Infectious Wisdom Series: Antimicrobial Resistance Beyond the Bedside: A Systems Approach to a Global Threat

Author: Carole W. Kamangu 

Antimicrobial resistance (AMR) is a global health issue affecting healthcare facilities and communities around the world. In this special edition of our “Infectious Wisdom” series, I sat down with three global experts in infection prevention and antimicrobial resistance, Teri Hulett, Jibi Thankachan and Professor Troy Skwor, shared their experiences, challenges, and insights in combating this growing global health threat. We discussed the interconnectedness of various factors contributing to AMR and addressed system-level strategies that countries and health systems can implement to combat the issue effectively.

The Infection Preventionist's Fight for Antimicrobial Stewardship

Teri Hulett, an infection preventionist with over four decades of experience, shared her journey and how she became deeply involved with antibiotic stewardship. After managing outbreaks in neonatal care, she transitioned into infection prevention, realizing its significance beyond acute care. Her experience with state hospital associations allowed her to witness the challenges faced by rural facilities, igniting her passion for antimicrobial stewardship. Teri’s efforts in leading a statewide antibiotic stewardship collaborative emphasize the importance of collaboration among diverse healthcare settings to combat AMR.

“I need to help people understand why doing the right thing is the right thing, and what the right thing is. [...] For me, it goes back to step one, prevent the infections.” Teri Hulett

Watch the full conversation on YouTube

The One Health Perspective on Antimicrobial Resistance

Troy Skwor, an associate professor at the University of Wisconsin-Milwaukee, discussed his extensive research in infectious diseases. His journey began with malaria research, eventually expanding to the study of antimicrobial resistance in aquatic environments. Troy’s serendipitous discovery of Aereomonas in Lake Erie propelled him into a deeper investigation of antimicrobial resistance patterns in wastewater. His work emphasizes the need for a One Health perspective, recognizing the interconnectedness of human, animal, and environmental health in addressing AMR.

“If we're going to combat antimicrobial resistance, especially with how easy it is to travel nowadays internationally, we really need to invest in other and poorer countries, economies and make sure that we can help them with their infrastructure and help them write policies to really implement them and make a difference.” Troy Skwor

Global Challenges in Combating Antimicrobial Resistance

Jibi, a senior specialist in infection control, brought to light the widespread misuse of antibiotics during the COVID-19 pandemic. He highlighted the urgent need for robust antimicrobial stewardship programs globally, emphasizing that many antibiotics were misused, leading to an increase in AMR. Jibi's experience across multiple countries has shown that education is key to addressing this challenge, as many healthcare professionals and the public remain unaware of the consequences of inappropriate antibiotic use.

“If I could recommend something, a big change to the current infection control policies related with AMR, it would be the mandatory integration of antimicrobial stewardship program into infection prevention control guidelines. [...] When we embed this AMS into IPC policies, we can ensure that every healthcare facility is, regardless of the size or the resources, they can actively monitor and optimize their antibiotic usage.” Jibi Thankachan  

Bridging the Gap with Diagnostic Stewardship

The discussion also touched on the critical role of diagnostic stewardship in controlling AMR. Teri pointed out that many providers lack the necessary education on antimicrobial stewardship, often leading to unnecessary antibiotic prescriptions. By emphasizing the importance of accurate diagnostics and reducing asymptomatic treatments, healthcare professionals can significantly impact antibiotic resistance rates.

Conclusion

The conversation provided valuable insights into the multifaceted challenges of combating antimicrobial resistance. Key takeaways include the necessity for collaboration across healthcare settings, the importance of education and awareness among healthcare professionals and the public, and the critical role of diagnostic stewardship in reducing inappropriate antibiotic use. As the experts emphasized, addressing AMR requires a holistic approach that considers the interconnectedness of human, animal, and environmental health.

Watch the full conversation on YouTube

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About Our Guests

Jibi Thankachan is a Senior Specialist & Lead Infection Control & AMR Expert with Over 14 Years of global experience

and an expert Infection Control Professional with over 14 years of

experience in the healthcare sector, spanning Saudi Arabia, the UK, UAE and India. He holds a bachelor’s degree in nursing and has extensive training and

expertise in infection prevention and control (IPC), with a Super Specialization

in surgical site infection prevention, Advanced Training in hand hygiene

strategy management and Expert Specialization in Antimicrobial Stewardship

& Resistance.

Jibi is a prolific educator and mentor in the field of infection control. He

has developed training programs for healthcare professionals and delivered

lectures at international conferences. Additionally, he has written extensively

for reputed publications, including CM Today, Clean Middle East, IP Insights,

and IPC UK.

He has been actively involved in research activities and performance

improvement projects in infection control and AMR. His contributions have garnered numerous accolades and recognitions across Saudi Arabia, India, the UAE, and the UK. With his extensive expertise and global experience, Jibi continues to be a leader in infection prevention and control, making significant contributions to

healthcare quality and safety.

Teri Hulett holds a bachelor’s degree in nursing, is board certified in infection prevention and control, and has earned the designation of Fellow in the Association for Professionals in Infection Control and Epidemiology (FAPIC). She has been in nursing for 45 years. Her experience includes 27 years as a bedside nurse with her area of specialty being neonatal ICU. She transitioned from the bedside to infection prevention (IP) in 2006.

Over her tenure as an IP, she has served in multiple leadership roles at the local level to include President of the APIC Mile High Colorado Chapter, and at the national level as Chair of the APIC Education Committee. She has been involved in multiple projects and initiatives at the local, regional, and national levels. Teri has presented at both the local and national levels and has co-authored multiple articles published in peer-reviewed journals. Infection prevention and control areas of focus include antimicrobial and diagnostic stewardship to include co-leading a 2-year statewide antibiotic stewardship collaborative for Colorado in 2016. Teri continues to partner with and mentor colleagues across the continuum of care.

Troy Skwor, Ph.D. is an Associate Professor of Biomedical Sciences and the Director of the Antibiotic Resistance and Antimicrobial Photodynamic Therapy Laboratory at the University of Wisconsin – Milwaukee. His laboratory has conducted extensive research on the prevalence and characteristics of antibiotic-resistant bacteria, especially within the genus Aeromonas and Escherichia coli. His studies have explored the distribution of these pathogens in environments such as wastewater, recreational beaches, and clinical settings.

Through the use culture and culture-independent methods, his group has revealed wastewater as a source of disseminating antibiotic-resistant bacteria, including strains resistant to critical antibiotics. These findings underscore the need for improved wastewater treatment strategies to mitigate the spread of resistant pathogens into natural water bodies. To address these challenges, Dr. Skwor’s team is actively developing alternative treatment approaches with a strong emphasis on antimicrobial photodynamic therapy to combat multi-drug resistant populations. His research has received funding from the U.S. Army Department of Defense (DoD), Environmental Protection Agency (EPA), and U.S. Department of Agriculture (USDA), reflecting the broad impact of his work on both environmental and clinical health. Through his contributions, Dr. Skwor aims to advance our understanding of AMR transmission pathways and develop innovative strategies to combat the growing threat of antibiotic resistance.