UCSF Leading New Infection Network

UC San Francisco will play a significant role in a nationwide project to research one of the most vexing problems facing hospitals in California and elsewhere: bacterial antibiotic resistance.

UCSF and Duke University have been chosen by the National Institute of Allergies and Infectious Diseases to oversee numerous studies to find solutions to the problem. Known collectively as the Antibacterial Resistance Leadership Group, the organizations will receive $2 million to create the network, which is expected to include other teaching hospitals and research-oriented institutions. Another $60 million will be give to the two organizations over the next six years, which UCSF and Duke are charged with allocating. Although the worldwide scientific community will be invited to submit research proposals, additional investigators have already been picked from UCLA, Harvard University, Johns Hopkins University, the University of Pennsylvania and several other institutions.

Antibiotic resistance has become a particularly thorny problem for providers over the last decade, prompted by a combination of the overprescription of such drugs for common conditions like sinusitis and the fact pharmaceutical manufacturers have abandoned developing new forms of the drug to focus on more lucrative product lines. 

As a result, inpatient facilities are being challenged by strains of hospital-acquired bacterias that can prove deadly. The eventual studies will focus on two strains that are quickly becoming antibiotic resistant: methicillin-resistant Staphylococcus aureus, better known as MRSA, and E. coli.

In California, MRSA rates have climbed steadily, and account for about two-thirds of the soft-tissue infections seen in Los Angeles County hospitals. It annually kills about 1,900 hospitals patients statewide.

A study by the University of Chicago Medicine and the University Health System Consortium concluded the rates of MRSA infections at teaching hospitals nationwide doubled between 2003 and 2008. And while there is conflicting data as to whether the hospital-acquired or community-acquired strains are waning or on the rise, antibiotic resistance is making any form of the infection harder to treat.

E. coli, which had been treatable by antibiotics for decades, has had several resistant strains develop in recent years. One such strain, ST 131, has been associated with a large number of infections acquired in hospitals and nursing homes.

“Infections caused by drug-resistant bacteria are challenging to treat because one often has to rely on second- or third-line antibiotics, the effectiveness of which is not well known, or if known, is less than drugs of choice. These antibiotics may be more toxic, as well,” said Henry Chambers, M.D., a UCSF professor of medicine and chief of the infectious disease division at San Francisco General Hospital. Chambers will serve as the chief co-investigator for the research network.

In addition to its focus on E. coli and MRSA, the research will also focus on new methods of stewardship and infection control, as well as the development of devices and diagnostics aimed at reducing the amount of time required to identify the specific infections. 

Both bacteria spread quickly, and antibiotic-resistant strains are far deadlier if not diagnosed promptly. However, standardized culturing and testing protocols take 48 to 72 hours to determine the strain of an infection and how it will respond to antibiotics. The lagtime often requires that antibiotics that may be ineffective are prescribed as a prophylactic measure.

“For most bacterial infections, our diagnostic strategies are still fundamentally thesame as they were 100 years ago,” said Vance Fowler, M.D., professor of medicine at Dukeand the network’s other principal investigator. “We’re still isolating, culturing and identifying bacteria that have been grown from a clinical sample. Each of those steps takes time, and clinicians don’t always have the luxury of time. Reducing the time to knowledge would have the dual benefit of improving care for individual patients, but on a broader scale can serve to reduce the need for unnecessary antibiotics.”

In addition to the research, the new network will also strive to create a new generation of experts in the field by providing a particular focus on mentoring and training.