Amanda Wilde (Host): Superbugs are a supersized dilemma. Stay tuned for a deep dive into the facts about antibiotic resistant infections or superbugs with Christopher Whitman, Antimicrobial Stewardship Clinical Pharmacy Specialist at Infirmary Health. Welcome to Lifecast, the podcast from Infirmary Health. I'm Amanda Wilde.

 Chris, thank you so much for being here to talk about superbugs.

Christopher Whitman, PharmD: Thank you for having me, Amanda.

Host: You are an Antimicrobial Stewardship Pharmacist. Can you unpack that title for us?

Christopher Whitman, PharmD: Yes, I love this question, and I could probably spend the entire podcast trying to answer this, but our day-to-day activities vary significantly. But ultimately, an Antimicrobial Stewardship Pharmacist facilitates the safe and appropriate use of antimicrobial drugs. So this includes antibacterial, antifungals, antivirals, even anti-parasitic medications. So the job of an Antimicrobial Stewardship Pharmacist is complex. It involves drug information, leadership, project management, education, that's education to our providers, nursing staff, to patients, patients' families. It involves research, lab use evaluations, medication use evaluations, and much more. So, I'm a team of four. So we have four Antimicrobial Stewardship Pharmacists here at Infirmary Health.

Host: I thought that title sounded really specialized, but it sounds like you have to have expertise in lots of areas. How do you look at superbugs?

Christopher Whitman, PharmD: So superbugs, that's just a label for germs like bacteria, viruses, fungi that have developed the ability to essentially defeat modern medicine. They're tiny enough to escape and don't really have respect for geographic borders. They can hitch a ride on anyone and travel anywhere around the globe.

So some common examples of these are big words like methicillin resistant staphylococcus Aureus, also known as MRSA or MRSA. Others in the news lately, have been a drug resistant or super bug gonorrhea. There are even a drug resistant fungus known as Candida auris.

Host: So how do we treat superbugs?

Christopher Whitman, PharmD: So the superbugs it's the same initial bug, e coli, and again, it's just developed those resistance mechanisms. So the common antibiotics like penicillin that we used to use, we have to use novel, newer antimicrobials in there. And, as this prevalence increases, we're starting to encounter some of these superbugs that are resistant to almost all of our common antibiotics where we have to kind of step outside of the box and some of these only IV antibiotics can be utilized.

Host: So this is how we work to stop resistance.

Christopher Whitman, PharmD: So to stop resistance, that's multifactorial. So careful and appropriate use of antibiotics there. Making sure that we're using the appropriate antibiotics. When we have viruses such as the common cold, COVID or the flu, we need to limit antibiotics there, cause again, antibiotics are used to fight, they're antibacterial. They're not used for viruses there. So anytime that we are exposed to just one single dose of an antibiotic, we're potentiating their resistance. So, according to estimates from the CDC, more than half of the antibiotics used in the US that are prescribed, are unnecessarily or used improperly. There as well, that helps stop resistance. We want to use antibiotics for the shortest appropriate duration of therapy. So even our common infections that used to be treated for seven or 14 days, our UTIs; there's data out there now showing that we only need three days of antibiotic exposure. Cause for every excess day of antimicrobial exposure, we're just at a higher risk of developing antimicrobial resistance now.

Host: Which results from overuse of antibiotics, and then these bacteria get to mutate and that's how the bacterial resistance develops, if I'm understanding correctly.

Christopher Whitman, PharmD: Yes, ma'am. And we want to use the most narrow and targeted antibiotic as possible. As we develop these new antibiotics that cover these multi-drug resistant organisms or superbugs, we don't want to use those for a simple infection that is susceptible to our penicillin. We want to narrow down and use a, a targeted therapy there.

Host: So how big of an issue is this, the impact of superbugs?

Christopher Whitman, PharmD: So without effective antibiotics, the run of the mill skin infection or urinary tract infection, may become life-threatening within days. One of my favorite statistics is looking at penicillin. It was discovered roughly in the late 1920s, I believe, 1928. So in just under a hundred years, antibiotics have changed modern medicine really, and helped extend the average human lifespan by almost 23 years. So just showing how those common infections without antibiotics can really impact the lifespan. The World Health Organization and CDC consider antibiotic resistance to be one of the greatest global health threats that we have today.

Even the Presidential Advisory Council on combating antibiotic resistance bacteria was formed. I know in the last President's annual budget, it did include a significant amount of funding there to address antimicrobial resistance as well.

Host: So superbugs are having a worldwide impact. What is the prevalence of superbugs in Alabama and the US compared to worldwide?

Christopher Whitman, PharmD: Yes, it is having a huge impact cause you may not necessarily see it a hundred percent day to day there, but for our children and future generations there, the antibiotics we're using now, at the track we're going, we may not have any antibiotics left. So nearly 3 million people across the US each year face antibiotic resistant infections each year as reported by the CDC. Here locally in South Alabama at Infirmary Health; looking over the last five years, we have seen an increase in multi-drug resistance. Carbapenems are one of our biggest class of antibiotics. One example here is meropenem. And this used to be one of the quote unquote big gun antibiotics. And we're seeing a lot more infections that are carbapenem resistant throughout, not only South Alabama, but throughout the US as well.

 So the same antibiotics that we could use five years ago to treat simple urinary tract infections, such as our fluoroquinolones, like levofloxacin, ciprofloxacin. Now, those only work about 40 or 50% of the time here, specifically, in South Alabama.

Host: Wow, those are rapid changes. Are there any new antibiotics in the pipeline to treat infections caused by the superbugs?

Christopher Whitman, PharmD: Yes. So again, our first antibiotics started in late 1920s, and it really wasn't until late 1960s that we first started developing true antimicrobial resistance. That was with our penicillin resistant strep was first identified. Then in 2015, we released one of the first novel antibiotics to treat these multi-drug resistant gram-negative infections. It was a big lull of new antibiotics. But just in that same year that we released this new antibiotic, which was known as AVYCAZ or ceftazidime and avibactam, that same year, there was already a strain of bacteria that emerged resistance to this new antibiotic. So even as we come out with new antibiotics, the bacteria are fighting and emerging resistance there.

So there are a few antibiotics in the pipeline. Just again, the CDC experts, you know have warned that the current pipeline of our new antibiotics in development is not sufficient enough to meet the current resistance threat that we have out there today. So they are increasing funding there.

So just extremely important for us to use what we have now, in an appropriate manner because the resistance can be turned around. There has been data showing that you know, as we decrease our broad spectrum antimicrobial use, we can also decrease our overall resistance.

Host: Ah, so not only do we have to look at inventing new drugs, but as we decrease our use of the ones we know, they may become more effective.

Christopher Whitman, PharmD: Yes, ma'am.

Host: That's great information. Thank you so much for the 411 on superbugs.

Christopher Whitman, PharmD: Awesome. Thank you, Amanda.

Host: That was Dr. Christopher Whitman Antimicrobial Stewardship Clinical Pharmacy Specialist at Infirmary Health. For more information, visit infirmaryhealth.org. And if you enjoyed this podcast, please share on your social media. This is Lifecast, the podcast from Infirmary Health.

I'm Amanda Wilde, and we'll talk again next time.