Belinda Ostrowsky, MD, MPH, Health Systems Director of Epidemiology, Antimicrobial Stewardship & Infection Prevention, Montefiore Medical Center, and Associate Professor of Clinical Medicine, Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine, explains how to be more sensible when it comes to testing for Clostridium difficile.
Listen In On Tuesday, March 22nd
“C. diff. Spores and More,” Global Broadcasting Network – innovative and educational interactive healthcare talk radio program discusses
“Taking aim at “super-bugs” and the latest CDC Vital Signs Report results”
With Our Guest, Dr. Clifford McDonald, MD, — Senior Advisor for Science and Integrity Division of Healthcare Quality Promotion at the CDC
Tuesday, March 22nd at the following times
10 a.m. Pacific Time
11 a.m. Mountain Time
12 p.m. Central Time
1 p.m. Eastern Time
The Centers for Disease Control and Prevention (CDC) sounds the alarm on the danger of modern medicine returning to a time when simple infections were often fatal. As the latest Vital Signs Report shows, much progress has been made in our hospitals and healthcare facilities to protect patients from healthcare-associated infections. But, more work needs to be done, because many of these infections are caused by antibiotic-resistant bacteria which are difficult, if not impossible to treat. The CDC believes clinicians are key to national progress in preventing infections. They have the power to change the direction of antibiotic resistance each and every time they care for their patients. It requires taking the appropriate steps every time.
We are in a race to slow resistance, and we can’t afford to let the “superbugs” outpace us, especially in healthcare settings.
Dr. McDonald 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 officer in the Epidemic Intelligence Service and former Chief of the Prevention and Response Branch in the Division of Healthcare Quality Promotion at the CDC where he currently serves as Senior Advisor for Science and Integrity in the same division. He is the author or co-author of over 100 peer-reviewed publications with his main interests in the epidemiology/prevention of HAI’s, especially Clostridium difficile infections, and prevention of antimicrobial resistance.
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.
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.
* In the news *
Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use
Judith Maria Wenischa,
Erna Singerc and
+ Author Affiliations
aDepartment of Hospital Hygiene, Wilhelminenspital, Vienna, Austria
bDepartment of Pathology and Microbiology, Wilhelminenspital, Vienna, Austria
cHospital Pharmacy, Wilhelminenspital, Vienna, Austria
Clostridium difficile infections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000- bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (± standard error of the mean [SEM]) of 1,038 ± 109 DDD per month (period 1) to 42 ± 10 DDD per month (period 2) (P = 0.0045). Total antibiotic use was not affected. The mean (±SEM) numbers of CDI cases in period 1 were 59 ± 3 per month and in period 2 were 32 ± 3 per month (46% reduction; P = 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.
Received 8 April 2014.
Returned for modification 12 May 2014.
Accepted 1 June 2014.
Address correspondence to Judith Maria Wenisch