Waging War Against Drug-Resistant Bacteria

    • October 7, 2013

As a child, Jason Farley had been taught that HIV was a punishment from God toward gay people. He secretly believed that he himself would one day be punished for being gay with the virus that causes AIDS.

“I thought HIV was something I would wake up one morning and discover I had,” says Farley, PhD, MPH, CRNP, a Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholar (2012-2014) and an assistant professor of nursing at Johns Hopkins University. 

But he learned the true etiology of HIV early on as a nursing student—a revelation that fueled his desire to study and care for people with the disease. He credits a progressive course, taught by Susan Gaskins, DNSc, MPH, RN, ACRN, in an undergraduate nursing program at the University of Alabama for the epiphany. “It opened my eyes to the biases I had been exposed to growing up and set me on a path that gave me a passion for working with people living with the disease,” he says.

In his senior year of college, Farley identified and pushed for a clinical placement at a distant HIV/AIDS clinic—the only one he knew of in the entire state. While there, he met a number of mentors who inspired him to advance his education so he could learn more about HIV and study ways to help the many types of people it affects, regardless of sexual orientation, race, socioeconomic status, or religious affiliation.

After earning separate master’s degrees in public health and nursing, Farley enrolled in a doctoral program at Johns Hopkins University and, at the same time, worked as an infection control epidemiologist at Johns Hopkins Hospital, where there was an emphasis on reducing the spread of Methicillin-Resistant Staphylococcus aureus (MRSA) and other antibiotic resistant organisms within the hospital.  This experience led Farley to study antibiotic resistant organisms in people with HIV infection. 

Farley completed a doctoral dissertation about the prevalence and molecular epidemiology of MRSA among newly arrested men within the Maryland Department of Corrections. He found that 16 percent were colonized by the bacteria—far higher than the 1 percent rate in the general U.S. population. The findings added greater evidence against the conventional wisdom at the time, which held that MRSA colonization and infections were acquired in hospitals but were less likely in community settings. “The study added further evidence to the changing paradigm,” he said. “We were seeing MRSA in subjects who had never been hospitalized.”

MRSA Deeply Misunderstood

Farley conducted a subsequent study that found similar rates of carriers of drug-resistant bacteria in newly admitted psychiatric patients at Johns Hopkins Hospital. And he will soon publish another study showing that routine testing procedures for drug-resistant bacteria—a major threat to patients with HIV—are inadequate. He says that is further evidence that MRSA is deeply misunderstood in the health care system.

“It is essential that we determine ways of preventing antibiotic-resistant organisms,” Farley said, noting that they pose a threat not only to patients but also to health care facilities, which must bear increasing financial costs associated with the spread of infection.

As an RWJF Nurse Faculty Scholar, Farley is evaluating the spread of MRSA in individuals with HIV and their household members. He is examining two approaches to eradication in people colonized by MRSA. In one group, individual patients receive chlorhexidine soaps (Hibiclens), mouthwashes, and antibiotic creams to eradicate the bacteria. In another group, the individual, as well as members of his or her entire household, are treated. “The key question is: If we have a more holistic approach, will we see longer intervals between when people become carriers of the bacteria and ultimately, will this intervention reduce infection?”

Farley’s work is not limited to the United States. An adjunct associate professor at the University of Kwa-Zulu, Natal, in South Africa, Farley is studying HIV patients there with strains of tuberculosis that are resistant to multiple drugs (MDR-TB). Although rare in the United States, tuberculosis is the leading cause of death globally among patients with HIV and the leading cause of death among all people in South Africa.

In an earlier study, Farley found poor treatment outcomes for South Africans with MDR-TB prior to antiretroviral therapy. That led to another study assessing knowledge, attitudes, and practices related to infection control at hospitals in South Africa that treat HIV patients with MDR-TB and work to increase access to effective treatments for the disease.

In addition to his research and teaching responsibilities, Farley works as an adult nurse practitioner at an outpatient clinic supervised by the Hopkins AIDS Service, serves on the editorial board of the American Journal of Infection Control, and is teaching a new massive open online course on global tuberculosis clinical management and research. He was recently elected to the position of president-elect of the Association of Nurses in AIDS Care, a position he will begin in January 2016. 

Over the past few decades, Farley has traveled far on the path he set out on as a young university student, and the world is taking notice of the groundbreaking work he is doing to treat patients with HIV. One recent example: Earlier this year, he was inducted as a fellow into the American Academy of Nursing, one of the profession’s most prestigious honors. “Becoming a member of this distinguished group of nurses demonstrates wonderful recognition of my research, clinical practice, and education in HIV and associated co-infections,” Farley said.

It also sends a very different message than the one he got as a child—a message grounded in acceptance and hope, rather than fear and ignorance.