In the 1990s, when Dr. Robert Bonomo began studying how bacteria became resistant to antibiotics, he had a limited view of the issue.
At the time, he and his peers thought resistance was just what they could observe, but unfortunately, the problem has escalated, said Bonomo, medical service chief at the Louis Stokes Cleveland VA Medical Center. Today, the World Health Organization calls antibiotic resistance "one of the biggest threats to global health, food security and development today."
With this in mind, Case Western Reserve University School of Medicine and the Cleveland VA have teamed up to study and tackle antibiotic resistance through the establishment of a new center.
Bonomo will be the director of the new Case VA CARES (CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology), which will include work ranging from basic science to drug discovery to new treatment approaches.
"As a result of this escalating crisis, we've been faced with challenges clinically," said Bonomo, who also is a professor at the CWRU School of Medicine. "The challenges that the future holds (are) even more scary than the present."
Increasingly, bacteria and other microorganisms are developing resistance to the antibiotics used to kill them, both imperiling health and adding to health care costs as doctors try different medicines, according to a news release. Studies show antibiotic resistance adds as much as $20 billion per year in excess direct health care costs.
"The antibiotics that we have now are not going to be able to stop resistance," Bonomo said. "We have to think of other ways."
Every year, at least 2 million people in the United States are infected with antibiotic-resistant bacteria and at least 23,000 die as a result, according to the Centers for Disease Control and Prevention.
The inappropriate use of antibiotics in humans and in livestock have contributed to the growth in antibiotic resistance, Bonomo said — plus the "inevitable consequence of evolution," as bacteria fight to survive.
Because the problem is a moving target, the center and a multidisciplinary group of dedicated researchers are crucial, he said.
Roughly a dozen physicians and scientists have been collaborating with Bonomo for years and have published about 100 papers in total.
Case VA CARES formalizes this work and is a timely partnership for a "critically important problem," said Dr. Murray Altose, chief of staff at the Cleveland VA. It provides a more systematic, organized approach to coordinating basic science, clinical science and patient care, he said.
Scientists and physicians with Case VA CARES will conduct new research, modify existing antibiotics, work toward new ones and use decoys to trick uncooperative bacteria.
The new center, one of only a handful of its kind in the country, is likely to benefit from Bonomo's connections to labs and scientists around the world. He developed this network over his more than two decades of work, during which he published nearly 340 peer-reviewed manuscripts of original research in scientific journals.
Mark Chance, vice dean for research at the CWRU School of Medicine, said the new center both recognizes Bonomo's accomplishments and gives him a foundation to expand his work with new faculty and recruits, as well as the involvement of other departments.
The loosely affiliated group of researchers that have studied antibiotic resistance with Bonomo have many strengths, Chance said, but there are some gaps that the new center can help to fill as CWRU and the VA pool resources.
The center's faculty members will come from both organizations and have expertise in infectious diseases, microbiology, molecular biology, biochemistry, pharmacology, proteomics and bioinformatics. Over the next few years, the goal is to bring about three new recruits to Cleveland to join the center with a focus on junior people to mentor and develop over time, Chance said.
"It's part of the brain gain strategy of building high-quality programs around the medical school, around the university, leveraging the assets in Cleveland," he said.
Cleveland can be a bit "pigeon-holed" as a medical device town, Chance said, but it can become equally successful in other biotech areas. Case VA CARES is a step toward that.
"We're already recognized for being a great health care center," said Bonomo, who also is a member of the National Institutes of Health-funded Antimicrobial Resistance Leadership Group, which addresses priorities for clinical research on antibiotic resistance.
"I think this broadens the impact of the health care delivery that Cleveland can bring and lead for the rest of the world," Bonomo said.
Although the center is a partnership between CWRU and the VA, Chance said that medical affiliations or appointments in other hospitals across the city will help make the effort Cleveland-wide.
"We want to make sure the researchers have the maximum opportunities for collaboration with other researchers, that they have the best equipment, and just sort of a level playing field across the entire city where they can go wherever they need to go to get things done," Chance said.