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Melanie Cole (Host): In recent decades, we've been facing an alarming increase in injections by bacteria that resistant to all existing antibiotics. Antibiotic resistance is a growing problem both in the United States and around the world. Today we're speaking with Professor Allon Moses on this episode of Hadassah On Call.

Welcome. My guest today is Professor Allon Moses. He's the Chairman in the Department of Clinical Microbiology and Infectious Diseases at the Hadassah Medical Organization in Jerusalem, Israel. Welcome to the show, Professor Moses. Tell us a little bit about yourself and how you came to the Hadassah Medical Organization.

Professor Allon Moses (Guest): Hi, Melanie. Very nice to talk to you today. I've been at Hadassah for many years. I started as a resident of medicine and then went through infectious diseases. I began my training in infectious diseases at Hadassah, and then spent two years at Harvard Medical School in the hospital. I did some clinical work and research, and then I came back to Hadassah Medical Center, and I've been Chairman of the department for the past thirteen years. We are the Department of Clinical Microbiology and Infectious Diseases. It's an unusual department where under one roof, the infectious disease doctors work together with the clinical microbiology lab, and I can tell you about that later.

Melanie: Wow, what a great story about yourself. So give the listeners a little quick description of what an infectious disease is, and why it's important that the Department of Clinical Microbiology and Infectious Disease work together in the same area.

Allon: So infectious diseases is a field where we treat any disease caused by microorganisms; bacteria, viruses, parasites, and fungi. And so the diseases caused by these microorganisms are infectious diseases. They can be in various parts of the body. In the lungs it would be pneumonia, in the head it could be meningitis, et cetera. So any of these diseases is treatable by us.

It's important for us to be close to the clinical lab because the clinical microbiology lab is where the technicians identify the bacteria. They grow them, they identify them, they see their susceptibility. Are they resistant or are they sensitive to antibiotics? And if we work together under one roof, it's possible for us to collaborate, and we always are proud that our infectious disease doctors are able to tell the technicians about the patient so it's not just an anonymous test that they're working on, and the infectious disease doctors can learn from the technician’s various secrets of the microbiology. So we feel that it's a mutual and nourishing collaboration.

Melanie: Professor, there seems to be a growing list of bacterial infections that are resistant to bacteria. We hear about this in the media all the time now. Please tell us a little bit about how this has changed the landscape of treatment for infectious diseases.

Allon: You know, resistant bacteria are part of the biology. If a bacteria is in contact with antibiotics, the natural thing that happens to the bacteria is to mutate and becomes resistant. We know from the first antibiotics in the 1940's, the famous penicillin, that just after a few months of treatment with penicillin, the first resistant bacteria emerged, and these were Staphylococci. Now we know that Staphylococci are about 99% resistant to penicillin. So over the years as bacteria are faced with antibiotics, they develop resistance.

Now so when antibiotics are used, the good side of it, we cure the infection. The bad part is the resistance forms, and therefore when antibiotics are used where they are unnecessary, we develop unnecessary resistance.

So the first rule is to give antibiotics only when they are necessary. For example, for viral infections we should not give antibiotics. We should give antibiotics for short periods of possible- if there's a specific infection we need to treat, or for short periods of time we need to treat it with a specific antibiotic and not a very broad spectrum antibiotic.

So we are faced with the fact- we have a saying, 'When you use it, you lose it.' So as long as we are using antibiotics, bacteria will become resistant to them. Over time, and this has been a growing problem for the past fifteen years, we are faced now with bacteria which are more and more resistant and actually we have- fortunately we have bacteria resistant to all antibiotics.

Years ago, the Infectious Disease Society of America came out with a slogan, 'Bad bug, no drug.' And this is getting worse, and I must say as an infectious disease doctor, we've been saying this for the past ten years, but during the year or two that we are not faced with a real problem. It is not uncommon for us to have a patient who has a resistant infection with a bug that we do not have any antibiotics. So this has become to be a worldwide problem. We face the problem in our hospital, but the same as all over the country, and much of it is in the world. Some countries have less resistance, unfortunately in Israel we have many resistant bacteria.

Melanie: Professor, is the use of antibiotics only in humans, or also in animals? And along the lines of that question, since this resistance is happening, and that overuse of antibiotics, does that include antibiotics that show up in our milk, in our food, in our chicken that are being used for livestock? Is that kind of all combined?

Allon: That's a very good point. The humans, when they meet the antibiotics, it doesn't matter if they come through the doctor's prescription because of an infection, or if they come through the food that we eat. It's definitely a known problem that antibiotics are used, for example, in chicken as a growth promoter. Antibiotics are used occasionally in cows to treat all sorts of infections, and the antibiotics which are given to the animals which are then served in our dinner, if they have antibiotics, they are passed to the human.

So we must be aware that some governments do not regulate well enough the use of antibiotics in animals, and that's a way for antibiotics to increase resistance in the animals, and then these animals also pass their bacteria to humans.

Melanie: So along those lines, hospitals are seeing this issue within their own surroundings. Tell us some of the most common causes of hospital acquired infections. What kinds of infections are spread in the hospital, and how are they spread?

Allon: So we deal for the past thirty years in infection control, and for the past ten years, infection control has been put into a very central part of our everyday lives, and infection control really has two parts. One is the hospital associated infections. A patient comes in for surgery, and unfortunately his wound is infected, so we try to prevent hospital acquired infections, sometimes it's termed healthcare associated infections.


There are two other parts of infection control, is to try and eliminate the forming of resistant bacteria, and these are actually two processes which are linked because healthcare associated infections are often over 70% caused by those resistant bacteria. So we put a lot of effort, the medical profession has now put many guidelines into how to control infections, and infection control has become for years now a very important part of our medical life, and through those guidelines, how to prepare patients for surgery, how to treat central lines inserted into patients, how to prevent pneumonia in the hospital. These guidelines help us lower the number of infections- of healthcare associated infections.

Melanie: Professor, what strategies do you use to reduce the spread of healthcare associated infections and resistant bacteria? And is this something that gets implemented within the healthcare setting with all employees, like washing their hands, for example?

Allon: Well we've increased our infection control team. We now have doctors dealing solely with this in the hospital. We've increased the number of nurses in our infection control team. I must say that our administration has been very supportive. The head of the hospital is now head of the infection control committee of the hospital, so we really feel that infection control comes from the top all the way to the person who cleans the rooms, and we put a lot of effort into thinking how can we reduce infections?

In fact at Hadassah, the year 2018 has been chosen to be the infection control year, and we are trying to have all sorts of projects in different departments all aimed at lowering the number of resistant bacteria and the number of hospital acquired infections.

Melanie: Professor, you do some amazing research. Tell us a little bit about your bacteriophages therapy. What is it? And how can it help in this bacteria resistance that we're seeing?

Allon: The bacteriophages story is an amazing story. Many years ago, Russians already found bacteriophages, which are viruses attacking bacteria can be used for medical purposes, but they never really were able to provide this as medicine. Since we now have these bacteria which are resistant to any antibiotics, we look for new methods to treat. And just a few weeks ago, we were able for the first time in Israel to use specific bacteriophages against a patient's bacteria.

The way we did this, and this was done in collaboration with Professor Schooley from California University, and his work was in Navy State Laboratory and adapted stage therapy. They all worked together to help us to provide our patients with new treatments. A professor at my department, Professor Nir-Paz was the physician scientist, worked in collaboration with a Dr. Hazan from the Hebrew University from our medical school. Dr. Hazan is an expert in bacteriophage production, and together we were able to take the patient's bacteria to find specific phages which would act against the bacteria. Once we found these phages, and this was with the help of Professor Schooley, we were able to take the bacteriophages and inject them to the patient.

The specific patient was a cab driver who had a severe accident, he broke both of his legs, and one of the legs got infected with Acinetobacter resistant to all antibiotics. And with the help of these bacteriophages, which were injected to him intravenously, we were able to hopefully cure his infection. Until we gave him the bacteriophages, the wound was infected, oozing with pus, and now that we've given him the treatment - this was already three or four weeks ago - we could see that his wound was healing, he was able to be discharged naturally. A few days ago was his first day in rehabilitation.

Now this is the beginning, this was the first patient in Israel to get this treatment, maybe the fifth or sixth patient in the world, and we are hoping at Hadassah to- this is Nir-Paz and Doctor Hazan, we are hoping to have the phage treatment center which would provide solutions for patients who have bacteria resistant to all antibiotics. This is the future.

Melanie: That's absolutely fascinating, Professor. So to wrap up, what would you like listeners to take away from what you're doing at the Hadassah Medical Organization? Is there something that we can all do to help stop the spread of infectious diseases that are becoming resistant to antibiotics? And for providers, we're learning more about stewardship, and antibiotic stewardship. So what would you like us all to know about what you're doing there and how we can get involved?

Allon: Well I think that everyone should know, if they're patients, that they must ask their doctor to wash their hands. Hand hygiene is first and foremost important. You always have to ask your doctor whether you really need antibiotics. So this is a general recommendation if someone is unfortunately a patient.

In terms of help for our project, I think that any support for opening our Hadassah Center for Phage Treatment would be fantastic. It's a way- we are working in a small lab, and to be able to overcome all difficulties of producing mass production of phages which would be delivered to our patients, it takes a lot of effort and also the support which we are looking for. In fact, Professor Nir-Paz and Dr. Hazan just received a very nice grant from the Binational Foundation in Israeli and America. So I think it's the beginning, but our future is to open a big center which will provide treatment for the whole of Israel.

Melanie: Wow, thank you, Professor, so much for being with us today and for sharing your expertise on this fascinating topic of bacteriophages therapy and the research that you're doing at the Hadassah Medical Organization, and also the ways that we can really get involved and use good information about antibiotic resistant bacteria and infectious diseases. Thank you again for joining us today.

This is Hadassah On Call: New Frontiers in Medicine, brought to you by Hadassah, the Women's Zionist Organization of America. The largest Jewish women's organization in America, Hadassah enhances the health of people worldwide through medical education, care, and research innovations at the Hadassah Medical Organization. For more information on the latest advances in medicine, please visit www.Hadassah.org, and to hear more episodes in this podcast series, please visit www.Hadassah.org/podcasts. That's www.Hadassah.org/podcasts. I'm Melanie Cole, thanks so much for listening.