Dr. Cesar Arias holds up antibiotic resistant disease samples from his lab.
Infectious Disease

Antimicrobial Resistance Expert Sounds the Alarm

On Medicine

Antimicrobial resistance is a growing threat to modern medicine and researchers are working toward more coordinated strategies to address it.

April 30, 2024
Eden McCleskey

Article Highlights

  • The projection that AMR-related mortality may surpass cancer by 2050 underscores its trajectory as a leading cause of death, positioning AMR as a critical priority for clinical practice, research and policy.
  • Comparative observations suggest that higher antimicrobial use — across human, veterinary, and other sectors — correlates with increased resistance burden, emphasizing the importance of stewardship across all domains of medicine.
  • Antibiotic prescribing is not benign; every exposure can induce bacterial adaptive responses, which may lead to resistant infections and patient-level complications, highlighting the need for precision in prescribing.
  • The establishment of international research efforts reflects both the worldwide spread of resistance and its amplified burden in resource-limited settings, where infrastructure and stewardship controls may be insufficient.
  • Efforts to develop rapid testing for resistant phenotypes (e.g., enzyme-mediated antibiotic degradation) and to reform antibiotic development and reimbursement models are key strategies to guide appropriate therapy and reduce morbidity and mortality.

When it comes to looming existential threats, war, famine and climate change tend to get top billing, but medical scientists are focused on one that deserves significantly more public attention than it gets: antimicrobial resistance.

Antimicrobial resistance occurs when infections develop the ability to defeat the drugs designed to kill them. To combat such infections, newer and stronger antimicrobials must be developed and deployed. Eventually the germs evolve new ways to respond and survive, trapping us in a costly, escalating and seemingly endless game of cat and mouse.

Dr. Cesar Arias, chief of Infectious Disease at Houston Methodist Hospital, has been at the forefront of antimicrobial resistance research for more than 25 years. He is fascinated by the way bacteria can change and adapt in response to antimicrobial agents and how this can have enormous clinical and public health consequences.

"Historically, we've underestimated bacteria's remarkable genetic abilities to adapt and survive and taken for granted that antibiotics would always work," Dr. Arias says. "That is already proving to be false, and the situation is only getting worse."

Antibiotic-resistant bacteria currently causes over 35,000 deaths in the United States each year and contributes to nearly 5 million annual global deaths.

"By the year 2050, there will be more deaths due to antibiotic resistant infections than cancer," Dr. Arias says. "This is one of the defining health problems of our age."

“Superbugs and MRSA outbreaks are certainly alarming, but our biggest fear is that we may reach a point where antibiotics simply don't work anymore. That would be catastrophic because nearly everything we do in modern day medicine, whether it's treating cancer or transplanting organs, performing an emergency c-section or developing one of the countless minimally invasive procedures to help patients manage chronic and acute conditions, all of these are dependent on our ability to control infections along the way.”

Dr. Cesar Arias
Chief of Infectious Disease at Houston Methodist Hospital

In 2021, Dr. Arias joined Houston Methodist to lead its renowned team of infectious disease researchers and clinicians and launch its ambitious new Center for Infectious Diseases Research dedicated to building on successes and lessons learned during the Covid-19 pandemic to advance public health.

By recruiting one of the most accomplished experts in the field, Houston Methodist singled out antimicrobial resistance as one of its top research priorities, a move it hoped would inspire others to follow suit.

To prevent that from happening, Dr. Arias and scientists at the Center for Infectious Diseases are working on a cutting-edge, NIH-funded initiative that could produce a more coordinated, strategic approach to the fight against antimicrobial resistance, a dramatic improvement over the current antibiotic arms race. They are also playing a key role in local, national and international efforts to push the agenda of antimicrobial resistance to the forefront of policy decisions.

Learn more about how Dr. Arias and his colleagues are addressing this international crisis by watching the video above.

Jump to Transcript
April 30, 2024
Eden McCleskey
Subscribe to our Newsletter
Please enter an email
Please enter a valid email
Related Articles
Transcript

00:00–00:30
By the year 2050, there will be more deaths due to antimicrobial resistant infections than cancer. This is one of the top health problems in the 21st century. My name is Cesar Arias. I am the chief of infectious diseases at Houston Methodist. I am also the co-director of the Center for Infectious Diseases at Houston Methodist Research Institute and a professor of medicine at Weill Cornell Medical College. I am the editor and chief of Antimicrobial Agents and Chemotherapy.


00:30–01:00
I also have the honor to be the Bookout Chair for Excellence in Research at Houston Methodist Research Institute. I am working on antimicrobial resistance for more than 25 years. I wanted to understand how these fascinating changes that bacteria actually do in response to the anti-microbial agents can have enormous clinical and public health consequences. So we have performed several studies both in the United States


01:00–01:30
and we have established some research units in South America. Because this particular problem is actually much more impactful in the developing world. We have been able to describe new mechanisms of resistance to antibiotics that are actually affecting patients. In the United States, our studies show


01:30–02:00
that the kind of organisms that we circulate here are highly resistant compared to other countries, like, for example, in Europe. And the only real difference is the vast amount of antimicrobial we use not only in human medicine, but maybe in medicine, veterinary medicine and other areas. Prescribing of antibiotics, particularly in this country, is something that we've been trying to regulate for years. So every time we give an antibiotic molecule, this bacteria will respond.


02:00–02:30
So how we use these antibiotics becomes an important and critical issue. So regulating that practice and the education for physicians to understand that, that every time you use the antibiotic, you can cause a really storm, a real storm in the that patient. Policy can help push a new model of antibiotic development, a new model of antibiotic reimbursement. We hope that we can show that this is really impactful for patient care.


02:30–03:00
Houston Methodist has created a new center for infectious diseases, in which antimicrobial resistance is a big part of it. Because of my focus on this research, we have been able to establish important connections, both locally, nationally and internationally, to try to push the agenda of of antimicrobial resistance throughout the entire globe.


03:00–03:30
We are currently working on a project that is NIH-funded to try to develop a test to quickly identify a very common bacteria that cause bloodstream infections like a Staphylococcus aureus, and that has a particular phenotype that is related to the production of an enzyme that destroys antibiotics. We're hoping to try to demonstrate that these tests deployed in clinical laboratories around the world can help clinicians decide how to use antibiotics


03:30–04:00
against these very common bacteria and potentially prevent complications and deaths caused by these organisms. So this is a very complex problem that affects many areas of healthcare and even the economy. If we don't do anything on this wave of antimicrobial infection, there will be a lot of lives lost not only in our world here, but the impact in the developing world is going to be incredible.