Category Archives: Antibitoc Resistance

Infection Prevention Awareness Worldwide

 

 

 

In early 2020, a simple online hand-washing demonstration went viral. The video, created by a restaurateur in India and imitated by health-care professionals and breakfast-television hosts around the world, showed a pair of hands in clean disposable gloves receiving a glob of children’s paint in one palm. The hands then went through all the motions of correct hand washing and, in the end, the gloves were fully coated with paint.

This message, and others like it, have helped to make 2020 a golden year for infection-prevention awareness. During the COVID-19 pandemic, public-health officials have reached the masses with their messages about how to avoid infection. Now, having seen how various nations have dutifully scrubbed, sanitized and distanced their way to try to bring down the number of coronavirus cases, researchers and public-health specialists are keen to keep the momentum going for another reason: to stall the spread of infections that are becoming resistant to antimicrobial drugs.

Prevention first

Antimicrobial resistance is a threat to human life that exceeds that posed by COVID-19 by orders of magnitude. Unless practices change, by 2050, an estimated 10 million people will be dying every year as a result of resistant bacteria1. Antibiotics are common treatments for illnesses — whether or not they are caused by bacteria. A 2016 analysis showed that only about 70% of antibiotic prescriptions in US hospitals were appropriate2. And a systematic review of reports published between 1970 and 2009 on non-prescription use of antimicrobials showed that the drugs were frequently used to treat non-bacterial diseases3. Unsurprisingly, it also found that resistant bacteria were common in communities with high levels of non-prescription use. The resistant bacteria then spread from person to person through surfaces such as mobile phones.

 

Preventing infection is an important facet of nearly all programmes designed to promote effective use of antibiotics, an area known as antimicrobial stewardship. According to the World Health Organization (WHO), global efforts to preserve the effectiveness of antibiotics must include strategies for preventing any infection that might be treated with the drugs, whether justifiably or not. Teena Chopra, an infectious-disease specialist at the Wayne State University School of Medicine in Detroit, Michigan, is fully behind this approach. Because infections are difficult to diagnose and treat quickly, Chopra says that the biggest impact will come from preventing infections in the community, not just in hospitals.

Pandemic lessons

Christina Vandenbroucke-Grauls, a medical microbiologist at VU University Medical Center in Amsterdam, chairs a group that monitors hospital outbreaks of resistant bacteria in the Netherlands. Over the course of the COVID-19 pandemic, such infections have almost disappeared in the country, she says. “Apparently, people are a lot more careful.” The sharp reduction could be because hospital staff are more diligent about hand washing — and many suspect that this is also the case elsewhere.

Infection-control messages have been effective outside hospital settings, too. Many countries have seen a fall in the number of non-COVID-19 infections, such as seasonal influenza. In Australia, for instance, fewer people have died from flu this year compared with 2019. And Sweden declared the end of its flu season almost two months earlier than usual, despite its controversial light-touch approach to managing the spread of COVID-19.

Chopra is keen to keep this hygiene momentum going and points out that the pandemic has revealed considerable weak spots. “This COVID-19 pandemic exposed a lot of vulnerabilities in our core health infrastructure,” she says. “We dealt with a lack of infection control in alternative health-care settings, like nursing homes, schools, daycare centres, dialysis centres, nursing facilities and rehab facilities.” She thinks that those who run these services need to have a more prominent role in antimicrobial stewardship.

To help manage COVID-19, Chopra recruited medical students to assist with prevention efforts in residential care facilities in Detroit. They coordinated the regular testing of residents for SARS-CoV-2, the virus that causes COVID-19, and showed the staff how to group infected individuals together to contain any outbreaks. Community-level interventions have also been crucial in other parts of the world for slowing the spread of COVID-19.

Better behaviours

Without such measures, people will continue to transfer microbes to each other. The risk of transmission can be limited by using microbe-destroying surfaces such as copper, and through rigorous disinfection with chemicals and exposure to ultraviolet light. However, such measures can be difficult to implement in communities. The only two universally effective methods are hand hygiene and staying away from others, Chopra says. “Hand hygiene is the cornerstone — not only in the hospital but everywhere.”

These strategies might seem simple, but they require people to change their behaviour, and that is easier said than done. Garth Graham at the University of Connecticut in Hartford, who developed the first US national plan to reduce health disparities, says: “Understanding of risk is the first step to getting people to adopt behaviours that help prevent infections.” In 2003, for example, people changed their behaviour by washing their hands more frequently and cleaning surfaces to prevent the spread of severe acute respiratory syndrome (SARS) virus once they understood the risk. Conversely, a lack of awareness of the effect of infections such as measles and polio has contributed to a growing hesitancy by some to vaccinate.

But after people understand the risk, says Graham, they then need information on how to change their behaviour effectively. And, he says, the campaigns that provide this information need to come from a trusted source and be tailored to the target group. “Some people trust government entities. Some trust their local physician. Some people trust their church,” he says.

In 2009, for example, a public-health team designed a hand-washing campaign called Hands up for Max! The team distributed posters to primary schools in the United Kingdom demonstrating the correct way to wash hands and distributed stickers to pupils. By contrast, a campaign run by the US Centers for Disease Control and Prevention (CDC) targeted parents using downloadable posters and social media posts with the hashtag #KeepHandsClean to drive home the message that family hand washing is an easy and effective way to prevent illness. “Public-health messaging starts with years of understanding the local infrastructure and the local community. Local organizations that have built trust for a long time with the target group are the most effective messengers.”

Chopra thinks that communities will now make permanent changes to keep infections at bay. “How we function, how we talk to each other, how we greet each other — all of that is going to change,” she says. Indeed, Anthony Fauci, director of the US National Institute of Allergy and Infectious Diseases in Bethesda, Maryland, has already declared the end of the handshake.

A broader view

Fervent measures aimed at preventing infection can come with downsides, however. Corinne Hohl, an emergency-medicine physician at the University of British Columbia in Vancouver, who leads the Canadian COVID-19 Emergency Department Rapid Response Network, points out that deaths unrelated to COVID-19 have increased during the pandemic in Canada and some other countries. Although the exact reason is not certain, physicians suggest that people might be choosing not to access emergency services because of fears that they might contract the coronavirus by leaving their homes.

In many parts of the world, behavioural change is unlikely to make a significant difference by itself. In some low-income countries, managing infection rates will require considerable investment in infrastructure. The WHO says that 1.1 billion people worldwide lack access to proper latrines, increasing the risk of bacterial infections that cause diarrhoea. Antibiotics can be seen as a quick fix to deal with deficits in basic infrastructure. India, which has one of the world’s highest rates of antimicrobial resistance, launched a country-wide initiative in 2014, with the goals of building toilets and stopping groups from manually collecting faeces for disposal.

Preventing infection is not an insignificant challenge, but perhaps now more than ever, the world is ready to talk about doing so. “I think infection control will generate, for a few years at least, much more interest,” says Vandenbroucke-Grauls. The coronavirus has brought an opportunity to raise awareness about the importance of infectious diseases as a cause of death. In the era of vaccines and broadly effective antibiotic medicines, Vandenbroucke-Grauls says, “this might be a kind of wake-up call for people — they shouldn’t think infectious diseases are a thing of the past”.

 

To view the article in its entirety, please click on the link below to be redirected. Thank you.

https://www.nature.com/articles/d41586-020-02885-2

 

United Nations Releases Critical Warning On Growing Concerns of Drug-Resistant Infections

With more and more common medications losing their ability to fight dangerous infections, and few new drugs in the pipeline, the world is facing an imminent crisis that could lead to millions of deaths, a surge in global poverty and an even wider gap between rich and poor countries, the United Nations warned in a report on April 29th – 2019.

Drug-resistant infections already claim 700,000 lives a year, including 230,000 deaths from drug-resistant tuberculosis, the report said. The rampant overuse of antibiotics and anti-fungal medicines in humans, livestock and agriculture is accelerating a crisis that is poorly understood by the public and largely ignored by world leaders. Without concerted action, a United Nations panel said, resistant infections could kill 10 million people annually by 2050 and trigger an economic slowdown to rival the global financial crisis of 2008.

The problem threatens people around the world. During the next 30 years, the United Nations experts said, 2.4 million people in Europe, North America and Australia could die from drug-resistant infections, making routine hospital procedures like knee-replacement surgery and childbirth far riskier than they are today.

“This is a silent tsunami,” said Dr. Haileyesus Getahun, director of the U.N. Interagency Coordination Group on Antimicrobial Resistance, which spent two years working on the report. “We are not seeing the political momentum we’ve seen in other public health emergencies, but if we don’t act now, antimicrobial resistance will have a disastrous impact within a generation.”

 

To read article in its entirety please click on the following link to be redirected:

https://www.nytimes.com/2019/04/29/health/un-drug-resistance-antibiotics

Running Out of Options; Bacteriophages to Treat Antibiotic Resistance Infections

Ella Balasa, a 26-year-old from Richmond, Virginia, recently made the news when she was apparently successfully treated for a lung infection using a kind of virus called a bacteriophage. The word “apparently” is important in terms of determining exactly how effective the treatment was, in a clinical sense.

A bacteriophage is a virus that infects bacteria. They aren’t typically used to treat bacterial infections, but in desperate cases, they have been used to treat particularly antibiotic-resistant infections. Such as the one that Balasa was battling.

“I’m really running out of options,” Balasa told AP. “I know it might not have an effect. But I am very hopeful.”

Balasa has cystic fibrosis, which is a disease that affects the lungs, scarring lung tissue, which can trap bacteria. She had picked up an antibiotic-resistant strain of Pseudomonas aeruginosa. At first, inhaled antibiotics controlled the infection, but then they stopped working. She was placed on intravenous antibiotics, but Balasa didn’t respond to those either.

Balasa took part in a procedure at Yale University that used bacteriophages that attack and kill P. aeruginosa. It was a last-ditch effort to avoid a high-risk lung transplant. She was the eighth patient to try the approach.

The first test case at Yale was an 82-year-old man who was close to death from a heart implant and untreatable pseudomonas infection. Benjamin Chan, a Yale biologist who focuses on phages, purified a phage found in a Connecticut lake that he matched to the patient’s strain of bacteria. With emergency permission from the U.S. Food and Drug Administration (FDA), physicians tried the purified phage on the man’s infection—successfully. The infection cleared up.

“People’s frustration with antibiotic resistance boiled over,” Chan told. “We’re more appreciative of the fact that we need alternatives.”

Bacteriophages were discovered independently by Frederick Twort in 1915 and Felix d’Herelle in 1917—a full decade before the discovery of penicillin. At that time, they were used to treat dysentery and cholera. But timing is important, and not much was known about viruses and phages at the time—it would be another 25 years, in 1940, before an image of a phage was made using an electron microscope.

And unlike broad-screen antibiotics, strains of phage are specific to strains of bacteria. A broad-screen antibiotic can be used to treat a range of bacterial infections, but phages need to be chosen and purified specific to the infecting bacteria.

On the other hand, as antibiotic-resistance becomes a bigger issue and development of new antibiotics is slow, attention is turning toward the possibilities of phages to treat antibiotic-resistant bacteria. A 2017 article by Veerasak Srisuknimit on the Harvard University blog, wrote, “Now that more and more bacteria have developed resistance to antibiotics, scientists around the world have a renewed interest in phages. The European Union invested 5 million euros in Phagoburn, a project that studies the use of phages to prevent skin infections in burn victims. In the USA, the FDA approved ListShield, a food addictive containing phages, that kills Listeria monocytogenes, one of the most virulent foodborne pathogens and one cause of meningitis. Currently, many clinical trials using phage to treat or prevent bacterial infections such as tuberculosis and MRSA are undergoing.”

And Balasa? She inhaled billions of phages over seven days. It appeared to have an almost immediate effect, although it took several weeks for her to feel better. And during that period she began retaking some antibiotics she had abandoned. As AP notes, without a formal study it’s hard to say just how successful the approach was, but the tests “suggest phages killed much of her predominant pseudomonas strain and made the survivors sensitive again to a course of those antibiotics.”

She was able to quit the antibiotics, but a second round of a different strain of phages did not seem to show more improvement. “The true test,” Balasa told AP, “is how long I can go without using any antibiotics again.”

By Mark Terry

 

To read this article in its entirety please click on the following link to be redirected. Thank you.

https://www.pharmalive.com/bacteriophages-to-the-rescue-a-possible-approach-to-antibiotic-resistance/

Breakout Labs Has Invested in SciBac, a Company Targeting the Growing Problem of Antibiotic Resistance

It’s not surprising that Breakout Labs, the Thiel Foundation‘s seed-stage fund that aims to propel radical science to improve human health, has invested in SciBac, a company targeting the growing problem of antibiotic resistance. Among health risks that threaten mankind, the one that may prove most deadly is the rise of superbugs — drug-resistant bacteria that can make simple surgeries and medical treatments like chemotherapy impossible.

Why Peter Thiel is backing a tiny start-up waging war against the global superbug crisis

  • 700,000 people worldwide die each year from antibiotic-resistant infections, and numbers are increasing.
  • Antimicrobial resistance is projected to kill more people than cancer by 2050, according to the World Health Organization.
  • Many big pharmaceutical companies are exiting the antibiotic drug development field due to low margins.
  • Start-ups like SciBac, which made the 2018 CNBC Upstart 100 list, are developing alternative solutions.

Over the years ever more powerful strains have spread around the world. It’s a crisis that has even garnered the attention of world leaders at the United Nations. That’s because the urgency is clear: 700,000 people die each year worldwide from antibiotic-resistant infections, and that number is increasing by the day. In the United States alone at least 2 million people become infected with antibiotic-resistant bacteria each year, according to the Centers for Disease Control and Prevention, and 23,000 die each year as a result of those infections.

The future trend is alarming. According to the World Health Organization, Hemai Parthasarathyis projected to kill more people than cancer by 2050, which would reduce global economic output by between 2 percent and 3.5 percent — a staggering $100 trillion cut in GDP globally — and severely cripple modern medical and surgical advances.

A $40 billion superbug market Big Pharma is neglecting

It’s no wonder many scientists call antimicrobial resistance “a slow-motion tsunami.” Yet lack of drug development and discovery by Big Pharma has exacerbated the problem. “Within the last two years, five large pharmaceutical and many biotech companies have exited the field due to the scientific, regulatory and economic challenges posed by antibiotic discovery and development,” said Thomas Cueni, chairman of the AMR Industry Alliance, a coalition of 100 companies and pharmaceutical associations set up to curb antimicrobial resistance. Among the pharmaceutical giants to exit this research field: Novartis, AstraZeneca, Sanofi and Allergan.

The void has spurred many nimble biotech start-ups to look for solutions in this new $40 billion superbug market. One is SciBac, a biotherapeutics company named to the 2018 CNBC Upstart 100 list. The Silicon Valley start-up shifts the paradigm on how to tackle superbugs. It is developing a microbe pill to boost the body’s microbiome in the gut, lungs and skin to kill bacteria that cause antibiotic-resistant disease. Its first product treats and prevents Clostridium difficile infection (CDI), commonly known as deadly diarrhea and our nation’s top antibiotic-resistant threat. It is also working on developing a drug to treat and prevent chronic Pseudomonas infections in the lungs of cystic fibrosis patients.

“Our patented platform technology has applications to treat other infections,” said SciBac CEO Jeanette Mucha. “It allows us to mate different species of microbes into a single hybrid that can target specific diseases through multiple modes of action that kill the bacteria and toxins in the body. At the same time, the technology bolsters the microbiome for fast recovery.”

SciBac CEO, Jeanette Mucha is on a quest to develop an antibiotic alternative.

According to Hemai Parthasarathy, Ph.D., scientific director of the Thiel Foundation’s Breakout Labs, “It’s clear we are running out of an arsenal to attack the superbug crisis, and the world needs new approaches.”

To help SciBac’s team move their technology out of the lab, Breakout has taken a board role to help with business strategy and will help introduce the founders to venture capitalists and potential business partners in the months ahead.

To date, the three-year-old upstart has raised $1.45 million in equity financing and a $3.7 million grant from CARB-X, a nonprofit public-private partnership funded by the U.S. government, Wellcome Trust, the NIH, Bill and Melinda Gates Foundation and the U.K government, that invests in antibacterial research worldwide. Its goal: to fast-track the development of a pipeline of new antibiotics, vaccines and other products to fight the war on superbugs.

“SciBac is essentially creating a new drug that is an antibiotic alternative,” said Kevin Outterson, executive director of CARB-X. “The microbiome is providing exciting new approaches to the prevention and treatment of life-threatening infections of all kinds. It’s a promising new scientific approach.”

SciBac’s answer to the superbug threat has caught the attention of investors.

As Outterson explains, most of the innovation in this field is coming from tiny pre-clinical trial companies like SciBac. That’s because many Big Pharma companies feel the margins aren’t worth the high R&D costs, which can run into the billions of dollars. “As soon as you make an antibiotic, it is already dying because bacteria are evolving in response to the drug. Eventually, random mutations will make antibiotic resistance come.”

For this reason, drug companies feel antibiotics are undervalued in the marketplace.

To help boost the start-up’s odds of success, CARB-X will provide SciBac with consultants and experts in R&D, toxicity and regulation that can help them navigate how to get their science from the lab to clinical trials for FDA approval. It has set milestones for the company that it must meet to get financing.

Like many entrepreneurs pursuing breakthrough science, Mucha seems energized by her formidable challenge of kickstarting the development of a new drug.

Mucha said she and co-founders Anthony Cann, a chemical engineer, and Derik Twomey, a cell biologist, stumbled on the idea. They had experience working with a species of bacteria known as clostridium while developing a biofuel for Cobalt Technologies. After that company closed shop, Mucha set up a lab in her garage to experiment with probiotics and see if she could induce gene transfer in bacteria. It worked. Then the entrepreneurs moved into an incubator, Molecular Sciences Institute in Milpitas, California, to set up a lab. Ten months later they applied to Breakout Labs for $350,000 of seed financing, which gave them matching funds to help secure the CARB-X grant. Now the company is in the midst of getting bridge financing to fund clinical trials and manufacturing.

“This drug development will take time,” Mucha said. “It won’t be ready for FDA drug approval until 2025. But we’re seeing a lot of investor interest in this alternative technology.”

 

To review article in its entirety please click on the following link to be redirected:

https://www.cnbc.com/2018/10/09/peter-thiel-backs-a-start-up-fighting-the-global-superbug-crisis.html

 

 

 

C. diff. Infections Related to Dental Care and the Unnecessary Use of Antibiotics

During the annual ID Week2017— an annual meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA) and the Pediatric Infectious Diseases Society (PIDS)— researchers presented findings that suggest that the prevalence of Clostridium difficile is likely caused by the unnecessary prescription of antibiotics by dentists.

“Dentists have been overlooked as a source of antibiotic prescribing, which can potentially delay treatment when doctors are trying to determine what is causing a patient’s illness,” Stacy Holzbauer, DVM, MPH, lead author of the study and career epidemiology field officer for the CDC and MDH, said in a statement. “It’s important to educate dentists about the potential complications of antibiotic prescribing, including C. diff.

To read the article in its entirety please click on the following link:

https://www.rdmag.com/article/2017/10/dentists-overprescribing-antibiotics-overlooked-cause-superbug-infection

“Dentists write more than 24.5 million prescriptions for antibiotics a year,” she added. “It is essential that they be included in efforts to improve antibiotic prescribing.”

C. diff is a deadly bacterial infection that causes severe and possibly fatal diarrhea. Taking antibiotics can put patients at an increased risk for developing the infection.

“Research has shown that reducing outpatient antibiotic prescribing by 10 percent could decrease C. diff rates outside of hospitals by 17 percent,” Holzbauer said. “Limiting the use of inappropriate antibiotics in dentistry could also have a profound impact.”

For the study, the Minnesota Department of Health tracked community-associated C. diff infections—patients who did not have an overnight stay in a hospital or nursing home—in five Minnesota counties.

For the study, the researchers interviewed 1,626 people with community-associated C. diff between 2009 and 2015, 57 percent of which reported they had been prescribed antibiotics.  The researchers also found that patients that were prescribed antibiotics for tended procedures tended to be older and likely received the medication ….   clindamycin.

The six-year study shows that 15 percent of those with the infection had taken antibiotics prescribed to them from dental procedures, one-third of which had a medical chart that did not list dental procedure-related antibiotics, highlighting the apparent disconnect between dental care and medical care.

Another study conducted by the MDH found that 36 percent of dentists prescribed antibiotics in situations that were generally not recommended by the American Dental Association.

“It is possible some dentists aren’t aware of the updated recommendations or are being asked by other healthcare providers to continue preventive antibiotics despite the change,” Holzbauer said.