Flu season is unpleasant enough already, with an excess of sniffling and rubbish bins overflowing with tissues, it brings community health to the forefront of everyone's mind. But community health is more than hand-washing and vaccinations. The threat of antimicrobial resistance simmers beneath the surface.
Antimicrobial resistance is the biggest global crisis that no one is talking about. If unaddressed, drug resistant infections are predicted to be responsible for more deaths globally than cancer.
Antimicrobial resistance describes the development of a microbe's ability to survive treatment with an antimicrobial as a result of overuse. Usually, this demands higher doses—which are increasingly dangerous to the patient—or alternative types of antimicrobials—of which we're running on a low supply. Overuse of antimicrobials increases the propensity for bacteria—whether targets or bystanders—to become resistant, meaning if you are unlucky enough to catch a resistant infection, there's no cure.
With this threat looming over us, one would expect a tight rein on antimicrobials at the regulatory level. But in fact, we see the opposite. Antimicrobials can be found in consumer products ranging from toothpastes and deodorants to meats and cheeses. Furthermore, people aren't talking about it. Irresponsible or uninformed use of antimicrobials shortens the lifetime of effective treatments, ushering us ever faster toward a post-antibiotic era.
Much like the response to climate change, every individual can take steps toward a more sustainable relationship with antimicrobials to delay the onslaught of resistant strains. To start this conversation with people in the community, graduate student Colleen McCollum founded the University of Colorado Boulder chapter of ARMOR, the Antimicrobial Resistance Mediation OutReach program, almost a year ago.
Working with other graduate students in her lab, Colleen organizes tabling and craft events (usually enticing passerby with free food) to set the scene for crucial conversations about how to use antimicrobials in an age where their efficacy is threatened.
At tabling events, ARMOR reps have conversations with community members about small steps they can take to stave off antimicrobial resistance. Things like finishing entire prescribed antibiotic courses, buying antibiotic-free dairy and meat, and using antimicrobial-free soap can make a huge difference in the community. Interactions usually go well, with folks being highly receptive to steps they can take, but CU ARMOR wanted to take it further.
"We can tell people to avoid using antimicrobial soap, but this event gives them an alternative right then and there," says Colleen. To reach an open audience, CU ARMOR teamed up with a residence hall on campus, Darley Hall, and invited residents to make their own ARMOR-approved, antimicrobial-free hand soap. "Residence halls house hundreds of students, all of whom share restrooms and community spaces; it's a petri dish of diseases. It's the last place you want to see antimicrobial resistance," warns Dana Stamo, co-founder of the CU ARMOR chapter.
For several hours on a Thursday evening, residents could walk in and make their own custom soap—liquid or bar—with hand-picked fragrances and shapes. All soaps are, of course, antimicrobial free, and come with individual ARMOR seals of approval. Colleen reports that students in attendance were open to a discussion of how to mitigate the development of resistant bacteria in their community. This made for great conversation while soaps hardened.
With over 30 students who stopped by to make soap, the room smelled like a springtime meadow and the CU ARMOR team took comfort in the productive conversations prompted by the event. "We can rest easy knowing every student who stopped by will share this information with their friends or family and continue to spread the information," Colleen summarized.
CU ARMOR plans to host more soap-crafting nights in other residence halls at CU Boulder as well as an antimicrobial soap trade-in, where people can swap their antimicrobial-loaded soaps for more sustainable antimicrobial-free soaps. With more creative ideas in the works, CU ARMOR is on its way toward setting the scene for valuable conversations to raise awareness about this key challenge in community health.
With new chapters starting around the world, this thread keeps track of the different ARMOR movements as they impact their community and encourage more sustainable use of antimicrobials.
UNIVERSITY OF COLORADO, BOULDER
June | CU Boulder Students Teach Underrepresented High School Students About Antimicrobial Resistance
CU Boulder graduate students helped with a program called the Pre-Collegiate Development Program (PCDP) by teaching about antimicrobial resistance with hands-on activities.
PCDP brings underrepresented high school juniors to the CU Boulder campus for a 3-week session to experience life on a college campus. With classes on scientific writing, research, and presentations, students who may not otherwise have considered attending college are left better prepared for their futures.
Two graduate students in CO-ARC co-founder Dr. Anushree Chatterjee's lab, Dana Stamo and Jocelyn Campos, taught their students about DNA, cell membranes, evolution, and antibiotics. Students walked away from this class understanding quantum dot technologies and how they can be used to revolutionize treatment for multi-drug resistant infections.
April 25 | Health & Wellness Fair
The CU Boulder team was invited to table at the first annual Health & Wellness Fair to spread the word about antimicrobial resistance. Students passed out handbills with tips about how to be more responsible about antimicrobial use in your daily life.
April 15 | ARMOR Kickoff Event
Student leaders bought pizza and spoke about the global antimicrobial crisis.
Antimicrobial resistance (AMR) describes the ability of bacteria to develop ways of evading antimicrobials. Antimicrobials kill bacteria and with this environmental pressure comes the selection for survivors, and those survivors propagate their survivor genes contributing to a population of superbugs–bacteria that can’t be killed with any known antimicrobial. This is challenging, because we rely on antimicrobials to help our bodies eliminate infection. What happens when we catch an infection that we don’t have treatment for? More often than not, these kinds of infections occur in individuals with suppressed immune systems, the very sick, the very young, and the very old.
Rodica Stamo, an immigrant from Romania, started her business in assisted living almost 16 years ago, and she’s grown intimately familiar with the threat of superbugs. “Maybe 30–40% of my residents will get infections that just don’t respond to antibiotics.” Centers for Disease Control and Prevention state that nearly four million individuals receive services at assisted living facilities across the U.S.. Antibiotics are commonly prescribed among residents, with 50-70% residents receiving at least one antibiotic course every year. As high as 75% of these are prescribed incorrectly and Rodica has observed this.
“I see doctors give them all sorts of medication, almost randomly.” A challenge in responsible use of antimicrobials is their application only when necessary. Doctors may prescribe broad-spectrum antimicrobials to treat an unidentified infection (and antibiotics don’t work for all infections) or use the wrong antibiotics, but this approach may hasten us toward a post-antibiotic era. Rodica takes these prescriptions with a grain of salt, questioning doctors and even giving residents remedies such as oregano oil, which she has seen be effective when nothing else helped.
Antibiotics are not selective. Everyone has a gut microbiome—an ecosystem of “good” bacteria necessary to help us digest food and protect against invasive “dangerous” bacteria. Antibiotics can kill off our good bacteria, and it can take up to 6 months to replenish this diversity of bacterial species.
It’s a common misconception that resistant bacteria are rare, exotic strains. MRSA—a bacteria responsible for over 10,000 infections annually—is staphylococcus aureus that has developed resistance. Staphylococcus aureus exists naturally on many healthy people’s skin and hair. Antibiotics create an environment that selects for AMR genes amongst our native microbiota, cultivating dangerous strains of superbugs that are very close to home. Some antimicrobials are used as “maintenance drugs.” Infections can become long-term and antibiotics must be taken to keep the resident stable and prevent the bacteria from overwhelming the immune system. Once the antibiotic treatment is taken away, the patient dies. But this long-term use of antibiotics continuously selects for AMR bacteria, curating strains of MRSA or C. difficile.
Rodica acknowledges that antibiotics should only be used when their benefits outweigh the risks. That’s why she prioritizes good hygiene, antibiotic-free food, and supplements to keep immune systems and bodies strong, preventing infections from starting in the first place. But despite her efforts, her residents will still catch bugs. After many years of experience across 4 separate locations, she’s noticed some patterns.
“They’ll stop moving, they become very static, so you treat them. The next year, they get another infection, so you treat them again. It keeps getting more and more frequent. By the time they have three infections within a year, the antibiotics stop working.”
The importance of sustainable use of antimicrobials goes beyond personal choice. By overusing antimicrobials, we accelerate the evolution of superbugs. For people with weaker immune systems—like Rodica’s residents—our antibiotics must remain effective to help these patients fight off infections. Otherwise, a simple urinary tract infection could mean death.
Rodica joined ARC Labs last month to support new research and new technology that can help her residents. In addition to encouraging responsible use of antimicrobials, she also works very closely with her residents’ doctors to ensure antibiotics are not being overprescribed. We’re so happy to have her on our team.
In an effort to raise awareness about AMR in the community, ARC Labs has started ARMOR (Antimicrobial Resistance Mediation Outreach) to encourage individuals to educate their communities about AMR and foster responsible use of antimicrobials. The program is designed to empower individuals to spearhead this movement on a local level, by offering downloadable content, project ideas, and inspiration.
Several students at the University of Colorado Boulder (CU Boulder) took charge and have officially established their own ARMOR Chapter. “We want CU to be a leader in preventing this issue from become a devastating global crisis,” said founding member Colleen McCollum when she applied to make ARMOR a student group. Supported by CU faculty Dr. Anushree Chatterjee and Dr. Prashant Nagpal, involved graduate and undergraduate students have been meeting weekly to apply for funding, come up with project ideas, and start building their presence on campus.
“This is a great opportunity for pre-med students,” commented founding member Dana Stamo, “Antibiotic stewardship is so important in the medical field, it’s really amazing to apply for medical schools having already demonstrated your commitment to that.”
Currently, the members of ARMOR are focusing on recruitment and raising awareness about their group, but they have big plans for future projects. A motivating factor for forming this group is CU’s use of antimicrobial soaps and the CU ARMOR chapter is hoping to tackle this issue with campaigning and petitioning this spring.
Catalyzed by Dr. Anushree Chatterjee, the students also contribute to the Global ARMOR Video Project, which gathers videos of people sharing their perspectives on AMR. “We want to show that AMR affects people from all walks of life,” stated Dr. Chatterjee. These videos are available on ARC’s YouTube, AMRconsortium.
CU Boulder has taken incredible initiative on combatting AMR. We’ll definitely be keeping an eye on them to see what great feats they accomplish.
If you want to start your own ARMOR chapter at your school or within your community, click below for official downloadable content that you can use to get started.
AMR is a pervasive, global problem that many people don’t know about. ARC Labs launched ARMOR (Antimicrobial Resistance Mediation Outreach) to facilitate grassroots efforts that raise awareness about AMR in communities around the world. One of our first movements is the Video Project.
The ARMOR Video Project is a call to action for medical practitioners, scientists, students, anyone who has a perspective to share on AMR. Make a video, share your experience, raise awareness.
That's exactly what Karoline Pedersen did. Karoline is the co-editor of the DANMAP Report, an annual program for the awareness of antimicrobial use and resistance in food and humans in Denmark. And with Karoline’s contribution to the Video Project, we have added an international perspective to this movement, further emphasizing that AMR is a global challenge that affects everyone.
Karoline shares some excellent insight in her video, check it out!