Tear down the wall of historical paradigms in Infectious Disease

Written by Linnea Soon, MSc'25 (Candidate)

On October 12th, 2023, Dr. Santiago Perez Patrigeon spoke at Medical Grand Rounds coordinated by the Department of Medicine at Queen's University. Dr. Perez's presentation was entitled, "Tear down the wall of historical paradigms in Infectious Disease". They gave an overview of the history of antibiotic medication and explained therapy recommendations. Recent research has shown that for some infections, antibiotics taken by mouth can be prescribed rather than antibiotics injected into the bloodstream, and that a shorter length of antibiotic therapy is just as effective as a longer length of therapy. Both findings are contrary to previous antibiotic therapy recommendations.

Following this presentation, for the second year, Dr. Perez participated in an active discussion with translational medicine graduate students following their presentation. Dr. Perez is a doctor specialized in treating infectious disease (ID) and is part of an ‘antimicrobial stewardship’ (AMS) program in Kingston. AMS programs apply evidence-based medicine to make sure the correct medication is used to treat infections in order to prevent the development of treatment resistance.1 Once resistance develops, it makes the infection much more difficult to treat. This program within hospitals is comprised of many pharmacists and doctors trained in treating ID, including Dr. Perez. This team consults on patients with infections and provides recommendations on their treatment throughout their hospital stay (Figure 1). In this role, they are examples of translational medicine in action by applying results of bench and clinical research to design treatment regimens for patients. One issue is that AMS is not often used outside of the hospital due to limited communication between the AMS team to community pharmacists and family doctors. Moving forward, it would be critical to improve this system so AMS would benefit patients not only in the hospital but also in the community.

It is essential for the AMS team to have excellent interpersonal skills as they must advocate for their patient’s treatment to assure the patient gets the best care. As Dr. Perez said, their interpersonal skills are critical especially when trying to compromise on the priorities of other departments. For example, in the Intensive Care Unit (ICU), patients are very sick, and they need treatment as soon as possible; however, bacterial cultures can take 24 to 72 hours to have a result that can determine the best possible treatment. In this scenario, both the ICU and ID doctors need to work together to decide what might be the patient’s best course of action.

During the pandemic, to feel connected socially, the average time per day a person spent on a screen and on social media increased greatly.2,3 An example of this social connectedness, was when a graphic designer asked Dr. Perez about the significance of a retracted study. This study detailed the use of an anti-parasite drug in COVID and was published in the New England Journal of Medicine. In fact, another study was retracted from The Lancet, regarding the use of an antimalarial drug in COVID.4 Both the Lancet and New England Journal of Medicine are well-known and respected journals, and a retraction implies the research was not carried out correctly. Normally, it would be rare for someone outside of science to understand the significance of the retraction of a specific study; however, due to the pandemic this controversy was a topic of everyday conversation as shown by Dr. Perez’s anecdote. Dr. Perez believes that the pandemic increased awareness of IDs and the role of ID doctors in medicine. Unfortunately, Dr. Perez believes that this awareness will wane over time as society moves past the COVID pandemic.

Another issue is that there are not enough ID doctors to implement a widespread and thorough AMS program. Adding to the problem is that specialists in other areas, such as urology and orthopaedic surgery do not have training and knowledge of antimicrobials drugs. In fact, to learn about IDs and antimicrobials, doctors have to seek out additional education as the subject is not extensively taught in medical school. One question is, how can doctors be incentivized to choose ID as a specialty or take additional courses in ID?

Overall, Dr. Perez detailed the translational value of AMS and the importance of antimicrobials in healthcare. For AMS to have the most benefit possible in future, there are three main areas to improve: communication between AMS teams and surrounding community medical professionals, societal interest in and understanding of ID and AMS, and uptake of ID courses and ID as a specialty.

References

1. Garau J, Bassetti M. Role of pharmacists in antimicrobial stewardship programmes. Int J Clin Pharm. 2018;40(5):948-952. doi:10.1007/s11096-018-0675-z

2. Pandya A, Lodha P. Social connectedness, excessive screen time during COVID-19 and mental health: A review of current evidence. Front Hum Dyn. 2021;3. doi: 10.3389/fhumd.2021.684137

3. Gibson KE, Sanders CE, Lamm AJ, Lamm KW. Examining the impact of media use during the COVID-19 pandemic on environmental engagement. Original Research. Front Environ Sci. 2022;10. doi:10.3389/fenvs.2022.789361

4. Pillar C, Servick K. Two elite medical journals retract coronavirus papers over data integrity questions. Science. June 4, 2020. https://www.science.org/content/article/two-elite-medical-journals-retract-coronavirus-papers-over-data-integrity-questions