Tag Archives: Antibiotic resistance

Facilities Work Together To Protect Patients and Reduce Spreading Infection


What can be done?

In the case of C diff and CRE a multipronged intervention approach is necessary. The federal government needs to track outbreaks and monitor antibiotic use. The state and local health departments need to coordinate infection control activities. Hospitals and nursing homes need to implement infection control plans and collaborate in sharing data. Doctors need to avoid excessive antibiotic use and practice hand hygiene.

As for the patients, they need to demand action: ask their health care providers what they and the facility are doing to protect the patient from C difficile and CRE infection. Also, patients need to wash their hands and insist that all health care worker wash their hands before touching them.


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“Superbugs” Multibillion-Dollar Global Support to Fund Antibiotic Research Is Needed


A multibillion-dollar investment into the global pharmaceuticals industry is needed to ward off the threat of drug-resistant “superbugs,” according to Jim O’Neill, the economist leading a review into antimicrobial resistance for the U.K. government.


Mr. O’Neill, best known for coining the “BRIC” acronym for Brazil, Russia, India and China while at Goldman Sachs, estimated that as much as $37 billion is needed over the next 10 years to spur the industry to develop innovative antibiotics, since there is little market incentive to do so.

Mr. O’Neill added that this sum was “modest” in comparison with the economic cost of ignoring the problem. In an earlier report, he estimated that antimicrobial resistance, or AMR, would kill 300 million people prematurely in the next 35 years if unaddressed, leaving global gross domestic product 2% to 3.5% short of what it otherwise would have been by 2050. That would mean $60 trillion to $100 trillion in lost economic output over that 35-year span.

Pharmaceutical companies largely retreated from antibiotic research during the 1990s, due to a high degree of uncertainty on the eventual market size for any novel drugs. A plentiful supply of older and cheaper antibiotics means that a novel product will be used only after other treatments have failed.

Now, the pipeline of new antibiotics has dried up, so there are few new drugs to combat bacteria that have developed resistance to existing treatments. U.K. Prime Minister David Cameron, who commissioned the review in July, has said increasing drug-resistance could cast the world back into the “dark ages of medicine where treatable infections and injuries will kill once again.”

Mr. O’Neill said extra investment was needed at every stage of the antibiotic development process to “radically overhaul” the antibiotics pipeline over the next 20 years.

He proposed giving companies that already have the “highest priority antibiotics” in their pipelines a “lump-sum” payment. This would “delink” profitability from sales volumes, lowering the risk of developing a novel antibiotic as well as reducing the incentive to oversell the drug once it is on the market.

In the USA –

March 2015:  Two million illnesses. 23,000 deaths. According to the Centers for Disease Control and Prevention, that’s the human toll from antibiotic-resistant “superbugs” each year in the United States. To fight the growing problem of infections that can’t be treated, the administration of President Barack Obama is implementing a five-year national action plan at a cost of $1.2 billion. Those funds, part of the President’s 2015 budget, which must still be approved by Congress, would nearly double the amount of federal money allocated to the fight. The plan calls for creating a “one-health” approach to testing and reporting superbugs around the country, as well as establishing a DNA database of resistant bacteria.  New, rapid tests to detect emerging resistant bacteria will be developed.  Research for new antibiotics and vaccines will accelerate. The plan calls for two new options for people, and three for animals, by 2020.

The National Action Plan for Combating Antibiotic-Resistant Bacteria

Global surveillance and cooperation is also stressed, including a global database for animals.


“Anti-microbial resistance has the potential to harm or kill anyone in the country, undermine modern medicine, to devastate our economy and to make our health care system less stable,” Dr. Tom Frieden, MD, CDC Director said.   Antibiotic resistance costs $20 billion in health care spending a year, Frieden said. To combat the spread of resistant bacteria, Frieden said the CDC plans to isolate their existence in hospitals and shrink the numbers through tracking and stricter prevention methods.


Dr. Arjun Srinivasan, MD, CDC Medical Epidemiologist states,  “Today’s antibiotics are miracle drugs, but they are endangered,”  “These new materials provide core elements and practical tools for beginning and advancing antibiotic stewardship programs.”

In July 2014 the United Sates Centers of Disease Control and Prevention (CDC)  rolled out a new way every hospital in the country can track and control drug resistant bacteria. CDC already operates the National Healthcare Safety Network (NHSN), with more than 12,000 health care facilities participating. Now we are implementing a breakthrough program that will take control of drug resistance to the next level – the Antibiotic Use and Resistance (AUR) reporting module. The module is fully automated, capturing antibiotic prescriptions and drug susceptibility test results electronically. With this module, we’ll be able to create the first antibiotic prescribing index. This index will help benchmark antibiotic use across health care facilities for the first time, allowing facilities to compare their data with similar facilities. It will help facilities and local and state health departments as well as CDC to  identify hot spots within a city or a region.  We’ll be able to answer the questions: Which facilities are prescribing more antibiotics? How many types of resistant bacteria and fungi are they seeing? Do prescribing practices predict the number of resistant infections and outbreaks a facility will face?  Ultimately with this information, we’ll be able to both improve prescribing practices and identify and stop outbreaks in a way we have never done before.  This will help deploy supportive and evidence-based interventions at each facility as well as at regional levels to help stop spread among various facilities.  The need for a comprehensive system to collect local, regional, and national data on antibiotic resistance is more critical than ever. The system now exists, and we need quick and widespread uptake.Rapid and full implementation of this system is supported through the proposed increase of $14 million contained in CDC’s 2015 budget request to Congress.

UK:  Mr. O’Neill highlighted antibiotics that were active against bacteria where the existing drugs are already the “last line” of defense as those that could receive priority funding. He also called for a “global AMR innovation fund” of around $2 billion over five years to kick-start basic research into new antibiotics.

While Mr. O’Neill didn’t specifically call on pharmaceutical companies to foot the bill for the innovation fund, he did urge the industry to act with “enlightened self-interest” in tackling AMR, “recognizing that it has a long-term commercial imperative to having effective antibiotics, as well as a moral one.”

He said these measures, along with efforts to link up early research with companies, could bring 15 new drugs a decade to market, at least four of which would be “truly novel.”

The proposals received broad support from the industry. Severin Schwan, chief executive of Roche Holding AG , said the company was “committed to working with the AMR Review Committee and being part of this solution.” Patrick Vallance, president of pharmaceuticals research and development at GlaxoSmithKline PLC, also said he welcomed the findings of the review.

In an earlier report, Mr. O’Neill had already called for more action to make better use of existing antibiotics, such as curbing excessive use or researching whether combining old drugs could prove more effective against superbugs.

The economist is scheduled to submit his final recommendations in the summer of 2016.

Two leading CDC Physicians discuss current issues focused on C. difficile infections (CDI) and Antibiotic usage, Tuesday, May 5th on C. diff. Spores and More, C diff Radio


C. diff. Spores and More”

UPCOMING SHOW:  Tuesday, May 5th: 

Two leading CDC Physicians discuss current issues focused on C. diff.Infections and Antibiotic usage.


Join us as we learn from our guests;

Dr. Clifford McDonald, MD, Senior Advisor for Science and Integrity, Division of Healthcare Quality Promotion at the CDC with main interests in epidemiology and prevention of Healthcare-Associated Infections, especially Clostridium difficile infections, and the prevention of antimicrobial resistance,

Dr. Arjun Srinivasan, MD, Associate Director for Healthcare-Associated Infection prevention programs in the Division of Healthcare Quality Promotion at CDC’s National Center for Emerging and Zoonotic Infectious Disease. Listen in as these two stellar Physicians discuss the topics of Clostridium difficile infections and Antibiotic usage, two important issues with potential solutions facing the citizens on a global level.

Guest Bio’s:

Dr. Clifford McDonald, MD, graduated from Northwestern University Medical School, completed his Internal Medicine Residency at Michigan State University and an Infectious Diseases Fellowship at the University of South Alabama, following which he completed a fellowship in Medical Microbiology at Duke University.  Past positions have included Associate Investigator at the National Health Research Institutes in Taiwan and Assistant Professor in the Division of Infectious Diseases at the University of Louisville. Dr. McDonald is a former Epidemic Intelligence Service officer and former Chief of the Prevention and Response Branch in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention (CDC), where he currently serves as the Senior Advisor for Science and Integrity.  He is the author or co-author of over 100 peer-reviewed publications with his main interests in the epidemiology and prevention of healthcare-associated infections, especially Clostridium difficile infections, and the prevention of antimicrobial resistance.

Dr. Arjun Srinivasan, MD, is Associate Director for healthcare-associated infection prevention programs in the Division of Healthcare Quality Promotion at the Center for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. Dr. Srinivasan is also a captain in the US Public Health Service. An infectious disease doctor, Dr. Srinivasan oversees several CDC programs aimed at eliminating healthcare-associated infections and improving antibiotic use. For much of his CDC career, Dr. Srinivasan ran the healthcare outbreak investigation unit, helping hospitals and other healthcare facilities track down bacteria and stop them from infecting other patients. Today, Dr. Srinivasan leads CDC’s work to improve antibiotic prescribing and works with a team of CDC experts researching new strategies to eliminate healthcare-associated infections.




Obama Administration Issues Detailed Plan National Action Plan for Combating Antibiotic-Resistant Bacteria


National Action Plan for Combating Antibiotic-Resistant Bacteria.

The Obama administration has issued a detailed plan to address the problem of antibiotic resistance, complete with milestones to help ensure the goals are actively addressed.

Drug-resistant bacteria cause 23,000 deaths and two million illnesses a year in the United States, according to the Centers for Disease Control and Prevention. Resistance also threatens animal health and agriculture, said the White House.

The 63-page National Action Plan for Combating Antibiotic-Resistant Bacteria, released                     March 27, 2015 was developed by a task force made up of representatives from at least a dozen federal agencies. The task force began meeting in September 2014, taking its cues from an executive order issued by President Obama on September 18, 2014, and from recommendations in a report on antibiotic resistance that was issued by the President’s Council of Advisers on Science and Technology around the same time.

The action plan aims “to enhance domestic and international capacity to prevent and contain outbreaks of antibiotic-resistant infections; maintain the efficacy of current and new antibiotics; and develop and deploy next-generation, diagnostics, antibiotics, vaccines, and other therapeutics,” according to the White House.

Five Goals

The plan sets 1-, 3-, and 5-year targets in each of the five overarching goals, which are to:

  • slow the emergence of resistant bacteria and prevent the spread of resistant infections;
  • strengthen national one-health surveillance efforts to combat resistance (the “one-health” approach to disease surveillance integrates data from multiple monitoring networks, according to the White House);
  • advance development and use of rapid and innovative diagnostic tests for the identification and characterization of resistant bacteria;
  • accelerate basic and applied research and development for new antibiotics, other therapeutics, and vaccines; and
  • improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development.

Having specific benchmarks is something that the Infectious Diseases Society of America (IDSA) has advocated, said Amanda Jezek, vice president of public policy and government relations at IDSA. “That helps ensure that this isn’t just an action plan that will sit on the shelf and collect dust,” Jezek told Medscape Medical News.

Hospitals will be required to implement programs to increase infection controls, such as judiciously washing hands, hospital surfaces and equipment, and reducing the use of antibiotics in patients.

Doctors working with the government’s Medicare and Medicaid health plans will be required to report their prescribing patterns for antibiotics, particularly when used to treat non-bacterial infections, such as common colds.

The plan calls for CDC to increase its screening of people arriving from countries with high rates of multi-drug resistant tuberculosis. The CDC currently screens 500,000 such arrivals per year, and the plan calls for doubling that within five years.


Urgent and Serious

Among other targets, the plan sets goals for eradicating pathogens that have been labeled urgent or serious threats by the Centers for Disease Control and Prevention. The 2020 targets include:

  • a 50% reduction from 2011 estimates in the incidence of Clostridium difficile,
  • a 60% reduction in hospital-acquired Carbapenem-resistant Enterobacteriaceae infections,
  • a 35% reduction in hospital-acquired multidrug-resistant Pseudomonas species infections, and
  • a 50% reduction from 2011 estimates in methicillin-resistant Staphylococcus aureus bloodstream infections.

Also by 2020, the action plan seeks a 50% reduction in inappropriate antibiotic use in outpatient settings and a 20% reduction in inpatient settings, as well as routine reporting of antibiotic use and resistance data to Centers for Disease Control and Prevention’s National Healthcare Safety Network by 95% of Medicare-eligible hospitals.

The plan also envisions by 2020 the development and wide dissemination of rapid diagnostic tests that can be used in a physician’s office or at the hospital bedside to distinguish between viral and bacterial infections, and thus help ensure more appropriate use of therapeutics.

Under research and development, the plan calls for the characterization of the gut microbiome of at least one animal species raised for food to potentially treat bacterial diseases without antibiotics, and at least three new probiotic therapies for animals by 2020.

In the same time frame, the plan dictates the development of at least two new drug candidates or nontraditional therapeutics and/or vaccines for the prevention of human disease.

The action plan also outlines proposals to work with other governments around the world to enhance the capacity to identify resistant pathogens and to help low- and middle-income countries develop stewardship plans.

$1 Billion to Start?

The White House said the plan’s aspirations are “consistent” with the president’s fiscal 2016 budget proposal, which seeks more than $1 billion to combat antibiotic resistance.

Jezek, from the IDSA, said the $1 billion is a good start and notes that there is bipartisan support for battling antibiotic resistance. “To me, the big question is, Can we get Congress to actually allocate all of that money?” she said.

The automatic budget cuts known as sequestration loom large over any request for funds that are not for mandatory programs, which could make it hard to get the full 2016 request from lawmakers, said Jezek.

The IDSA is also calling on the federal government to ensure the establishment of antibiotic stewardship programs in all healthcare facilities and to pass incentives to encourage drug, diagnostic, and vaccine development.

The federal interagency task force is scheduled to provide a progress report on the action plan within 6 months of its release — by September. It will then make annual progress reports and make recommendations to modify goals if necessary.

The task force is also supposed to work in conjunction with the Presidential Advisory Council on Combating Antibiotic Resistance, a 30-member board that has yet to be constituted.

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C. diff. and Healthcare-Associated Infections Discussed Live on C. diff. Radio



C Diff Foundation, Sponsor, with Founder            Nancy C. Caralla, Executive Director and               Dr. Chandrabali Ghose, Chairperson of the Research and Development Community will be broadcasting live on Tuesdays delivering the most up-to-date information pertaining to a leading super-bug/ Healthcare Associated Infection (HAI),  C. difficile, with additional HAI’s, and a variety of related healthcare topics.

Topic experts will be joining your hosts to discuss prevention, treatments, clinical trials, and environmental safety products on a global level.

Tune in Tuesdays beginning March 3rd at 11 AM Pacific Time (2 PM Eastern Time, 7 PM UK) on the VoiceAmerica network  http://www.voiceamerica.com/show/2441/c-diff-spores-and-more


C. diff. – New CDC Study – National Burden of Clostridium difficile (C. diff.) Infections

Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released today, February 25, 2015, by the Centers for Disease Control and Prevention (CDC).

• More than 100,000 of these infections developed among residents of U.S. nursing homes.
Approximately 29,000 patients died within 30 days of the initial diagnosis of a C. diff. infection. Of these 29,000 – 15,000 deaths were estimated to be directly related to a
C. diff. infection. Therefore; C. diff. is an important cause of infectious disease death in the U.S.
Previous studies indicate that C. diff. has become the most common microbial cause of Healthcare-Associated Infections found in U.S. hospitals driving up costs to $4.8 billion each year in excess health care costs in acute care facilities alone. Approximately
two-thirds of C. diff. infections were found to be associated with an inpatient stay in a health care facility, only 24% of the total cases occurred in patients while they were hospitalized. The study also revealed that almost as many cases occurred in nursing homes as in hospitals and the remainder of individuals acquired the
Healthcare-Associated infection, C. diff., recently discharged from a health care facility.


This new study finds that 1 out of every 5 patients with the Healthcare-Associated Infection (HAI), C. diff., experience a recurrence of the infection and 1 out of every 9 patients over the age of 65 diagnosed with a HAI – C. diff. infection died within 30 days of being diagnosed. Older Americans are quite vulnerable to this life-threatening diarrhea infection. The CDC study also found that women and Caucasian individuals are at an increased risk of acquiring a C. diff. infection.


CDC Director, Dr. Tom Frieden, MD, MPH said, “C. difficile infections cause immense suffering and death for thousands of Americans each year.” “These infections can be prevented by improving antibiotic prescribing and by improving infection control in the health care system. CDC hopes to ramp up prevention of this deadly infection by supporting State Antibiotic Resistance Prevention Programs in all 50 states.”

The Agency for Healthcare Research and Quality (AHRQ) has developed a toolkit to help all hospitals begin antibiotic stewardship programs to reduce C. diff. infections.
Based on the National Plan to Prevent Healthcare – Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. diff. and all hospitals participating in the Centers for Medicare & Medicaid Services (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. diff. infection data to the CDC’s National Healthcare Safety Network since 2013. The baseline data allows for continued surveillance for C. diff. infections to monitor progress in prevention.

Improve the use of antibiotics in preventing C. diff. infections:
150,000 of the half a million C. diff. infections – the new study revealed that they were community-associated and had no documented health care exposure. A separate recent CDC study found that 82% of patients with community-associated C. diff. infections reported exposure to outpatient health care settings (e.g., physicians or dentist office) within twelve weeks before being diagnosed with a C. diff. infection. Through this finding confirms the need for infection control in these settings as well and the need for improved antibiotic use. Another recent CDC study showed a 30% decrease in the use of antibiotics lined to a C. diff. infection in hospitals could reduce newly diagnosed infections by more than 25% in hospitalized and recently discharged patients. A new retrospective study being conducted at a Canadian hospital found that a 10% decrease in overall antibiotic usage through different wards was related to a 34% decrease in newly diagnosed C. diff. infections. A third CDC study among patients without a recent hospitalization or nursing home stay (i.e. community-associated cases) found that a 10% reduction in the use of all antibiotics in outpatient settings could reduce newly diagnosed            C. diff. infections by 16%. In recent years England has seen a reduction of newly diagnosed          C. diff. cases by 60% largely due to improvements in antibiotic prescribing.

C. diff.; Different strains? The North American pulsed-field gel electrophoresis type 1 (NAP1) strain was more prevalent among healthcare-associated than community-associated infections. Changes in the epidemiology of C. difficile infections have occurred since the emergence of this strain in 2000, which has been responsible for widespread dispersed hospital-associated outbreaks. The NAP1 strain was first detected in Pittsburgh, PA and Montreal and is now global. It is causing the majority of infections in communities and healthcare settings. 30% detected in the study and increase seen in healthcare facilities as it is more easily transmitted. “All organisms producing toxins, all infections – must be looked upon with seriousness.”                          Dr. Michael Bell, MD and Dr. Clifford McDonald, MD both concurred.

The diagnosing and detection of a C. difficile infection is at the transition point in how this infection is being diagnosed. There is a need to use better methods of testing and who gets tested and a combination of clinical symptoms and laboratory tests. The Enzyme assay may not be sensitive enough and the PCR is more readily used, is more sensitive, and was used in this study with 50% laboratory producing a C. diff. diagnosis.
The care involved treating a patient with a C. difficile infection begins as a short-term treatment and can develop into a long-term illness with many recurrences.

Dr. Michael Bell, MD shared a brief C. diff. infection possible scenario:
• The patient may have been on an antibiotic within 90 days and develops diarrhea, then the individual should see a medical physician and get tested for a C. diff. infection.
• If the test result is positive for a C. diff. infection then treatment begins with a prescribed oral antibiotic.
• It may take multiple rounds of a oral antibiotic to suppress a C. diff. infection.
• There is a challenge treating a C. diff. infection as the antibiotic continually disturbs the bacteria in the bowel.
• Toxic forming C. diff. can put one’s life at risk as leaks develop in the bowel allowing bacteria to enter the blood stream (bacteremia).
• The infection may progress and the physicians may have to perform a surgical procedure and remove part or the entire colon (colectomy).
• Or the progression of a C. diff. infection leads the patient diagnosed with a C. diff. infection into becoming a surgical patient which will change their life through a diversion of the bowel (colostomy).
Ways to prevent C. diff. infection recurrences:
Do not take antibiotics unless absolutely necessary and diagnosed with a infection that a antibiotic will be effective. The use of an antibiotic treating symptoms caused by a virus is not effective. (Antibiotic stewardship).
Make the clinician aware that a antibiotic has been taken to treat a infection.
Antibiotics are lifesaving medications and need to be prescribed correctly to avoid antibiotic-resistance.
Healthcare facilities must implement and maintain Hand-washing (hand-hygiene) programs – Infection control.
Probiotics – are found in foods (e.g., Kefir, Yogurt) and are sold as a nutritional supplement, (1) “The U.S. Food and Drug Administration (FDA) has no definition of probiotics and regulates them based on whether they fall into one of the existing regulated product categories,” says Hoffmann, who along with faculty members from the University of Maryland School of Medicine’s Institute for Genomics Sciences, the University of Maryland School of Pharmacy and the University of Maryland Carey School of Law, investigated how probiotics are being regulated
(1) See more at: http://www.thedailysheeple.com/fda-to-change-regulations-for-probiotics_102013#sthash.4IGLf8aE.dpuf


C. diff. spores and outpatient settings: There were C. diff. spores found in outpatient settings. A study done at outpatient clinics found that patients who had recently been treated for a C. diff. infection in a hospital, and discharged continued shedding C. diff. spores from weeks to months after recovering from the infection. Clostridium difficile (C. diff.) spores were found on the exam table and in the clinic exam areas. Based on this information it is beneficial to continue disinfecting hard non-porous surfaces utilizing EPA registered disinfecting products, with C. diff. kill claim, in home-care and within healthcare facilities to continue decreasing the spread of        C. diff. spores and maintain infection control. There are Infection programs ongoing with the CDC with continued monitoring/studies.


Preventing C. difficile is a National Priority

Based on the National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination, new 2020 national reduction targets are being established for C. difficile, and all hospitals participating in the Centers for Medicare & Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program have been reporting C. difficile infection data to CDC’s National Healthcare Safety Network since 2013. Those baseline data will allow continued surveillance for C. difficile infections to monitor progress in prevention.

The State Antibiotic Resistance Prevention Programs that would be supported by the funding proposed for CDC in the President’s FY16 budget would work with health care facilities in all 50 states to detect and prevent both C. difficile infections and antibiotic-resistant organisms. The FY 16 budget would also accelerate efforts to improve antibiotic stewardship in inpatient and outpatient settings. During the next five years, CDC’s efforts to combat C. difficile infections and antibiotic resistance under the National Strategy to Combat Antibiotic Resistant Bacteria will enhance national capabilities for antibiotic stewardship, outbreak surveillance, and antibiotic resistance prevention. These efforts hold the potential to cut the incidence of C. difficile infections in half.

For more information please click on the link provided below:


Antibiotic Resistance; India hospitals receive assistance how to track and tackle superbugs

An article published explaining the Antibiotic-Resistance and struggles being experienced in Indian hospitals.

The Center for Disease Dynamics, Economics & Policy, a Washington-based research center, is showing Indian hospitals how to track the trends of antibiotic-resistance on their premises.

It’s a breakthrough method that may eventually help hospitals implement strategies to tackle superbugs over the long term.

India is facing harsh criticism from the global community for its inability to tackle its superbug epidemic.

More than 58,000 infants died last year from bacterial infections that could not be treated, according to the New York Times.

“Until recently, this was very much a developed world problem. That’s where antibiotics were used and abused,” said Keith Klugman, director of the pneumonia  program at the Bill & Melinda Gates Foundation. (Disclosure: BMGF funds TakePart World.) “But very rapidly, India is taking over the rest of the developed world as a focus of resistance.”

Indeed, antibiotics are sold indiscriminately across India. Researchers at Princeton University and CDDEP found it was the biggest consumer of antibiotics worldwide in 2010. Public health activist Abhay Bang blames antibiotic abuse on what he calls the “mind-set” of doctors and patients. “Patients want quick-fix medications,” Bang said. “Doctors in competitive private medical practices have no choice but to provide them.”

CDDEP’s solution currently focuses mainly on big, multi-specialty hospitals. The magic wand: the Drug Resistance Index. Developed by CDDEP director Ramanan Laxminarayan along with Klugman, the concept was first introduced in a paper in BMJ Open, a prominent open-access journal of medical science, in 2011.

DRI pools data about two crucial sets of information: how much and which antibiotics are being consumed to target a particular bacterial species or group of species, and how resistant that microbe is in a particular setting, such as a hospital room or a country overall. That information is then compressed into one figure on a scale of 0 to 1—think of it as a Dow Jones Index for bacterial resistance. A DRI of 0 means all infections caused by a pathogen are treatable with antibiotics available at the hospital; a DRI of 1 means none of the available antibiotics can tackle it, explains CDDEP researcher Suraj Pant.

“This index provides a quick, intuitive overview on the overall state of bacterial resistance and can be used to measure the effectiveness of interventions aimed at reducing antibiotic use or preventing infections in hospital settings,” said Pant, who is supervising the collaboration in India.

CDDEP is providing technical know-how to 12 hospitals in India to calculate DRI for five to six major pathogens on a pro bono basis. “We offer our expertise to whoever approaches us,” said Pant.

But what is this index really telling us? “The main power of DRI lies in trends over time,” Pant added. For example, if the DRI of E. colifamiliar to Americans as the cause of many outbreaks of food-borne illness—is 0.4 in 2014 and 0.6 in 2016 in a particular hospital, then that means the infections caused by the pathogen have become more difficult to treat.

Some medical experts are still not convinced about DRI’s usefulness. “We’re still figuring out what it means in the Indian context,” said Chand Wattal, honorary senior consultant in the department of microbiology at Sir Ganga Ram Hospital in New Delhi. The leading hospital has been calculating DRI on its own since 2011. “It doesn’t help with day-to-day patient management,” Wattal said. “It really is geared toward helping policymakers understand trends in microbial resistance.”

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