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It’s a new year with an entirely new line up of guests eager to share their C. difficile research, infection prevention methods, clinical trials in progress, the updates in the C. diff. community, and much more.
In March the post-Patient and Family Symposium presentations will broadcast, in the event you weren’t able to attend the live-online event hosted on January 15th. The first annual Patient and Family Symposium was sponsored by Seres Therapeutics
Do you have a specific topic of interest or would like to learn more about a specific product or procedure? Send an email to firstname.lastname@example.org share your suggestions and interests.
“None of us can do this alone ~ All of us can do this together.”
U.S. Antibiotic Awareness Week (USAAW) is an annual observance that highlights the steps everyone can take to improve antibiotic prescribing and use. U.S. Antibiotic Awareness Week is November 18-24, 2020. Antibiotics can save lives and are critical tools for treating a number of common and more serious infections, like those that can lead to sepsis.
Antibiotics can save lives and are critical tools for treating a number of common and more serious infections, like those that can lead to sepsis. At least 28% of antibiotics prescribed in U.S. outpatient settings are unnecessary and each year, enough prescriptions are written in outpatient settings to give five out of every six people one antibiotic prescription.
Any time antibiotics are used, they can cause side effects and contribute to the development of antibiotic resistance, one of the most urgent threats to the public’s health.
Antibiotic resistance happens when germs, like bacteria and fungi, develop the ability to defeat the drugs designed to kill them. Each year in the United States, more than 2.8 million infections from bacteria that are resistant to antibiotics occur and more than 35,000 people die as a direct result. Many more die from complications from antibiotic-resistant infections.
Improving the way healthcare professionals prescribe antibiotics, and the way we take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that these life-saving drugs will be available for future generations.
USAAW is a collaboration of CDC, state-based programs, nonprofit partners, and for-profit partners. You can join official USAAW events or host your own. There are many ways to get involved!
How To Participate
Share social media messages, images, and animated graphics on your organization’s social media channels. Remember to use #USAAW20 and #BeAntibioticsAware in every post
Include information about Be Antibiotics Aware and U.S. Antibiotic Awareness Week in your organization’s print and e-newsletters.
Printand share handouts and posters with patients and healthcare professionals. Select items are now available in Spanish, French, Portuguese, Vietnamese, Chinese and Korean.
Play videos (available in English and Spanish) on iPads and TV screens in your medical office, pharmacy, waiting room, or lobby.
CDC encourages patients and families to:
Get the facts about antibiotics. Antibiotics do not work on viruses, such as those that cause colds, flu, bronchitis, or runny noses, even if the mucus is thick, yellow, or green. When antibiotics aren’t needed, they won’t help you, and the side effects could still cause harm.
Ask your healthcare professional about the most appropriate treatment for you or your loved ones’ illness. If antibiotics are not needed, ask about the best way to feel better while your body fights off the virus.
If you need antibiotics, take them exactly as prescribed. Talk with your healthcare professional if you have any questions about your antibiotics.
Talk with your healthcare professional if you develop any side effects, especially severe diarrhea, since that could be a Clostridioides difficile (C. difficile or C. diff) infection, which needs to be treated immediately.
Do your best to stay healthy and keep others healthy by cleaning hands by washing with soap and water for at least 20 seconds or using a hand sanitizer that contains at least 60% alcohol; covering your mouth and nose with a tissue when you cough or sneeze; staying home when sick; and getting recommended vaccines, such as the flu vaccine.
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.
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.
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.
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”.
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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.”
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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
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