Is Antimicrobial Resistance Threatening Modern Medicine? with Jennie Kwon, DO

Erin Spain, MS: Since the COVID-19 pandemic, there has been a renewed recognition of just how essential infectious disease research is, not only in moments of global crisis, but in the everyday care happening across hospitals and clinics. Today we’re joined by a leader at the forefront of that work. Dr. Jennie Kwon is a physician-scientist, the Gene Stollerman Professor of Medicine, and the newly appointed chief of infectious diseases at Northwestern University Feinberg School of Medicine. Her work brings together clinical care, medical education, and research with a focus on what some say is one of the most pressing challenges in medicine today: antimicrobial resistance. Her lab studies how resistant organisms emerge, persist, and spread across patients, healthcare settings, and the environment. We’re delighted to have her on the show today to talk with us about her new leadership role and what’s ahead for infectious diseases research at Northwestern Medicine. Welcome. 

Jennie Kwon, DO: Thanks for having me, Erin. I am so excited to be here with you. 

Erin Spain, MS: You’ve taken on this major leadership role at Northwestern. Tell me about your decision to step into this position. 

Jennie Kwon, DO: I think we know that academic medicine, in particular the field of infectious diseases, is at a critical inflection point. Clearly, the status quo is no longer acceptable and the vulnerabilities in our academic systems have been laid bare, especially with the pandemic and all of the external pressures that we face. This opportunity to join Northwestern is one for someone who wants to reimagine the field of infectious diseases. It is for someone who wants to prepare us for what’s to come, to train that next generation of leaders, and to support our scientists as we learn about new and reemerging infectious diseases. We also need to continue to provide the best clinical care for our patients. I’m here because I sense at Northwestern that there is a hunger to be a better version of ourselves, to be resilient, and to prepare for that new future. I think that at Northwestern University, we are prepared to meet that challenge. It was a very easy decision for me. 

Erin Spain, MS: Let’s go back to COVID-19 for a bit. Tell me about your role during that time, and in the big picture, how our understanding of the importance of infectious diseases research changed during and after the pandemic. 

Jennie Kwon, DO: I was able to see firsthand the impact of the pandemic on not just our patients, but our healthcare workers. Globally, what the pandemic showed us is that we really need to be aware of infectious diseases and the threats they pose to all of modern society. What other kind of disease has brought the entire global economy and nations of people to their knees? We learned from COVID-19 that infectious diseases are not just limited to one person or one healthcare system. This is something everybody needs to care about. When it comes to antimicrobial resistance, this is truly a global public health threat. 

Erin Spain, MS: Let’s talk about your lab and your research. Tell me about the mission of your lab and what you’ve brought to Northwestern Medicine. 
 
Jennie Kwon, DO: We are dedicated to our mission of combating antimicrobial resistance. We want to explore novel ways to detect, prevent, and treat antimicrobial-resistant infections. Our team is driven by the sense of urgency that we need to create real-world solutions to this crisis. 

Erin Spain, MS: Tell people more about the antimicrobial resistance (AMR) crisis. What is it exactly? Why is it such an urgent issue? 

Jennie Kwon, DO: Imagine a world where we can’t do routine surgeries or give chemotherapy to cancer patients because it is too dangerous. Why? Because these things can suppress immune systems and make people more likely to get infections. We are nearing a time where we won’t have enough antibiotics or antifungals to treat these resistant infections.When that happens, modern medicine can no longer practice in the way that it does or make the advances that it makes. This is why we need to care about it. This is not just about the infection itself, but the way we practice medicine.The issue is that we don’t have enough new agents to combat these infections, and the pace of drug development and approval takes a lot longer than the time it takes for an organism to become resistant. We really have to do something now as a society before it’s too late. 

Erin Spain, MS: Can you talk about what you’re seeing day-to-day in the hospital that illustrates this problem? Are infections becoming noticeably harder to treat? 

Jennie Kwon, DO: Absolutely. What made me interested in this field is when I was a medical student in the Chicago area taking care of a patient who had a liver transplant. As you can imagine, the patient went through so much to be able to survive, and the healthcare system poured so much into this person to give them a chance to live a fulfilling life. When I saw this individual, they were critically ill in the ICU and turned out to have an extremely drug-resistant bacterial infection. At that time, it was so resistant there simply wasn’t an antibiotic we could give this individual to save them, and they ultimately went on hospice care. As a student, that left a lasting impression on me.It was a combination of emotions. I remember feeling extremely sad to see this patient go and seeing what the family had to go through. But there was also a sense that this isn’t right; it shouldn’t be this way. How is it that we have the most advanced medical system in the world, yet patients succumb to an infection because we can’t treat it? That was the light bulb moment where I realized this is what I want to do with the rest of my life. I dedicated myself to this because people should not die because we can’t treat their infections. 

Erin Spain, MS: Tell me how you’re tackling this problem. I know you’re looking at where these resistant organisms live—whether it’s the gut or the skin. Why is the environment such a critical piece of this puzzle? 

Jennie Kwon, DO: As a physician-scientist, I try to cross barriers with my research. I try to understand what matters at the patient level when I’m at the bedside, and what we can do as a multidisciplinary team to create solutions. We take questions from our rounds, such as: How did this patient get this infection in the first place? Where did it come from? We turn that into research. I am interested in understanding the reservoirs for resistant organisms. Is it in the gut microbiome? Is it in the environment? Does it get transferred into the person to cause an infection? We leverage relationships with genomicists, bench scientists, clinicians, and epidemiologists to answer these clinically relevant questions and create novel but pragmatic solutions. I view this research as highly relevant and something that can directly make people’s lives better. 

Erin Spain, MS: You mentioned the microbiome, and we’re hearing so much more about its importance these days. You’ve studied how antibiotics themselves can disrupt the microbiome and increase the risk for infections like C. diff. Can you walk us through how antibiotic exposure alters the microbiome and contributes to the risk for resistant infections? 

Jennie Kwon, DO: Antimicrobial resistance can be silent and then suddenly cause severe infections. Our team conducted a study where we recruited healthy people and gave them common antibiotics received in the outpatient setting—just five days of oral antibiotics. We looked at what happened to their gut microbiome before, during, and for six months after the treatment. We followed these folks for about six and a half months to get a comprehensive look at the short-term and long-term impact on the gut microbiome. In the 20 individuals we studied, right after taking antibiotics, everyone had a disruption in their microbiome. The diversity of organisms decreased, and we saw an increase in the amount of antimicrobial resistance genes present in the gut microbiota. We then compared those individuals to patients in the ICU. We found that the microbiomes of people who took antibiotics temporarily shifted to look similar to the gut microbiomes of ICU patients. In good news, after six months, the majority went back to their pre-antibiotic state. There was a gut resilience that showed the microbiome can return to how it looked before. However, for three individuals, their gut shifted toward that ICU-like state and stayed there for three months. This is what we call an antibiotic scar. These are lasting damages to the gut microbiome that reduce our resistance toward these organisms. If we had repeated exposures, multiple scars could form. In that scenario, we could eventually become someone who gets an infection with a resistant organism. This is foundational data that is being used in the antimicrobial stewardship world to show what antibiotics can do to a gut microbiome. 

Erin Spain, MS: What can clinicians or everyday people do if they are given a course of antibiotics to help protect that microbiome and prevent some of these scars? 

Jennie Kwon, DO: These are exactly the types of questions we are researching now. From a patient and clinician standpoint, what’s clear is we should not be giving or taking antibiotics unless we truly need them. We want to make sure they are for an infection that can be treated with antibiotics, not necessarily a virus or other reasons. It is due diligence for all of us to ensure there isn’t an alternative cause. Antibiotics are not harmless; the people who receive them and get these scars don’t know it’s happening, but we can detect it through our research. Point number one is to make sure we only take antibiotics if we truly need them. What we don’t know yet is exactly how to better detect this or have strategies to reduce colonization with resistant organisms. These are the types of studies our group is working on, and I know it is a priority in the research world right now. 

Erin Spain, MS: What steps should be taken in the next five years to ensure antimicrobial resistance is at the forefront of people’s minds and we’re able to start implementing new drugs to attack this issue? 

Jennie Kwon, DO: We need to be proactive rather than reactive. We have to leverage the knowledge and relationships—especially between the public and private sectors—that we gained during the pandemic. We must work together as a unit with academia, medical societies, industry, and policymakers to create work that preserves modern medicine. We need to act decisively on next-generation diagnostics and therapeutics, and think about creative ways to prevent these infections. A scientist alone cannot do this; we all have to work together. This is best exemplified by the work of the National Action Plan to Combat Antibiotic-Resistant Bacteria. This is important not just at the local level, but at the federal level as well.  

Erin Spain, MS: Is this happening all over the world? Are there countries where this isn’t as prevalent, or is it mostly in Western countries? 

Jennie Kwon, DO: Antimicrobial resistance is a global pandemic. It is estimated by the WHO that if we do nothing, by 2050 antimicrobial resistance will kill more people than cancer. It is something we need to be aware of and work toward globally. 

Erin Spain, MS: Are there any collaborations you’ve been able to start at Northwestern to investigate these ideas? 

Jennie Kwon, DO: Oh my goodness, there are so many fantastic people to work with here. I’ve been here for less than six months and have already met with great people in basic sciences and implementation science to start putting together proposals and real-world studies to combat this crisis. 

Erin Spain, MS: There is that gap between research and real-world practice. What does it take to turn these insights into something that can improve patient care? 

Jennie Kwon, DO: In all of medicine, it often takes years, if not decades, to put actual evidence into medical practice. In the past, we moved at a slower pace than we should, but we don’t have that luxury now. When we find medical insights, it is upon us as physician-scientists to partner with leaders in our healthcare system and university to build those insights into our systems to prevent patient harm. Northwestern is a fantastic place for that because our campuses are connected; for instance, I can walk to the clinic right from my lab. We are in a great place to take what we find at the bench and translate it into patient care. 

Erin Spain, MS: As you lead this division forward, where do you see the biggest opportunities to make progress in the field of infectious diseases? 

Jennie Kwon, DO: Infectious diseases are at an important crux as we continue to define ourselves after the pandemic and years of work on the HIV epidemic. We have to reimagine the future. As medicine and funding move, we must be creative and think about not just the infections of the past, but the new and reemerging pathogens that threaten society. I spent my first few months listening to our faculty, staff, and leaders. I feel very lucky to be here with smart and thoughtful people who care about Chicago and the health of the nation. We are focusing on our strengths and opportunities and coming together for a strategic planning session to create our mission and vision. I’m working with people who have been here for decades, and we are going to build a mission for our team together. 

Erin Spain, MS: Thank you so much for coming on the show and sharing your vision. We can’t wait to see what’s next for the Division of Infectious Diseases at Northwestern. 

Jennie Kwon, DO: I am so thrilled to be here. Thank you for the time. 

Erin Spain, MS: Thanks for listening. Please click the bell to receive notifications about our latest episodes and follow us on social media @NUFeinbergMed to stay up to date with our latest research findings. 

Physicians who listen to this podcast may claim continuing medical education credit after listening to an episode of this program.

Target Audience

Academic/Research, Multiple specialties

Learning Objectives

At the conclusion of this activity, participants will be able to:

1. Identify the research interests and initiatives of Feinberg faculty.
2. Discuss new updates in clinical and translational research.

Accreditation Statement

The Northwestern University Feinberg School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit Designation Statement

The Northwestern University Feinberg School of Medicine designates this Enduring Material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Board of Surgery Continuous Certification Program

Successful completion of this CME activity enables the learner to earn credit toward the CME requirement(s) of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.

Disclosure Statement

Jennie Kwon, DO, has nothing to disclose. Course director, Robert Rosa, MD, has nothing to disclose. Planning committee member, Erin Spain, has nothing to disclose. FSM’s CME Leadership, Review Committee, and Staff have no relevant financial relationships with ineligible companies to disclose.

All the relevant financial relationships for these individuals have been mitigated.