In October, ARLG co-principal investigator Vance Fowler shared insight from his two decades studying Staphylococcus aureus as part of an IDWeek 2020 lecture titled “Staphylococcus aureus: Lessons Learned from 20 Years with the Persistent Pathogen.” The Finland lecture is awarded each year to someone who has made key contributions in the areas of bacterial pathogenesis, antimicrobial agents, emerging infections, and hospital-acquired infections.
Dr. Fowler began the lecture by discussing his first major lesson: “plans change.” While in residency, he thought his career would be dedicated to studying malaria in East Africa but his mentor, Ralph Corey, MD, suggested he study S. aureus instead. During his residency, he started the S. aureus Bacteremia Group (SABG) that has been central to his career.
“Dream big, start small” was the second major lesson Dr. Fowler highlighted as he described the influential clinical and translational work that has been performed through the SABG over the last 25 years. His group was able to show that patients with S. aureus bloodstream infections now have more comorbidities, higher rates of prosthetic devices, and are more likely to have severe disease with metastatic sites of infection than patients with S. aureus bacteremia 20 years ago. Dr. Fowler discussed how research through the SABG has generated key clinical practice recommendations for treating patients with S. aureus bacteremia. His group led some of the original studies showing the importance of performing echocardiography, consulting infectious diseases, and using the appropriate antibiotics. Each of these interventions was subsequently shown to significantly decrease mortality in patients with S. aureus bacteremia in large datasets and are now considered standard, evidence-based practices.
In the third and fourth major lessons presented, Dr. Fowler shared that even the most thorough bedside evaluation can be limited which is why biorepositories of patient samples can be crucial to answering clinical questions. Dr. Fowler’s lab has been able to use a large biorepository of samples from patients with S. aureus bacteremia to answer important translational question including understanding 1) which patients with S. aureus bacteremia and cardiac devices will develop a cardiac device infection and 2) which patients with methicillin-resistant S. aureus bacteremia will develop persistent bacteremia. Both of these questions were inspired by bedside clinical questions but involved using the biorepository to investigate mechanisms in the pathogen and host response. Dr. Fowler urged other institutions to create similar biorepositories as a way to promote hypothesis-generating and hypothesis-testing research.
Dr. Fowler concluded his lecture by stating that trainees led and published much of the research he presented and emphasized the importance of mentorship. He thanked his mentor, Dr. Ralph Corey, for believing in him and expressed his hope to provide the same support for current infectious diseases trainees.
Article by Jessica Howard-Anderson, MD, MSc