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TYPE Field Grand Challenge

PUBLISHED 10 February 2023


DOI 10.3389/fbrio.2022.1005421

Frontiers in bacteriology:
OPEN ACCESS Challenges and opportunities
EDITED AND REVIEWED BY
Myron Christodoulides,
University of Southampton, Eleftherios Mylonakis*
United Kingdom
Division of Infectious Diseases, Rhode Island Hospital and The Miriam Hospital, Alpert Medical
*CORRESPONDENCE School of Brown University, Providence, RI, United States
Eleftherios Mylonakis
emylonakis@Lifespan.org

RECEIVED 28 July 2022


ACCEPTED 22 August 2022
It is a Frontiers tradition to herald the start of a new journal with an editorial that
PUBLISHED 10 February 2023
highlights the challenges and opportunities of the relevant field. For Frontiers in
CITATION
Mylonakis E (2023) Frontiers in
Bacteriology, the start of the journal coincides with a pivotal era for the field,
bacteriology: Challenges with the slow-moving epidemic of antimicrobial resistance threatening
and opportunities. medical progress.
Front. Bacteriol. 1:1005421.
doi: 10.3389/fbrio.2022.1005421
KEYWORDS
COPYRIGHT
© 2023 Mylonakis. This is an open- bacteriology, medical progress, antibacterial resistance, medicine discoveries, one
access article distributed under the health (OH) - approach
terms of the Creative Commons
Attribution License (CC BY). The use,
distribution or reproduction in other
forums is permitted, provided the
original author(s) and the copyright
owner(s) are credited and that the
original publication in this journal is
cited, in accordance with accepted
academic practice. No use, Bacterial drug resistance and the
distribution or reproduction is
permitted which does not comply with challenges ahead
these terms.

Antibacterial agents, combined with infection prevention measures, have allowed for
medical treatments and procedures, such as cancer chemotherapy and transplantation.
These breakthroughs have resulted in a sharp rise in life expectancy (Hutchings et al.,
2019). Microbial resistance can undermine all Medicine discoveries (World Health
Organization, 2022). Our current approach is centered on leveraging chemical
compounds that target bacterial pathways. However, bacteria have shown that they
can overcome these treatments, and we are starting to understand the long-term effects of
these treatments to cross-kingdom interaction and the microbiome. The challenge of
bacterial drug resistance can only be addressed through a multidisciplinary approach that
moves outside of silos.

Bacteriology is a One Health Science


Bacteriology impacts food safety and health equity (Lambraki et al., 2022; Shurson
et al., 2022) and we are coming to appreciate that bacteriology and the challenge of
antimicrobial resistance is a One Health challenge (World Health Organization, 2017),
where veterinary treatments, use of antibacterial agents in aquaculture and agriculture,
and environmental factors (including climate change) all affect the bacterial world and

Frontiers in Bacteriology 01 frontiersin.org


Mylonakis 10.3389/fbrio.2022.1005421

the development of resistance. As humans, we are guests in an evaluation of large data which minimize the use of “empiric
environment that is shaped by microorganisms. Even within our therapy” and allow for a personalized approach to antibacterial
own bodies, our cells are a minority compared to our different prophylaxis and treatment (Corbin et al., 2022). Selection of
microbiota and especially bacteria. The interplay between host, optimal treatment and development of clinically reliable
bacteria, and the environment is dynamic and continual and we biomarkers for response to treatment are needed. The role of
also have a permanent effect in the bacterial world (for example, providers needs to extend from providing treatment against a
consider for a second the effects of hospital wastewater or the use specific pathogen, and focus on providing timely, minimal, and
of antibacterial agents for human activities). In this context, effective treatment as well as the recovery of a healthy
expanding our thinking about bacteriology should also include microbiome and eubiosis (microbial balance within the body).
studies that help advance health equity and help alleviate In this context, there is growing interest in steps to restore the
inequity (Mitnick et al., 2016). microbiome after an infectious disease and its treatment.
Importantly, antibacterial therapy, infection prevention, and
antimicrobial stewardship need to be considered in the
A new approach to continuum of care, and encompass outpatient, acute, and
antibacterial discovery long-term care, including nursing homes.
Addressing the slow-moving pandemic of bacterial resistance
Historically the role of bacteria was mostly investigated in requires a revamped and realistic approach to antimicrobial
the context of disease. However, as we realize the impact of the drug discovery and a requires a complete rethinking of the
microbiome in overall health, future studies in bacteriology will antimicrobial market chain that includes early concepts, screens,
need to evaluate the impact of broadly defined dysbiosis (an hit to lead development, and every step included in the
imbalance between the types of organism present in a host’s development of new antibacterial therapies. This is particularly
natural microflora) (Naylor et al., 2018). Understanding vaccine urgent as most large pharmaceutical companies have moved out
development and the use of bacteria as probiotics or as part of of this market, and smaller companies cannot survive even when
treatments to combat cancer or other infections (Sedighi et al., they have a product that makes it through regulatory approval,
2019) also requires deep understanding of bacterial immunity new incentives, and a complete revaluation of the market that
and the evolution of virulence traits and immune responses. includes cross-border cooperation, smart incentives, and rewards
Moreover, we are discovering the complex role of the linked to availability and not the use. The bankruptcy of Achaogen
microbiome in controlling resistant pathogens and how it and other similar failures are well documented and remind us that
influences the immune system, metabolism, and a range of the antibacterial market needs to be revisited (Jit et al., 2020;
gastrointestinal conditions (Zheng et al., 2020). Aagaard et al., 2021) towards a framework that provides a positive
This complex challenge also includes a renewed approach in collaboration between academia and the pharmaceutical industry.
antimicrobial drug discovery with whole animal testing and the
advancement of novel approaches such as anti-virulence agents
(Fleitas Martinez et al., 2019) and phages (Brives and Pourraz, An inter-disciplinary forum
2020), as well as immunomodulatory agents that enhance and for bacteriology
regulate the immune system to fight infection (Pirofski and
Casadevall, 2006; Fura et al., 2017). This new approach in To address these challenges, the field can benefit from an
antimicrobial drug discovery can draw on new mammalian inter-disciplinary forum that encompasses all different One
and non-mammalian model hosts, artificial intelligence (AI, Health disciplines and provide a forum for the reporting of
machine learning approaches), mathematical modelling, and a studies evaluating all aspects of bacteriology and the complex
personalized approach to bacterial prophylaxis and treatment dynamic of host-pathogen interactions. Frontiers in Bacteriology
that could include genomic analysis of the host, the pathogen, aims to become such a forum. We aim to publish rigorously
and the microbiome. peer-reviewed novel and cutting-edge research across the entire
spectrum of bacteriology, including pathogenesis, immune
response (including evolutionarily conserved traits), vaccine
Changing our approach to development, microbial resistance, beneficial bacterial
antibacterial therapy interactions (such as in the context of microbiome and
probiotics), cross-kingdom interactions, as well as translational
Clinical medicine also needs to change as we develop new and clinical studies on population health, diagnosis, treatment,
tools to identify bacteria and novel approaches to combat cost-effectiveness models, and antimicrobial stewardship.
diseases. The role of Microbiology and Infectious Disease Supported by an outstanding Editorial Board of international
needs to evolve in an era with rapid diagnostics and AI-aided researchers who cover all aspects of molecular and clinical

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Mylonakis 10.3389/fbrio.2022.1005421

bacteriology, Frontiers in Bacteriology multidisciplinary open- bacterial vaccinology, policy and public health measures,
access journal is at the forefront of disseminating and emerging bacterial threats, the impact of climate change,
communicating scientific knowledge and impactful discoveries molecular real time clinical diagnostics (including medical,
to researchers, clinicians, and the public worldwide. Using a veterinary, aquaculture, and agriculture), and discoveries in
system that allows for transparent peer review, we envisage a antimicrobial drug discovery and stewardship.
forum for high-level research on all bacterial phyla and all
different conditions such as biofilms, and persister or tolerant
forms (Yan and Bassler, 2019). In addition to the field of bacterial
Author contributions
pathogenesis, host response, and vaccine and drug discovery, the
journal also welcomes reports on human and veterinary bacterial
Each author who contributes to Frontiers in Bacteriology
infections, all pathogens (including mycobacteria, Helicobacter
will be paving the way to progress in light of the challenges we
pylori, etc.), and interactions of bacteria with bacteriophages. Also,
now face concerning antimicrobial resistance. The journal
we seek studies on clinical infectious diseases in the continuum of
welcomes a range of approaches, turning to the innovative and
care (including in the community and non-acute health care), as
novel in order to tackle the changing bacterial landscape and
well as studies focusing on relevant vaccines, veterinary medicine,
ensure we all live healthy lives on a healthy planet. The author
or the role of non-pathogenic and beneficial bacteria as parts of
confirms being the sole contributor of this work and has
the microbiome or their use as probiotics.
approved it for publication.

The challenge for the field and the


role of Frontiers in Bacteriology Conflict of interest
The author declares that the research was conducted in the
In order to preserve the medical advances of our era, we need
absence of any commercial or financial relationships that could
to address the challenge of microbial drug resistance and the
be construed as a potential conflict of interest.
need for a balanced bacteriome. This new era of bacteriology
requires a multifaceted approach that includes studying cross-
kingdom interactions and the use of novel antibacterial
approaches that include immune modulation, phage, and anti- Publisher’s note
virulence assays. Frontiers in Bacteriology aims to provide a
forum for this new era in bacteriology by publishing all One All claims expressed in this article are solely those of the
Health research related to the role of bacteria. We understand authors and do not necessarily represent those of their affiliated
the challenges that authors go through in order to prepare their organizations, or those of the publisher, the editors and the
manuscript and we hope to provide a home for innovative reviewers. Any product that may be evaluated in this article, or
research on the global impact of bacteria, highlighted aspects claim that may be made by its manufacturer, is not guaranteed
of evolutionarily preserved traits of host-bacteria interactions, or endorsed by the publisher.

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