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Release: Immediate

UI Iowa medical centers collaborate in statewide surveillance of common bacteria

IOWA CITY, Iowa -- Everyone knows that many bacteria are developing resistance to antibiotics, and the emergence of a "superbug" resistant to all treatment is a real possibility. What they may not know is that July 1, University of Iowa researchers and 16 Iowa medical centers launched the first-ever statewide effort to prevent the superbug from becoming a reality.

UI professors of pathology, Gary Doern, Ph.D., Ronald Jones, M.D., and Michael Pfaller, M.D., designed and implemented a project to track the emergence of antibacterial resistance in nine bacteria in Iowa that are acquired either in the hospital or community. The investigators will also determine which drugs most effectively fight the infections caused by these bacteria.

During the five-year study, titled Emerging Infections and the Epidemiology of Iowa Organisms: A Prospective, Statewide, Longitudinal Surveillance Study of Antimicrobial Resistance, the UI researchers will keep a database of bacteria samples collected from the participating medical centers (see attached). In order to get the most accurate picture of the situation in Iowa, the UI investigators elected to solicit samples from the most highly populated regions of the state. Once the investigators decided which areas of Iowa they wanted to study, they selected individual medical centers that would provide bacteria samples from a broad cross-section of the population including the young, old, chronically and acutely ill.

According to Doern, director of the project, the researchers don't know of any existing bacterial hot spots in the state, but tracking at the state level has never been done before. Actual facts and figures are necessary before significant steps can be taken to solve the problem of antibiotic resistance.

"Frankly, we are behind the eight ball with regard to surveillance in this country," Doern said. "We know we have a problem, but how can you create innovative solutions without data?"

There are four primary objectives to this study, Doern said:
1) To determine the magnitude and scope of antibiotic resistance in Iowa.
2) To measure the changes in resistance over the long term.
3) Identify appropriate solutions to the problem.
4) Implement those solutions.

Doern believes that prevention is the most effective way to control the spread of antibiotic-resistant bacteria. Few new antibiotics are on the horizon, and the uses of antibiotics themselves are part of the problem, he said.

Bacteria "learn" to resist drugs in a very Darwinian survival-of-the-fittest fashion. They reproduce themselves about every 20 minutes. Several mutations are certain to occur with such a frequent rate of cell division, and some of those mutations are likely to protect the bug from a particular antibiotic. Only a few bacteria may have developed protection against a drug, but they will survive treatment to become the dominant species and pass from person to person. In this way, the more antibiotics a bacteria is exposed to, the more likely it is to develop resistance to a wide spectrum of drugs.

It is important for the "bacteria trackers" to know if antibiotic-resistant microbes are previously mutated bacteria that are being passed on to others, or if they represent newly developed protective mutations. This knowledge will help scientists distinguish between a problem in controlling the spread of the bacteria and a problem resulting from exposure to antibiotics -- a crucial piece of information for determining the next step toward a solution. One of the procedures used in the UI study will permit this distinction to be made.

"Problems can be identified almost as quickly as the samples arrive and reported back to the institution," Doern said. "In addition, information on antibiotic resistance at each center will be reported to them on a yearly basis along with the state average. This will allow institutional bench marking." The figures for individual institutions will be confidential; however, the yearly state averages will be available to the public.

"This is the first systematic statewide surveillance project of this sort in the country. It is our hope that it may serve as a model for other programs," Doern said. "There is no reason every state can't conduct surveillance studies such as this one. It clearly needs to be done."

Bacteria tracked in the study and some of the most common infections caused by them:
E. Coli -- urinary tract infections, diarrhea
Klebsiella pneumoniae -- pneumonia, urinary tract infections
Enterobacter cloacae -- general systemic infections -- primarily acquired in hospitals
Pseudomonas aeruginosa -- general systemic infection
Staphylococcus aureus -- skin infections
Streptococcus pneumoniae -- otitis media, sinusitis, bronchitis, pneumonia, meningitis
Enterooccus species -- gastrointestinal disturbance, sepsis
Haemophilus influnzae -- otitis media, sinusitis, bronchitis, pneumonia
Yeast (blood stream only) -- systemic infections

Participating medical centers:
Burlington Burlington Medical Center
Cedar Rapids St. Luke's Hospital
Clinton Samaritan Health Systems
Council Bluffs Jennie Edmundson Memorial Hospital
Des Monies Iowa Methodist Medical Center, Mercy Hospital, Veterans Affairs Medical Center
Dubuque Cathedral Square
Fort Dodge Trinity Regional Hospital
Iowa City UI Hospitals and Clinics and the VA Medical Center
Mason City North Iowa Mercy Health Center
Ottumwa Ottumwa Regional Health Center
Quad Cities Genesis Medical Center Moline Metropolitan Lab
Sioux City St. Luke's Regional Medical Center
Spencer Spencer Municipal Hospital
Waterloo Allen Memorial Hospital