Tag Archives: American College of Physicians

Super-bugs Capture Attention As A Worldwide Health Threat

About 2 million Americans catch drug-resistant infections each year, and 23,000 die, according to the CDC.

As superbugs capture attention as a worldwide health threat, Washington University will be part of a national campaign against drug-resistant bacteria with a $2 million federal grant. The Centers for Disease Control and Prevention awarded $14 million to 25 medical schools and other organizations for research into how microorganisms in the body, known as the microbiome, can track and prevent infections by outsider, drug-resistant germs.

“Understanding the role the microbiome plays in antibiotic-resistant infections is necessary to protect the public’s health,” Dr. Tom Frieden, CDC director, said in a statement. “We think it is key to innovative approaches to combat antibiotic resistance, protect patients, and improve antibiotic use.”

The microbiome includes “good” bacteria and other beneficial organisms that live in the skin and in the digestive and respiratory tracts. Antibiotics that are supposed to fight “bad” bacteria can disrupt the natural habitat by unbalancing the good and bad. Then drug-resistant bacteria can take over and create an environment for out-of-control bugs, including methicillin-resistant staphylococcus aureus (MRSA), carbapenem-resistant enterobacteriaceae (CRE) and clostridium difficile (C. diff.).

Overexposure to antibiotics has been blamed for the rise in superbugs, with the CDC estimating that one in three antibiotic prescriptions is unnecessary.

The research project will look at how early exposure to antibiotics affects the development of the microbiome and whether there are better ways to protect the microbiome.

Four teams of researchers at Washington University were named to the local project:

  • Dr. Jeffrey Henderson will lead a team working to identify how diet and metabolism interact with the gut microbiome in a study to combat C. diff. intestinal infections.
  • A team led by Gautam Dantas will study the long-term effects of antibiotic therapy in premature infants and how their digestive microbiomes are affected.
  • Dr. Jennie Kwon will study antibiotics and the microbiome as it relates to pneumonia.
  • Dr. Brian Gage will help look at hemorrhages linked to the use of blood thinners.

The United Nations General Assembly focused on superbugs — in a rare discussion of health issues. The meeting comes after a new superbug resistant to last-resort antibiotics infected a Pennsylvania woman over the summer, and a resistant strain of E. coli was recently found in a 2-year-old Connecticut girl.

The CDC recommends increased testing for the superbug gene among certain types of E. coli bacteria that show resistance to the powerful antibiotic colistin. The gene spreads readily among bacteria, and it could make these multi-drug-resistant strains almost impossible to treat.

A cluster of gonorrhea infections in Hawaii has shown resistance to all treatments. Doctors are increasingly worried that the common sexually transmitted disease is gaining strength as one of the most urgent superbug threats. If untreated, the disease can lead to infertility.

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

http://www.stltoday.com/lifestyles/health-med-fit/health/antibiotic-resistance-focus-of-washington-university-and-national-research-project/article_b192afec-7dbe-59b8-8e06-5e64b7d8795c.html

Study Finds Community – acquired Clostridium difficile (Cdiff) Infection (CDI) Greater Than Hospital-acquired CDI

GRAPHCdiff2016

 

 

 

 

 

 

ASM Microbe 2016 (Poster 290)

Community-onset CDI cases increased at a higher rate than hospital-acquired cases—accounting for almost half of the cases—in an examination of clinical data from 154 U.S. hospitals over eight years, according to research presented at the ASM Microbe 2016 (Poster 290)

Researchers from Merck and Becton Dickinson wanted to examine this trend, and looked at where CDI began by analyzing clinical data from 154 hospitals from 2008 to 2015.

>> Thank You Merck and Becton Dickinson For Conducting This Study <<

A CDI case was defined as a positive C. difficile toxin or molecular assay of a stool specimen obtained from a patient without a positive assay in the previous eight weeks.

First, they looked at the overall CDI rate in those facilities in that eight-year period and found 154,629 total CDI cases.

Then the teased out whether the case was acquired in the community or hospital. They also dived a little deeper to understand which community cases really were “community” that is there was no hospital stay within a certain time before the onset of disease, explained Andy DeRyke, PharmD, director scientific strategy lead at Merck, and one of the researchers.

They used these three definitions:
Community-onset-community-associated: CDI occurred in an outpatient setting or within three calendar days after hospital admission and the patient had not had an overnight hospital stay in the prior 12 weeks before onset of infection;
Community-onset-hospital-associated: CDI occurred in an outpatient setting or within three days after hospital admission, but the patient had spent at least one night in the hospital in the prior 12 weeks to the onset of infection; and
Hospital-onset: CDI occurred after spending three days in the hospital.

Although not knew information—other studies as well as the Centers for Disease Control and Prevention (CDC) have reported community-acquired infection—they were surprised by how many cases were community acquired.

From 2008 to 2015, the total number of CDI cases increased from 14,686 to 25,273 (72% increase, P<0.01).

Those that were Community-onset-community-associated rose from 6,586 to 13,975 (112%, P<0.01).

While the cases that probably stemmed from a hospital exposure also increased, the rate was much lower, according to Dr. DeRyke.

Those that were community-onset-hospital-associated rose from from 4,545 to 6,524 (44%, P<0.01); while hospital-onset rose from from 3,555 to 4,775 (34%, P<0.01).

The community-onset-community-associated cases accounted for half of overall cases and proportionately increased from 45% in 2008 to 55% in 2015 (P<0.01).

They also looked at cases geographically and found that the Midwest had the highest CDI rate in the country.

“The rates of C. diff are increasing over time,” he said. “Despite all these efforts to eliminate C. diff, it continues to increase.”

Ambulatory patients and caregivers will find the same problems that hospitals have in trying to rid the environment of C. difficile, he said. “The problem is, it’s everywhere,” he said and recommended that any person caring for a patient with CDI make sure that they wash their hands frequently and disinfect with bleach.

https://cdifffoundation.org/hand-washing-updates/

 

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

http://www.idse.net/Hospital-acquired-infection/Article/06-16/C-diff-Not-Just-a-Hospital-Problem-Anymore/36793

Acute Respiratory Tract Symptoms? American College of Physicians and the CDC Publish Recommendations On the Use Of Antibiotics To Treat

Antibiotics are NOT always the answer………….

The American College of Physicians and the CDC have published a set of recommendations on the appropriate use of antibiotics for acute respiratory tract infection.

The recommendations, published in the Annals of Internal Medicine, include the following:

  • Bronchitis: Clinicians shouldn’t order tests or start antibiotics unless they suspect pneumonia.

  • Group A streptococcal pharyngitis: Clinicians should conduct a rapid antigen detection test and/or culture for group A Streptococcus in symptomatic patients. Only patients with confirmed streptococcal pharyngitis should receive antibiotics.

  • Acute rhinosinusitis: Clinicians should prescribe antibiotics only in patients with symptoms that have lasted over 10 days; with severe symptom onset or high fever and purulent nasal discharge or facial pain that has lasted for 3 days or more; or with worsening symptoms after a viral illness that was improving.

  • Common cold: Antibiotics shouldn’t be prescribed.

 

The groups also provide a set of talking points for clinicians when discussing antibiotic use with patients who have an acute respiratory tract infection.

http://www.jwatch.org/fw111074/2016/01/19/acp-cdc-offer-advice-use-antibiotics-acute-respiratory?query=pfwTOC&jwd=000020001882&jspc=EM#sthash.ap0ILqds.dpuf

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