Federal Funding for the Study of Antimicrobial Resistance in Nosocomial Pathogens: No ESKAPE

The discovery of potent and safe antimicrobial agents is arguably single greatest health care advance in history. The availability of these agents rapidly reduced morbidity and mortality associated with a host of formerly fatal diseases. In addition, confidence that infections could be prevented or treated by antibiotics allowed major leaps forward in treatment of noninfectious diseases, including serious heart disease, cancers, and organ failure requiring transplants. Medical care, as we now know it, could not exist without availability of effective antibiotics. The widespread use of antibiotics has been associated with what we now know to be predictable emergence of resistance. Early confidence that infections would eventually be conquered has given way to a greater appreciation of genetic flexibility of common human pathogens. Moreover, we have come to appreciate role played by microorganisms in our homeostasis. Microorganisms are an intrinsic part of us, and we would do well to learn to live with them. Where we cannot live with them is in hospital, because patients with compromised defenses are particularly vulnerable to bacterial diseases. Although many bacteria remain susceptible to most of our antimicrobial agents, a coterie has emerged that escape lethal action of antibiotics. In hospitals in both developed and developing world, this small group Enterococcus faeciumy Staphylococcus aureusy Klebsiella pneumoniaey Acinetobacter baumanni, Pseudomonas aeruginosa, and Enterobacter species, hereafter referred to as the ESKAPE is same. The ESKAPE bugs are extraordinarily important, not only because they cause lion's share of nosocomial infections but also because they represent paradigms of pathogenesis, transmission, and resistance. If we learn to control these microorganisms, our hospitals will be immeasurably safer, because lessons learned could be applied to virtually any species that attempts to take their place. Unfortunately, ESKAPE bugs are increasingly prevalent in our hospitals and increasingly resistant to many of our antimicrobial agents. In this issue of Journal Peters et al. [ 1 ] detail research agenda of National Institute of Allergy and Infectious Diseases (NIAID) for antimicrobial resistance. As primary federal agency for conducting and supporting medical research, National Institutes of Health (NIH) is standard-bearer for federal government's commitment to health research. NIAID manages most, but certainly not all, of work performed by NIH in areas of antimicrobial resistance and infectious diseases. As such, NIAID agenda defines weight of federal government efforts in area of infectious diseases. One need look no further than pivotal role played by NIAID in enormous success of AIDS research effort over past 2 decades to understand profound impact this institute's agenda can have on growth and success of individual research areas. Peters et al. indicate that NIAID funding of antimicrobial research has grown considerably over past decade, now totaling more than $800 million annually. In considering this very large number, it is important to realize that it represents NIAID's total commitment to all areas defined as being related to antimicrobial therapy. This category includes research on antibacterial, antifungal, antiparasitic, and antiviral therapies, whether related to treatment of diseases or to their prevention through use of vaccines. It is therefore difficult to get a firm grip on what level of support is devoted to antibacterial therapy and resistance, particularly in reference to ESKAPE bugs. Regarding research specific to issues involving antimicrobial resistance, Peters Received 26 December 2007; accepted 3 January 2008; electronically published 7 March 2008. Potential conflicts of interest: none reported. Reprints or correspondence: Dr. Louis Rice, Medical Service 111(W), Louis Stokes Cleveland VA Medical Center. 10701 East Blvd.. Cleveland, OH 44106 (louis.rice@va.gov).