The use of antibiotics among Americans with commercial health insurance has decreased during the past several years, according to a new analysis that nevertheless
shows lingering variations for different ages and in different parts of the country.
The study released provides the latest evidence of how doctors and patients have begun to heed warnings that excessive antibiotic use breeds dangerous drug resistance and “superbug” bacteria.
The analysis is based on 173 million insurance claims from people under age 65 with Blue Cross Blue Shield coverage
who filled prescriptions
between 2010 and 2016.
It is a sequel of sorts to research by the federal Centers for Disease Control and Prevention, which found a smaller decline and comparable age and geographic variations.
The CDC reported a 5 percent decrease overall between 2011 and 2014 in antibiotic prescriptions written in outpatient settings such as doctors’ offices, clinics and hospital emergency rooms.
The study by the Blue Cross Blue Shield Association found that 9 percent fewer antibiotics prescribed in outpatient settings were filled in 2016, compared with 2010.
These two leading topic experts will be discussing significant ways to unlock the mysteries of the human microbiome; how it affects our health, the immune system, and why it is so important to protect it.
As part of the Centers for Disease Control and Prevention (CDC) efforts to protect patients and slow antibiotic-resistance, the CDC is investing in research to discover and develop new ways to prevent antibiotic-resistant infections.
To Listen To the Podcast – click on the following link:
Repeated infection with the bacterium Clostridium difficile (C. difficile, C.diff.), which causes abdominal pain, fever, diarrhea is linked to higher death rates, as well as having a significant impact on health services in terms of cost and hospital beds occupied.
In the first of two presentations at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) (tomorrow (Saturday), Professor Alistair Leanord, from Glasgow University, UK, will say that in Scotland the extra impact on the health service from C. difficile infections amounted to 10,600 bed days a year. “This is the equivalent to a 30-bed hospital ward being fully occupied all year,” he will say.
He will tell the congress that the (median) average cost of a patient with C. difficile infection was £7,500 (€8,600 approximately) compared to £2,800 (€3,200 approx) for patients with other medical conditions. In Scotland over a one year period, from October 2015 to October 2016, there were 1,150 cases of C. difficile infection in patients aged 15 and over. This cost the National Health Service (NHS) in Scotland a total of £8,650,000. Out of this amount, the additional costs of treating C. difficile infection, over and above the basic cost of a hospital bed and normal medical care, was £1,955,000. The calculations were carried out at Strathclyde University, which is part of the Scottish Healthcare Associated Infection Prevention Institute (SHAIPI) research consortium.
Until now, little has been known about the impact on health service resources from C. difficile infections, and on patients in terms of recurrence of infection, readmission to hospital, length of stay and death rates.
Prof. Leanord and his colleagues in Scotland identified 3,304 patients with C. difficile in Scottish hospitals between 2010 and 2013 and matched them with 9,516 patients who did not have the infection (the control group). Approximately two-thirds of the C. difficile patients acquired the infection in hospital.
They found that patients with C. difficile infection had more than double the risk of dying from any cause within two months of being admitted to hospital; nearly a third of all C. difficile cases (29%) died within two months compared to 14% of patients in the control group. Patients with C. difficile stayed in hospital a (median) average 9.7 days longer than the patients without the infection. Of the 1,712 C. difficile patients who were discharged from hospital within 30 days of the first episode of infection, 59% were readmitted within six months; of the 626 cases discharged more than 30 days after the first episode 53% were readmitted within six months. Few of these re-admissions were directly related to C. difficile infection.
“However, nearly a sixth of patients (14%) who were cured of the initial infection recurred within three months, and nearly one third of them (29%) had a second recurrence within a year,” says Prof. Leanord.
Older people were more vulnerable to a recurrence. Among the patients with C. difficile infection, 22% were aged 85 or over, and patients aged 75 and over had approximately double the risk of a recurrence of the infection compared to those aged under 65. Patients aged between 65-74 had 1.5 times the risk of recurrence compared to younger patients.
Prof. Leanord will conclude: “Having a clear understanding of the nature of C. difficile infections in Scotland will allow the Scottish government to target resources at the most appropriate patients to try to reduce the overall burden of the disease on the health service. Our findings are very likely to be applicable to the rest of the UK and other countries as well.”
In a second presentation on Saturday, Dr David Enoch, a consultant microbiologist and infection control doctor at the National Infection Service, Public Health England, Cambridge (UK), will report the outcomes of 6,874 patients who had acquired C. difficile infection in hospital between 2002 and 2013 in England. Of these, 1,141 (16.6%) had recurrences of the infection.
“We found that 49% of hospital patients who suffer a recurrent episode of C. difficile infection die within a year, compared to 38% of those who suffer an initial infection only,” he will say. “In addition, 21% of patients with a recurrence suffered other complications as well, such as dehydration, malnourished and sometimes even perforation of the bowel, compared to 18% of patients who did not have a recurrence.”
Dr Enoch estimates that there are approximately 125,000 cases of C. difficile infection in Europe each year, and between 15-30% of these recur. “Cases in the UK have been coming down since 2008, which is most probably due to improvements in antibiotic prescribing and cleaning regimens in hospitals. This is encouraging but more still needs to be done.”
The average age of the patients was 77 and the average length of stay in hospital was 38 days.
“The main risk factor for developing C. difficile infection is prior antibiotic use. These patients are often already ill from some other underlying illness, which explains why they needed antibiotics in the first place. Older people are at greater risk of C. difficile infection as they are often sicker, have other illnesses or conditions, and so need more antibiotics,” he will say.
Dr Enoch continues: “Although much has been done, particularly in the UK, to try to prevent C. difficile infection, strict adherence to antibiotic guidelines by clinicians and thorough cleaning of the hospital environment are crucial in ensuring that patients don’t develop C. difficile infection in the first place. Treatment with a new drug called fidaxomicin has also been shown to reduce the risk of recurrence in patients who are unfortunate enough to develop an infection. However, we still have a lot to learn, particularly about how C. difficile infection occurs in the community, and how best to treat it.”
Treatments for recurrences of C. difficile infection —– include stopping the antibiotic that made the patient susceptible to the infection and starting a different antibiotic that is effective against C. difficile infection. These antibiotics include metronidazole, vancomycin and fidaxomicin. Supportive therapy, such as extra fluids, and surgery in serious or life-threatening cases may also be necessary. Faecal transplantation is emerging as a promising option; this is a process in which the good bacteria that the gut needs but which has been killed off by antibiotics is transplanted into the patient from a healthy donor.
To provide a background and definition of each of them the following information is beneficial.
Bacteria are a large group of microscopic, unicellular organisms that exist either independently or as parasites. Some bacteria are capable of forming spores around themselves, which allow the organism to survive in hostile environmental conditions. Bacterial spores are made of a tough outer layer of keratin that is resistant to many chemicals, staining and heat. The spore allows the bacterium to remain dormant for years, protecting it from various traumas, including temperature differences, absence of air, water and nutrients. Spore forming bacteria cause a number of diseases, including botulism, anthrax, tetanus and acute food poisoning. (1)
Bacillus is a specific genus of rod-shaped bacteria that are capable of forming spores. They are sporulating, aerobic and ubiquitous in nature. Bacillus is a fairly large group with many members, including Bacillus cereus, Bacillus clausii and Bacillus halodenitrificans. Bacillus spores, also called endospores, are resistant to harsh chemical and physical conditions. This makes the bacteria able to withstand disinfectants, radiation, desiccation and heat. Bacillus are a common cause of food and medical contamination and are often difficult to eliminate.
Clostridium are rod-shaped, Gram-positive (bacteria that retain a violet or dark blue Gram staining due to excessive amounts of peptidoglycan in their cell walls) bacteria that are capable of producing spores. According to the Health Protecton Agency, the Clostridium genus consists of more than a hundred known species, including harmful pathogens such as Clostridium botulinum, Clostridium difficile, Clostridium perfringens, Clostridium tetani and Clostridium sordellii.
Some species of the bacteria are used commercially to produce ethanol (Clostridium thermocellum), acetone (Clostridium acetobutylicum), and to convert fatty acids to yeasts and propanediol (Clostridium diolis).
Scientists discovered C. diff in 1935, but they didn’t recognize it as the major cause of antibiotic-associated diarrhea until 1978. The rise of C. diff in the 1970s was triggered by the widespread use of the antibiotic clindamycin. Over the next 20 years, broad-spectrum antibiotics in the penicillin and cephalosporin families fueled the C. diff epidemic, and in the early years of this century, fluoroquinolone antibiotics were linked to a new and more dangerous hypervirulent strain of C. diff.
C. diff is classified as an anaerobic bacterium because it thrives in the absence of oxygen. Like its cousins, the Clostridia that cause tetanus, botulism, and gas gangrene, C. diff passes through a life cycle in which the actively dividing form transforms itself into the spore stage. Spores are inert and metabolically inactive, so they don’t cause disease. At the same time, though, spores are very tough and sturdy; they are hard to kill with disinfectants, and they shrug off even the most powerful antibiotics.
Here’s how C. diff causes trouble. Patients with C. diff shed spores into their feces. Without strict precautions, spores are inadvertently transmitted to hands, utensils, and foods, and then swallowed by someone else. The spores come to life in the second person’s GI tract, but in the best of circumstances, the normal bacteria keep C. diff in check and illness does not develop. But if the “good” GI bacteria have been knocked down by antibiotics, C. diff gets the upper hand. As C. diff multiplies and grows, it produces toxins that injure the lining of the colon, producing diarrhea, inflammation, and sometimes worse. Ordinary strains of C. diff produce two toxins, called toxins A and B, but the new, worrisome hypervirulent strains produce up to 16 times more toxin A and 23 times more toxin B. (2)
C. diff is an old bacterium,…..the CDAD epidemic is new ……..What turned a medical curiosity into a major threat? In a word, antibiotics.
Antibiotics are marvelous medications, and they are obviously here to stay. But doctors must use them wisely. That means prescribing an antibiotic only when it’s truly necessary, choosing the simplest, most narrowly focused drug that will do the job, and stopping treatment as soon as the job is done. Patients can help by resisting the temptation to demand an antibiotic for every potential infection.
When it comes to using antibiotics properly, less can be more.
Sporolactobacillus is a group of anaerobic, rod-shaped, spore forming bacteria that include Sporolactobacillus dextrus, Sporolactobacillus inulinus, Sporolactobacillus laevis, Sporolactobacillus terrae and Sporolactobacillus vineae. Sporolactobacillus are also known as lactic-acid bacteria for they are capable of producing the acid from fructose, sucrose, raffinose, mannose, inulin and sorbitol. Sporolactobacillus are found in the soil and often in chicken feed. According to “Fundamentals of Food Microbiology,” the spores formed by Sporolactobacillus are less resistant to heat than those formed by the Bacillus genus.
Sporosarcina are a group of round-shaped (cocci) aerobic bacteria that include Sporosarcina aquimarina, Sporosarcina globispora, Sporosarcina halophila, Sporosarcina koreensis, Sporosarcina luteola and Sporosarcina ureae. According to “Antibiotic Resistance and Production in Sporosarcina ureae,” Sporosarcina is thought to play a role in the decomposition of urea in the soil.
Revival and Identification of Bacterial Spores in
25- to 40-Million-Year-Old Dominican Amber
Raid J. Cano* and Monica K. Borucki
A bacterial spore was revived, cultured, and identified from the abdominal contents of extinct bees preserved for 25 to 40 million years in buried Dominican amber. Rigorous surface decontamination of the amber and aseptic procedures were used during the recovery of the bacterium. Several lines of evidence indicated that the isolated bacterium was of ancient origin and not an extant contaminant. The characteristic enzymatic, biochemical, and 1 6S ribosomal DNA profiles indicated that the ancient bacterium is most closely related to extant Bacillus sphaericus.
To read the article in its entirety please click on the following link:
A Nevada woman has died from an infection resistant to all available antibiotics in the United States, public health officials report.
According to the Centers for Disease Control and Prevention, the woman’s condition was deemed incurable after being tested against 26 different antibiotics.
Though this isn’t the first case of pan-resistant bacteria in the U.S., at this time it is still uncommon. Still, experts note that antibiotic resistance is a growing health concern globally and call the newly reported case “a wake up call.”
“This is the latest reminder that yes, antibiotic resistance is real,” Dr. James Johnson, a professor specializing in infectious diseases at the University of Minnesota Medical School, told CBS News. “This is not some future, fantasized armageddon threat that maybe will happen after our lifetime. This is now, it’s real, and it’s here.”
According to the report, the woman from Washoe County was in her 70s and had recently returned to America after an extended trip to India. She had been hospitalized there several times before being admitted to an acute care hospital in Nevada in mid-August.
Doctors discovered the woman was infected with carbapenem-resistant Enterobacteriaceae(CRE), which is a family of germs that CDC director Dr. Tom Frieden has called “nightmare bacteria” due to the danger it poses for spreading antibiotic resistance.
The woman had a specific type of CRE, called Klebsiella pneumoniae, which can lead to a number of illnesses, including pneumonia, blood stream infections, and meningitis. In early September, she developed septic shock and died.
The authors of the report say the case highlights the need for doctors and hospitals to ask incoming patients about recent travel and if they have been hospitalized elsewhere.
Other experts say it underscores the need for the medical community, the government and the public to take antibiotic resistance more seriously.
According to the CDC, at least two million people become infected with antibiotic resistant bacteria each year, and at least 23,000 die as a direct result of these infections.
The World Health Organization calls antibiotic resistance “one of the biggest threats to global health.”
A grim report released last year suggests that if bacteria keep evolving at the current rate, by 2050, superbugs will kill 10 million people a year.
While scientists are working to develop new antibiotics, that takes time, and experts encourage doctors and the public to focus on prevention efforts.
One of the most important ways to prevent antibiotic resistance is to only take antibiotics only when they’re necessary.
“Drug resistance like this [case] generally develops from too much exposure to antibiotics,” assistant professor of pediatrics at Johns Hopkins University School of Medicine and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital, told CBS News. “Every time you’re placed on an antibiotic it’s important to question if it’s absolutely necessary and what’s the shortest amount of time you can take this antibiotic for it to still be effective.”
Johnson notes that medical tourism – the practice of traveling to another country to obtain medical treatment, typically at lower cost – may no longer be worth the risk. “With this [antibiotic] resistance issue, the risk/benefit of this approach really changes and I think that people really need to be aware and seriously consider if it’s a good idea given the possibility of this kind of thing,” he said.
Frequent hand washing, particularly in healthcare settings, is also extremely important in preventing the spread of germs.
To read the article in its entirety please click on the link below to be redirected: