CONTACT: L. E. OHMAN
283 Medical Laboratories
Iowa City IA 52242
(319) 335-6660; fax (319) 335-8034
UI Iowa medical centers collaborate in statewide surveillance of
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
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
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
"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,
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
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,
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
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