URI microbiologist hopes to demystify scary topic of antimicrobial resistance

URI class this fall on antimicrobial resistance as a global public health threat.

Kristen Curry

The bacterium Pseuodomonas aeruginosa is multi-drug
resistant, meaning there are few options to treat
infections caused by this pathogen.

Neil Greene’s fall seminar in the University of Rhode Island’s Honors Program is not for the squeamish, or hypochondria-inclined. A collection of students from across the Kingston Campus are gathering in Lippitt Hall weekly to think about a big issue that starts small, considering microbes and what they mean in our world.

Antimicrobial resistance (AMR) endangers global public health and jeopardizes advancements in modern medicine made over the past few decades. There are different ways microbes become resistant to antimicrobial drugs, and numerous factors contribute to the rate at which resistant microbes grow and spread.

Greene, a URI cell and molecular biology professor, is leading a course on the topic this fall, helping students from diverse disciplines better understand the pressing health issue. They’ll make presentations on “superbugs” right around Halloween, which might be appropriate—such disease-causing organisms can indeed be terrifying. In addition, they will brainstorm innovative, interdisciplinary strategies for how to address this problem.

Scary costume ideas aside, Greene says he hopes to reach a wide audience on the topic, to make more people aware of a complex issue.

“It warrants awareness and education,” he says.

Our post-antimicrobial world

Antimicrobial resistance occurs when pathogenic microbes (such as bacteria, viruses, and fungi) are no longer susceptible to drugs (such as antibiotics, antivirals, antifungals) used to control their growth.

“We often hear about the nightmare scenarios and there are causes for concern, but I want to take the optimist’s view,” he says. “My hope is to talk about microbiology and put it under a microscope for us to better understand drivers of risk and how we as a society are using antimicrobials in appropriate medical settings and how we can avoid overuse. I hope students leave the class looking at the world a little differently and begin to talk about these issues with others.”

Greene has also lined up several guest speakers for the course, including Ph.D. students Michelle Marder and Kate Remy ’24, on using antibiotics to study the bacterial ribosome and treatments for urinary tract infections caused by E. coli; Thomas Lavoie, assistant professor, College of Pharmacy, antimicrobial stewardship; Abigail Helm ’19, an infection preventionist in Rhode Island; and Jaime Barrett, postdoctoral fellow, antimicrobial use in agriculture.

Greene recently discussed antimicrobial resistance in an interview.

How does antimicrobial resistance happen and is there anything people can do to avoid it?

Antimicrobial resistance is when microbes (fungi, viruses, bacteria) no longer respond to or aren’t affected by drugs used to control them. We need to understand the drivers of resistance and how it develops and spreads. Microbes grow exponentially and are capable of mutation. We also see horizontal gene transfer, when even unrelated bacteria can share genes with one another.

We are seeing a new resistance problem today. In the last few years, public health institutions like the World Health Organization and the Centers for Disease Control and Prevention have worked to demonstrate the impact of antimicrobial resistance. There was an awareness of this possibility from our initial use of these drugs, but scientists at the time were unable to foresee how antimicrobial use would develop in our world. We put all of our eggs in one basket, so to speak.

Antimicrobials are meant to be taken when really needed. Antimicrobials is a broad term that encompasses different types of drugs, including antibiotics for bacteria, antivirals for viruses or antifungals for fungi. Therefore, it is important to choose the right drug to treat each specific infection.

Everyone has a role to play. If you’re taking antimicrobials, be sure to take the full dose as prescribed. Take appropriate measures to protect yourself from illness. Be educated. Know what they are for and understand what can or can’t be treated. We can arm people with knowledge to better understand drugs and their implications for themselves and family members.

What are some trends in the field?

There is a move in the field toward developing and using more narrow-spectrum antibiotics. They’re like a sniper to protect the microbiome, unlike broad-spectrums which operate like a grenade and risk causing negative health outcomes.

It’s important to remember that our use of antimicrobials shapes microbial communities in all facets of life. We need to raise awareness that not all microbes are harmful; in fact, the majority that we encounter on a daily basis are harmless or beneficial.

In many cases, antimicrobials are still useful; I’m not saying never use them. Amoxicillin was a help to me when my kids had ear infections and usually starts to work in a day, thank goodness. As a society, we need to be more responsible with how they are used.

However, other approaches and options to counteract resistance can also work. Phage therapy is an example, using viruses that infect bacteria to cure infection—it’s used elsewhere in the world but not yet FDA-approved in the United States. We need to input more money into researching these innovative approaches.

These are global issues: infectious disease is a burden in the world. Many of these illnesses may not be endemic here but misuse of antimicrobials anywhere threatens our ability to fight infections everywhere since we live in such an interconnected world. Antimicrobial resistance also makes certain medical procedures riskier. Antimicrobials are part of the health care infrastructure; they are necessary to reduce the risk of infection associated with invasive medical procedures or to protect against opportunistic infections during cancer treatment, for example.

What do you see as possible solutions to the antimicrobial resistance crisis?

I’d like to see more widespread antimicrobial stewardship: improved diagnostic testing to ensure that the right drug is used in the right dosage within the right parameters to minimize adverse effects to the microbiome. We need to adopt a more holistic view that also includes how antimicrobials are used not just in the clinical setting but also the agricultural sector. We need increased funding for both basic and translational research around infectious disease.

In addition to its toll on health, antimicrobial resistance also poses an economic issue—for individuals having to take time out of work, for health care and organizations impacted by it. It is important to address all facets of this problem, from discovering novel treatments to implementing better management and prevention practices. We need ongoing discussion of this threat that affects everyone.

Alternative treatment strategies such as virulence inhibition should be explored further. How can we better understand and convey the importance of the microbiome? That has increasingly come up for discussion in recent years with news stories about fecal microbiota transplantation, for example. It sounds icky but now can be delivered via a pill and is becoming more common. We all have microbiomes and greater understanding will open new options.

Popular science has made these topics more accessible; I encourage anyone interested to learn more. There’s a whole interesting history of germ theory and disease, and now we know, not all germs are bad. Most microbes are benign or positive; we don’t need to get rid of all of them. By changing our perception of microbes in the first place, we may be able to design more strategic and innovative ways to tackle infectious disease.

There is currently debate about vaccines in public health. Have antimicrobials managed to stay out of the political fray or are they political, too?

Not as much. Things are more political when people are healthy; when they’re sick, they want treatment. It is important to look at drugs and vaccines in terms of statistics and risks. There is nothing without risk in health care; the question is how can we mitigate risk? At the same time, not doing anything is also a risk. Antimicrobials are not without controversy, though; for example, their use as growth promoters in animal husbandry or access without a prescription in some countries.

Are there any habits you observe in your own life to help minimize the risk of antimicrobial resistance?

Washing hands and basic infection prevention is really key. That’s first. Talk with your health care providers; ask questions.

I also encourage my students to be curious and skeptical. Being skeptical sometimes gets a bad rap but scientists, by nature, are skeptical. Ask questions, be incredulous, look at data and facts.

Don’t be afraid to change your mind in light of new information. Reevaluate the available evidence holistically and come to the best conclusion. Identify your assumptions and be open to changing your mind, in or out of the lab.

Greene is teaching a seminar on Antimicrobial Resistance at URI this fall, sponsored by the URI Honors Program. To schedule an interview with Greene, contact the URI Department of Communications.