Though the COVID-19 pandemic remains a top priority for the U.S. Army and government’s healthcare and medical research apparatus, SARS-CoV-2 is just one of many ongoing infectious disease-related public health concerns. Antibiotic-resistant bacteria remain a significant threat to the public as well as Service Members, on and off the battlefield.
Antibiotics are critical tools for healthcare providers to treat bacterial infections. However, through evolution, bacteria can develop resistance to antibiotics, diminishing the drugs’ utility. Overuse of antibiotics in humans and animals, counterfeit antibiotics and other misuse can accelerate the development and spread of resistance.
Most Americans encounter multidrug-resistant infections in hospital settings, where bacteria can spread rapidly from patient to patient when unchecked. In 2019, more than 2.8 million antibiotic-resistant infections occurred in the U.S., resulting in over 60,000 deaths.
For the Warfighter, combat wounds are easily infected in field environments. Limited access to evacuation and resupply, paired with decreasingly effective antibiotics, only heightens the risk. These bacteria move with patients as they transfer to other hospitals, increasing the danger to other healthcare facilities.
Recognizing this global threat, the White House released a National Action Plan in 2015 outlining steps for implementing the 2014 U.S. National Strategy for Combating Antibiotic-Resistant Bacteria. On October 9, it released the next iteration of this plan.
Leading the DOD’s efforts to support the National Strategy, the Multidrug-resistant organism Repository and Surveillance Network at WRAIR serves as the primary surveillance organization to track antibiotic-resistant bacteria across the military healthcare system and beyond. Celebrating its tenth anniversary in 2019, it has thus far collected and analyzed in excess of 82,000 bacterial isolates from over 60,000 patients.
The 2015 National Action Plan specifically tasked the MRSN to expand its detection capabilities for high-risk, drug-resistant pathogens from Army military treatment facilities to the entire MHS. This capability paid off in 2016 when the MRSN was the first organization to identify a bacterium with mcr-1, a gene that confers resistance to the antibiotic of last resort, colistin, from a patient in the United States.
“Using bacterial genomics, the MRSN can quickly identify bacteria that may be closely related from different patients, suggesting possible transmission between patients. Analyzing antibiotic resistance genes can also provide insight into possible treatment options for physicians,” said Col. Jason Bennett, director of the MRSN. “Performing biosurveillance on the movement of antibiotic-resistant bacteria enables us to provide an early warning signal to military and civilian hospitals around the world, informing antibiotic stewardship, infection prevention and research.”
The 2015 National Action Plan also tasked WRAIR to transition one antibiotic drug candidate from discovery to advanced development. “Working closely with our partners in industry, academia and other government agencies, we are evaluating and advancing novel antibiotic classes through our antibacterial high-throughput drug discovery platform and applying cutting-edge artificial intelligence and machine learning screening approaches to identify candidate antibiotics,” said Lt. Col. Charlotte Lanteri, director of WRAIR’s Experimental Therapeutics Branch.
“A unique aspect of our strategy is leveraging the MRSN’s bacterial diversity panels to test novel drug candidates using relevant, clinical samples, allowing us greater confidence in a new drug’s clinical utility for our military population,” Lanteri continued, referring to existing diversity panels covering a number of bacterial species.
Product development efforts also include bacteriophage, or viruses that inactivate specific strains of bacteria. WRAIR scientists have seen success with these phages, using them to save the life of a patient with a multidrug-resistant bacterial infection in 2019.
Leveraging overseas laboratories in Southeast Asia, sub-Saharan Africa and the Republic of Georgia, WRAIR also works closely with governmental and others partners to track and sequence multidrug-resistant organisms in local health systems, expanding understanding of disease threats circulating around the world.
In support of the next five-year National Action Plan, WRAIR will continue its product development efforts, serve as a resource to industry partners looking to test new antibiotics, provide expanded real-time pathogen surveillance within the MHS and Veterans Health Administration and improve data-sharing partnerships.