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Pitt team wages war on antibiotic resistance

| Wednesday, Nov. 12, 2014, 12:13 a.m.

Antibiotics won't do an ounce of good for most cases of acute bronchitis, a nasty chest cold that can stir up a bone-jarring cough for months.

Yet doctors prescribe the bacteria-killing drugs for as many as 70 percent of patients with the sickness, often because they just can't tell whether a bacterial infection or a virus is the underlying cause, University of Pittsburgh researchers warn.

They say a simple blood test might solve the mystery and prevent unnecessary antibiotic use, a move that could help inhibit antibiotic-resistant germs that sicken thousands. Pitt researchers began a study of the blood test last week on patients with suspected lung infections.

“Over the long term, you will induce antibiotic resistance in that specific patient and in the world at large,” said Dr. David T. Huang, a Pitt associate professor in emergency medicine who cautioned against antibiotic overuse for lung infections.

He called antibiotic resistance “a disaster, because as the bacteria get more and more resistant, it's going to get harder and harder to treat them, which is why it's so important to use antibiotics only when they're truly needed.”

Huang's five-year study with Drs. Aaron Brown and Franziska Jovin at Pitt will expand on earlier findings in Switzerland, where researchers discovered a protein known as procalcitonin at high rates in patients with bacterial infections, but not in those with viral infections.

At UPMC Presbyterian in Oakland, medical students in the next three years will monitor emergency patients for coughs or fevers that could suggest a lung infection.

Researchers will take a closer look at those who might be eligible to join the study and ask their permission.

Lung infection patients who enroll in the research, called the Procalcitonin Antibiotic Consensus Trial, will receive either standard treatment or standard treatment with an extra blood test to measure procalcitonin levels.

Test results will be available within an hour for attending emergency physicians, who will decide whether to prescribe antibiotics, according to Pitt. Researchers will follow up with patients to check on their health, antibiotic use and — for those admitted to the hospital — procalcitonin levels.

Huang said the results should illustrate how well the protein can serve as a detector for bacteria-induced infections. He hopes patient recoveries will be just as robust while antibiotic use drops off, he said.

The project follows an executive order in September from President Obama, who ordered federal agencies to tamp down antibiotic-resistant bacteria. About 23,000 deaths and 2 million illnesses each year nationwide are tied to antibiotic-resistant infections, according to the Centers for Disease Control and Prevention in Atlanta.

That costs the domestic economy as much as $20 billion in health care costs and $35 billion in lost productivity, the White House said in a statement. The National Institutes of Health supplied a $5 million grant for the procalcitonin trial, which is set to expand to about 10 other hospitals nationwide and enroll more than 1,500 lung infection patients within several years.

“I don't think the problem these days is so much clinical,” said Ellen Silbergeld, a professor of environmental health sciences and epidemiology at the Johns Hopkins School of Public Health in Baltimore.

She praised the health care sector for cutting down on avoidable antibiotic use and raising awareness through education.

Now the agriculture sector should follow suit, Silbergeld said. She said federal estimates show about 80 percent of antibiotics manufactured in the U.S. go into animal feed.

“Getting control of that is not insignificant. If we can do that without suffering any economic or other consequences, it seems to me it's something we can do as a high priority,” Silbergeld said.

Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or asmeltz@tribweb.com.

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