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.
As the incidence of Clostridium difficile (C. diff) infection spirals, physicians should emphasize the importance of antibiotic stewardship.
A study published in the journal affiliated with the National Foundation for Infectious Diseases (NFID) summarized a recent NFID webinar by Carolyn V. Gould, MD, and L. Clifford McDonald, MD, Centers for Disease Control and Prevention (CDC) and Thomas M. File, Jr., MD, Editor-in-Chief, Infectious Diseases in Clinical Practice.
While C. diff is mainly a significant hospital-acquired infection, recently approximately 5% of C. diff cases are diagnosed outside hospitals.
Since prior antibiotic treatment is the primary risk factor for C. diff, antibiotic stewardship is considered a key factor in controlling significant spikes in incidences.
Antibiotics are capable of disrupting intestinal balance, thereby creating the opportunity for C. diff spores to produce diarrhea-causing toxins.
According to the CDC, there are six essential methods to consider for C. diff prevention:
· Careful prescribing and use of antibiotics
· Early and reliable diagnosis
· Immediate isolation of infected patients
· Contact precautions – wearing gloves and gowns for all contact with the patient and patient-care environment
· Adequately cleaning patient care environments; using an EPA-registered C. diff sporicidal disinfectant
· Effective communication about C. diff status when patients are transferred between healthcare facilities
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Healthcare Professionals, employed in all areas of healthcare, attended the first “Raising C. diff. Awareness” Continuing Education class being offered in allied health at the Community Colleges.
Attendees learned about C. difficile prevention, treatments, and environmental safety.
The class learned how to prevent contamination with the opportunity to practice safe infection control techniques, discuss the physical, psychological, social, and financial impact this infection causes to a patient, families, and healthcare industry and how to prevent infections in their everyday practices.
Congratulations to all the attendees of “Raising C. diff. Awareness” Continuing Education Workshop – Spring Class 2015! Each attendee learned something new today and each has a voice – Now is the time to take the knowledge and continue raising C. diff. awareness in every area of practice. Each student joins us in the shared goal~ to witness a decrease in newly diagnosed C. diff. infections worldwide.
Thank you to all who attended this workshop and it was a pleasure to provide you with valid information for C. diff. prevention, treatments, and environmental safety.
“None of us can do this alone…..all of us can do this together!”
Nancy Caralla, Founding Executive Director C Diff Foundation,
Shelby Lassiter, RN, BSN, CPHQ, CIC, Consulting Infection Preventionist for C Diff Foundation
Karen Factor, RD, MBA, Chairperson Nutrition and Wellness C Diff Foundation
Angelo Ortiz, Treasurer, C Diff Foundation
Linda Davis, RN, BSN, Community Nurse for C Diff Foundation
Continuing Education through Durham Community Colleges
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.
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 superbugsover 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. coli—familiar 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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