett, PhD

Simon Fraser University
e-mail | web site | publications

Kitty Corbett is a medical anthropologist and director of undergraduate programs at the Faculty of Health Sciences at Simon Fraser University in British Columbia. Her research includes studying patterns of community-based antibiotic use in North America and beyond, as well as developing effective campaigns of public outreach around this subject. In Colorado, she directed the media design and implementation of a health communication campaign that reduced inappropriate prescriptions of antibiotics for acute respiratory infections. Corbett has also worked with the Centers for Disease Control on a national campaign to reduce antibiotic use.

Corbett received her PhD in medical anthropology from the University of California at Berkeley in 1986. From 1987 to 1991 she was a research scientist in the division of research of Kaiser Permanente Medical Care in California, and from there moved to the University of Colorado at Denver, where she was a professor in the Health and Behavioral Sciences program and in the Anthropology Department. She joined Simon Fraser University in 2005.

Martin J. Blaser, MD

New York University School of Medicine
e-mail | web site | publications

Martin Blaser is the Frederick H. King Professor and chair of the Department of Medicine at New York University School of Medicine, as well as professor of microbiology at that school. He is former president of the Infectious Diseases Society of America and a member of the organization's executive committee. He also serves on the board of directors of the National Foundation for Infectious Diseases and is the founder of the Virtual Museum of Bacteria. He is widely known for his research into Helicobacter pylori and other organisms in the human digestive tract, the co-evolution of humans and microbes, and the potential role of microbes in immune system dysfunction and cancer.

Blaser received his MD from NYU in 1973, followed by a fellowship in infectious diseases at the University of Colorado Medical Center. From 1979 to 1981 he was an Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention.

He received the Squibb award from the Infectious Diseases Society of America in 1992.

Kathleen McGowan

Kathleen McGowan is a freelance magazine writer specializing in science and medicine.