Microbe managers

By: Morgan Sherburne

Too much of a good thing can be a bad thing — something Nicole Iovine, M.D., Ph.D., knows well. As the director of the Antimicrobial Management Program at UF Health Shands Hospital, Iovine says her first priority is to provide the best possible care to patients. But she also makes sure that care does not unintentionally create harm by causing microbes to become resistant to antimicrobial medication.

Antimicrobial medications are more broad-spectrum than antibiotics and target bacterial infections as well as fungal, viral and parasitic infections.

“They’re also called ‘big guns’ because they are so powerful. They can treat a very wide range of organisms,” said Iovine, an assistant professor in the College of Medicine and epidemiologist at UF Health Shands Hospital.

This is a good thing when patients are in dire need of care.

“As soon as you know what the patient has and how to treat it, you need to act on that information and narrow the spectrum of antiomicrobials,”
Iovine says. “Otherwise, we’ll end up with what the Centers for Disease Control and Prevention called
‘the nightmare bacteria.’ ”

One of those nightmare bacteria is clostridium difficile, which causes clostridium difficile colitis. Antibiotics given intravenously
may wipe out infection, but they also can wipe out all of the good bacteria in a patient’s intestines. This leaves room for c-diff bacteria, which may already exist in the intestine, to take hold.

About 15 to 20 percent of infected patients relapse. A smaller percentage of people develop a disease that can require their colons to be removed, and an even smaller percentage of those patients can die from their illness.

To cut the risk of c-diff, Iovine and teammates Kenneth Klinger, Pharm.D., and Samuel Borgert, Pharm.D., have developed a c-diff management algorithm. Using the algorithm, doctors can determine whether a patient needs to take different kinds of antibiotics. 

Another way the team keeps tabs on infectious diseases is through a surveillance system that sifts through data coming out of the hospital’s microbiology lab. The system sends alerts whenever a highly resistant infection shows up.

The team also conducts research about resistant infections.

The antimicrobial management team hopes its approach will result not only in fewer resistant microbes, but also in saving the hospital money, both by not having to administer costly antimicrobial medications and by not having to mediate infections should they occur in the hospital. Iovine said she has seen a hospital environment troubled with resistant infections at another institution. 

“UF Health Shands is so much better than that environment, but it always makes me really vigilant because I don’t want that to happen here,” Iovine says. “It takes a multipronged approach — it takes an antimicrobial management program; it takes epidemiology; it takes vigilance, constant checking and re-checking. When a resistant bug does come in, we have to pounce on it — which we do.”