Increasing numbers of germs are resistant to antibiotics – and endanger human lives. Dr. Can Imirzalioglu and his team are researching these pathogens to prevent them from spreading. In this interview, Imiraglioglu — the medical director of the Institute for Medical Microbiology at the University Hospital in Giessen — explains his strategy and what each individual can do to prevent the spread of antibiotic resistance.
Why are multi-resistant germs dangerous?
Dr. Can Imirzalioglu: These pathogens, which are associated with many outbreaks of infections in hospitals, are characterized by the fact that they colonize in the intestines of many people. It is now assumed that up to ten percent of the population carry such resistant pathogens permanently in their intestinal flora. For some pathogens, we have received indications that they occur more frequently in the population than in the past. The problem with all multiresistant pathogens is that they can colonize in the intestine for years or decades without causing symptoms. These pathogens can spread more than others and pass on their resistance.
How can the pathogen spread?
Dr. Can Imirzalioglu: For example, these pathogens can trigger an infection in a patient after an operation, which may also mean a weakening of the immune system. Or he may pass the germs on to other people in the hospital. For example, if a resistant E. coli bacterium sits next to a non-resistant bacterium in the intestine, the first bacterium can pass on the resistance to the second. But these transmission mechanisms are difficult to understand.
What exactly are you working on?
Dr. Can Imirzalioglu: Within the framework of the German Centre for Infection Research (DZIF) we are mainly concerned with the problem of the spread of multi-resistant Gram-negative pathogens such as Escherichia coli and Klebsiella pneumoniae. By means of gene analyses we can gain deep insights into the spread patterns of the multi-resistant pathogens. This gives us the opportunity to develop new approaches to combat the spread, prevention, diagnosis and therapy of infectious diseases.
What results have you achieved so far?
Dr. Can Imirzalioglu: We have been able to gain a wide range of insights into the spread of resistances and multi-resistant pathogens in humans, animals and the environment. Among other things, we have detected the resistance gene mcr-1 for the first time in Germany. This gene conveys resistance to an absolute reserve antibiotic. We were also able to show that a transfer from animals to humans probably took place here. Through the use of certain antibiotics in animal breeding, this resistance gene was able to spread and was then probably gradually transferred to humans.
What can be done against the spread of antibiotic resistance?
Dr. Can Imirzalioglu: For me, it is important to stress that everyone can influence the spread of antibiotic resistance through their actions and activities. A lot depends on our own attitude and how we deal with diseases. Of course, we must also take responsibility for countries where resources are not as available as they are here. That is why a global, holistic approach involving each individual is the only way to prevent the situation from worsening further in the long term.
What role does digitisation play in your research?
Dr. Can Imirzalioglu: The genome analyses we perform are based on processes from bioinformatics. In cooperation with the Department of Systems Biology and Bioinformatics, we have developed various processes for the analysis of these data. So far, we are still working without approaches from artificial intelligence. But in the future, this could have a significant influence on the performance of complex analyses. For example, the use of artificial intelligence could simplify genomic sequencing and bring it into clinical routine. This would result in enormous added value for patients because scientific findings could be quickly transformed into diagnostic and therapeutic approaches.
How do you cooperate with other institutions?
Dr. Can Imirzalioglu: On a local level, we work together with other clinical departments of the University Hospital Giessen, such as Infection Medicine and Urology, but also with veterinary colleagues. At the Hessen level, we cooperate with other university institutions in Frankfurt and Marburg that are active in this research area, and with the Hessen State Examination and Health Authority. On a national level, we are networked with other DZIF locations and the Robert Koch Institute. But we also have a wide range of international cooperations, such as in India, France and Spain. Our role in these collaborations is to precisely characterize the bacterial pathogens and to confirm certain properties experimentally. By means of bioinformatic analyses, we can prove or confirm epidemiological relationships.