Tag Archives: Centers for Disease Control and Prevention

CDC Studies Show Decline in C. difficile and Multidrug-Resistant Bacteria In USA Hospitals

Published April 2, 2020

Declines in C diff

2011 – 2017

The decline in C difficile infections may be another sign of improved infection prevention and antibiotic stewardship in US hospitals

C difficile, a bacterium that causes severe diarrhea, is the primary cause of hospital-associated diarrhea and is linked primarily to broad-spectrum antibiotic use, which can disrupt the balance of bacteria in the gut. Reduction of C difficile prevalence has been among the goals of efforts to improve infection prevention and antibiotic use in US hospitals over the past decade.

To assess progress in reducing C difficile infections, CDC researchers used data from the Emerging Infections Program (EIP), which conducts C difficile surveillance in 35 counties in 10 states.

As with the other study, they classified infections as either healthcare-associated or community-associated. Although primarily considered an infection that affects hospital patients, C difficile infections in people with no recent hospital or nursing home stays have been on the rise.

The researchers also adjusted their findings to account for increased use of nucleic acid amplification testing (NAAT) over the study period. NAAT is more sensitive than other types of
C difficile testing but cannot distinguish between colonization and infection, which has raised concerns about overdiagnosis.

The percentage of cases diagnosed using NAAT at the EIP hospitals increased from 55% in 2011 to 83% in 2017.

The initial estimate showed a small decline in the total national burden of C difficile infection—from 476,000 cases (154.9 cases per 100,000 population) in 2011

to 462,100 cases (143.6 cases per 100,000 population) in 2017.

But after adjusting NAAT use to the 2011 rate of 55%, total
C.  difficile
infections fell by 24% from 2011 through 2017, driven by a 36% decrease in healthcare-associated infections.

Total hospitalizations for C difficile infection fell by 24%.

The adjusted estimate for community-associated C difficile infections—which accounted for 50% of all infections in 2017—saw no change.

The authors of the study say the reductions in healthcare-associated C difficile could be linked to better adherence to recommended infection-prevention practices, as well as to reduced use of fluoroquinolone antibiotics in hospitals.

…………………………………

In the midst of the COVID-19 pandemic, new data published today in the New England Journal of Medicine (NEJM) provides a glimmer of good news on the infectious disease front.

A study conducted by researchers from the Centers for Disease Control and Prevention (CDC) found that the incidence of infections caused by four multidrug-resistant (MDR) organisms (MDROs) decreased in US hospitals from 2012 through 2017, with the declines ranging from 20% to 39%. While the burden of MDR infections in US hospitals remains substantial, and more work is need to sustain the progress that’s been made, the authors of the study say the findings, which formed the basis for the CDC’s 2019 report on antibiotic resistance, are encouraging.

“For some resistant pathogens, encouraging reductions have been observed in recent years, suggesting that current prevention efforts, particularly infection control interventions focused on healthcare settings, are yielding important benefits,” lead author John Jernigan, MD, of the CDC’s Division of Healthcare Quality Promotion, told CIDRAP News.

In another study today in NEJM, a different team of CDC researchers reported that the national burden of Clostridioides difficile infection and associated hospitalization decreased by nearly a quarter from 2011 through 2017, largely owing to a decline in healthcare-associated C difficile infections.

Declines in 4 MDR pathogens

For the study on MDR infections, Jernigan and his colleagues used electronic health record data from 890 US short-term acute care hospitals to generate a national case count and examine temporal trends for infections caused by the primary MDR pathogens associated with healthcare: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter species, MDR Pseudomonas aeruginosa, and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae.

In 2017, these pathogens, which are considered urgent or serious threats by the CDC because they can cause severe, hard-to-treat invasive infections and spread easily in healthcare settings, caused an estimated 622,390 infections among hospitalized patients. Of these cases, 83% (517,818) were community-onset (either obtained in the community or within the first 3 days of hospitalization) and 17% (104,572) were hospital-onset.

From 2012 through 2017, the researchers found that the incidence decreased for infections caused by MRSA (from 114.18 to 93.68 cases per 10,000 hospitalizations), VRE (24.15 to 15.76 cases per 10,000 hospitalizations), carbapenem-resistant Acinetobacter species (3.33 to 2.47 cases per 10,000 hospitalizations), and MDR P aeruginosa (13.10 to 9.43 cases per 10,000 hospitalizations). There was no significant change on the incidence of CRE infections (3.36 to 3.79 cases per 10,000 hospitalizations).

Although the study did not determines the reasons for these declines, Jernigan says it’s likely that improved infection prevention and control efforts in hospitals have contributed to reducing the spread of these pathogens, particularly MRSA and VRE, which tend to be prevalent in patients who’ve had a lot of healthcare exposure. The incidence of hospital-onset MRSA and VRE declined nearly twice as fast as in community-onset cases.

“During the past decade, healthcare decision makers have placed increased emphasis on infection control in healthcare, including efforts to improve implementation of strategies for preventing device- and procedure-related infections and general infection control measures such as hand hygiene,” he said. “In addition, there has been widespread implementation of MDRO-specific measures designed to prevent healthcare transmission of the pathogens we studied, and many healthcare systems have increased emphasis on antimicrobial stewardship as well.”

Neil Clancy, MD, an associate professor of medicine and infectious disease specialist at the University of Pittsburgh who was not involved in the study, says the data are a welcome bright spot as the nation grapples with the COVID-19 pandemic.

“Taken together, these data suggest that national efforts over the past decade in antimicrobial stewardship and infection prevention, many led by CDC, are making a positive impact on AMR [antimicrobial resistance] in this country,” Clancy said. He’s particularly encouraged by the declines in two of the most worrisome MDR gram-negative (GN) pathogens—carbapenem-resistant Acinetobacter and MDR Pseudomonas.

“Although infections by these pathogens are less common than those caused by MRSA, there are fewer antibiotics active against MDR-GNs,” he said. “Moreover, these bacteria are often acquired by very sick patients in the hospital, so their impact on death and poor outcomes in general is high.”

Notes of caution

But there’s some bad new with the good news. The study also found a 53% rise in incidence of infections caused by ESBL-producing Enterobacteriaceae, largely driven by an increase in community-onset infections. The authors hypothesize that this increase could be linked to Escherichia coli sequence type (ST)131—an epidemic MDR E coli strain that has become a primary cause of antibiotic-resistant infections worldwide and is the most common cause of urinary tract infections.

“More widespread emergence of ESBL bacteria, particularly among otherwise healthy people who are not in the hospital or nursing homes, but rather living in the community, is a potential public health nightmare,” said Clancy, noting that infections caused by ESBL bacteria are also problematic because there are currently no active oral antibiotics for treating them.

Clancy also pointed out that, with 83% of the MDR infections found to be originating in the community, it’s not only the sick people in hospitals who need to worry about those infections.

“The study serves as a reminder that antimicrobial resistance, over the long-term, is as big a public health threat as emerging viral pandemics,” he said.

In an editorial that accompanies the study, infectious disease experts from the University of Washington and the University of California, San Diego, say the results of the study suggest that when it comes to antibiotic resistance, the glass is half full. While the observed reductions indicate that progress is being made, the rise in community-onset MDR infections, and the dwindling pipeline of new antibiotics, underscore the challenges that remain and the need for innovative approaches.

“We cannot afford to be complacent about recent progress in the health care setting, because resistant pathogens are still too common in most institutions, and favorable trends can be readily reversed,” they write. “Moreover, the continued presence of MDR organisms and the rapid emergence of antimicrobial resistance to recently introduced agents mean that new strategies for the treatment of infections by MDR organisms must continue to be a high priority.”

Jernigan agrees.

“Innovative interventions and strategies, tailored for the spectrum of healthcare and community settings, will be needed to sustain progress in combating antibiotic resistance,” he said.

 

Source: https://www.cidrap.umn.edu/news-perspective/2020/04/cdc-studies-show-drop-mdr-bacteria-c-diff-us-hospitals

Breakout Labs Has Invested in SciBac, a Company Targeting the Growing Problem of Antibiotic Resistance

It’s not surprising that Breakout Labs, the Thiel Foundation‘s seed-stage fund that aims to propel radical science to improve human health, has invested in SciBac, a company targeting the growing problem of antibiotic resistance. Among health risks that threaten mankind, the one that may prove most deadly is the rise of superbugs — drug-resistant bacteria that can make simple surgeries and medical treatments like chemotherapy impossible.

Why Peter Thiel is backing a tiny start-up waging war against the global superbug crisis

  • 700,000 people worldwide die each year from antibiotic-resistant infections, and numbers are increasing.
  • Antimicrobial resistance is projected to kill more people than cancer by 2050, according to the World Health Organization.
  • Many big pharmaceutical companies are exiting the antibiotic drug development field due to low margins.
  • Start-ups like SciBac, which made the 2018 CNBC Upstart 100 list, are developing alternative solutions.

Over the years ever more powerful strains have spread around the world. It’s a crisis that has even garnered the attention of world leaders at the United Nations. That’s because the urgency is clear: 700,000 people die each year worldwide from antibiotic-resistant infections, and that number is increasing by the day. In the United States alone at least 2 million people become infected with antibiotic-resistant bacteria each year, according to the Centers for Disease Control and Prevention, and 23,000 die each year as a result of those infections.

The future trend is alarming. According to the World Health Organization, Hemai Parthasarathyis projected to kill more people than cancer by 2050, which would reduce global economic output by between 2 percent and 3.5 percent — a staggering $100 trillion cut in GDP globally — and severely cripple modern medical and surgical advances.

A $40 billion superbug market Big Pharma is neglecting

It’s no wonder many scientists call antimicrobial resistance “a slow-motion tsunami.” Yet lack of drug development and discovery by Big Pharma has exacerbated the problem. “Within the last two years, five large pharmaceutical and many biotech companies have exited the field due to the scientific, regulatory and economic challenges posed by antibiotic discovery and development,” said Thomas Cueni, chairman of the AMR Industry Alliance, a coalition of 100 companies and pharmaceutical associations set up to curb antimicrobial resistance. Among the pharmaceutical giants to exit this research field: Novartis, AstraZeneca, Sanofi and Allergan.

The void has spurred many nimble biotech start-ups to look for solutions in this new $40 billion superbug market. One is SciBac, a biotherapeutics company named to the 2018 CNBC Upstart 100 list. The Silicon Valley start-up shifts the paradigm on how to tackle superbugs. It is developing a microbe pill to boost the body’s microbiome in the gut, lungs and skin to kill bacteria that cause antibiotic-resistant disease. Its first product treats and prevents Clostridium difficile infection (CDI), commonly known as deadly diarrhea and our nation’s top antibiotic-resistant threat. It is also working on developing a drug to treat and prevent chronic Pseudomonas infections in the lungs of cystic fibrosis patients.

“Our patented platform technology has applications to treat other infections,” said SciBac CEO Jeanette Mucha. “It allows us to mate different species of microbes into a single hybrid that can target specific diseases through multiple modes of action that kill the bacteria and toxins in the body. At the same time, the technology bolsters the microbiome for fast recovery.”

SciBac CEO, Jeanette Mucha is on a quest to develop an antibiotic alternative.

According to Hemai Parthasarathy, Ph.D., scientific director of the Thiel Foundation’s Breakout Labs, “It’s clear we are running out of an arsenal to attack the superbug crisis, and the world needs new approaches.”

To help SciBac’s team move their technology out of the lab, Breakout has taken a board role to help with business strategy and will help introduce the founders to venture capitalists and potential business partners in the months ahead.

To date, the three-year-old upstart has raised $1.45 million in equity financing and a $3.7 million grant from CARB-X, a nonprofit public-private partnership funded by the U.S. government, Wellcome Trust, the NIH, Bill and Melinda Gates Foundation and the U.K government, that invests in antibacterial research worldwide. Its goal: to fast-track the development of a pipeline of new antibiotics, vaccines and other products to fight the war on superbugs.

“SciBac is essentially creating a new drug that is an antibiotic alternative,” said Kevin Outterson, executive director of CARB-X. “The microbiome is providing exciting new approaches to the prevention and treatment of life-threatening infections of all kinds. It’s a promising new scientific approach.”

SciBac’s answer to the superbug threat has caught the attention of investors.

As Outterson explains, most of the innovation in this field is coming from tiny pre-clinical trial companies like SciBac. That’s because many Big Pharma companies feel the margins aren’t worth the high R&D costs, which can run into the billions of dollars. “As soon as you make an antibiotic, it is already dying because bacteria are evolving in response to the drug. Eventually, random mutations will make antibiotic resistance come.”

For this reason, drug companies feel antibiotics are undervalued in the marketplace.

To help boost the start-up’s odds of success, CARB-X will provide SciBac with consultants and experts in R&D, toxicity and regulation that can help them navigate how to get their science from the lab to clinical trials for FDA approval. It has set milestones for the company that it must meet to get financing.

Like many entrepreneurs pursuing breakthrough science, Mucha seems energized by her formidable challenge of kickstarting the development of a new drug.

Mucha said she and co-founders Anthony Cann, a chemical engineer, and Derik Twomey, a cell biologist, stumbled on the idea. They had experience working with a species of bacteria known as clostridium while developing a biofuel for Cobalt Technologies. After that company closed shop, Mucha set up a lab in her garage to experiment with probiotics and see if she could induce gene transfer in bacteria. It worked. Then the entrepreneurs moved into an incubator, Molecular Sciences Institute in Milpitas, California, to set up a lab. Ten months later they applied to Breakout Labs for $350,000 of seed financing, which gave them matching funds to help secure the CARB-X grant. Now the company is in the midst of getting bridge financing to fund clinical trials and manufacturing.

“This drug development will take time,” Mucha said. “It won’t be ready for FDA drug approval until 2025. But we’re seeing a lot of investor interest in this alternative technology.”

 

To review article in its entirety please click on the following link to be redirected:

https://www.cnbc.com/2018/10/09/peter-thiel-backs-a-start-up-fighting-the-global-superbug-crisis.html

 

 

 

Clifford McDonald, MD and Alison Laufer-Halpin, Ph.D., of the CDC Discuss the Human Microbiome on C. diff. Spores and More

C Diff Foundation’s “C. diff. Spores and More Global Broadcasting Network” is honored to announce Doctors McDonald and Laufer-Halpin as our guest speakers on

Tuesday, July 25, 2017 at 10 a.m. PT / 1 p.m. ET

(www.cdiffradio.com)

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:

https://www.voiceamerica.com/episode/100322/the-human-microbiome-how-it-works-how-it-affects-your-health-your-immune-system-and-why-it-is

 

Learn more about C Diff Radio at: http://www.cdiffradio.com/.

Antibiotic Resistance IS A Serious Global Health Concern

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:

http://www.lasvegasnow.com/news/nevada-woman-died-from-superbug-resistant-to-all-available-antibiotics-in-us/640548775

Centers for Disease Control and Prevention (CDC) Provides Updates On C. difficile Infection Management and Treatment

According to the Centers for Disease Control and Prevention (CDC), Clostridium difficile infection (C. difficile) “has become the most common microbial cause of healthcare-associated infections in U.S. hospitals and costs up to $4.8 billion each year in excess health care costs for acute care facilities alone.”

Statistics provided by the CDC suggest that C. difficile cause nearly 500,000 infections in patients in the US annually.

In one study noted by the CDC, among infected patients, nearly 29,000 died within 30 days of being diagnosed, and more than half of those deaths (15,000) were directly attributable to C. difficile infection.

With C. difficile infection prevention being declared a national priority by the CDC, researchers, public health officials, infectious disease specialists, and others continue to research more effective ways to combat this microbe. Below, we’ve collected links and information on several recent developments.

THE GOOD NEWS
The Center for Infectious Disease Research and Policy (CIDRAP) recently -hospital-stewardship-lowers-antibiotic-use-infections”>reported some good news about the effectiveness of antibiotic stewardship programs (ASPs) in reducing antibiotic usage, especially among patients in the intensive care unit.

Citing the results of a meta-analysis published in Antimicrobial Agents and Chemotherapy, the CIDRAP report noted that, following the implementation of an ASP, “hospital antimicrobial consumption across all studies declined by 19.1%, and antibiotic costs fell by 33.9%. Though a modest decrease of 12.1% in antimicrobial use occurred in general medical wards, antimicrobial use in ICUs fell by 39.5% across the four studies that looked at that parameter.”

The meta-analysis also found that ASPs were effective in curbing the use of non-antibiotic therapies. In the six studies that also monitored antifungal prescription rates, the authors reported a 39.1% decline after ASP initiation.

The use of third- and fourth generation antibiotics (such as cephalosporins, vancomycin, tigecycline, linezolid, imipenem, meropenem, and fluoroquinolones) declined by 26.6% in facilities that implemented an ASP.

The meta-analysis found that bacteria infection rates declined 4.5% in the studies that measured clinical outcomes, and length of hospital stay fell by nearly 9% in studies that measured that metric.

However, the CIDRAP report noted that ASP implementation was not “associated with declining risks for Clostridium difficile (C diff) infections.” The authors of the meta-analysis did note that, in three studies that evaluated C difficile rates, “significant publication bias favored studies that reported ASPs’ negative effects.”

Let’s just get right to the heart of this report from Reuters:

“Fifteen years after the U.S. government declared antibiotic-resistant infections to be a grave threat to public health, a Reuters investigation has found that infection-related deaths are going uncounted, hindering the nation’s ability to fight a scourge that exacts a significant human and financial toll. Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them.

The Centers for Disease Control and Prevention (CDC), the go-to national public health monitor, and state health departments lack the political, legal and financial wherewithal to impose rigorous surveillance.”

The report goes on to outline how incomplete, “patchwork” infection reporting requirements for hospitals, and lax requirements in many states regarding physicians’ responsibilities when filling out death certificates, have led to deaths caused by (or at the very least associated with) MRSA and other drug-resistant pathogens to be “grossly under-reported.”

For example, according to Reuters, only 17 states require notification of C. difficile infections. Only two of the so-called “superbug” infections (MRSA bacteremia and C. difficile) are required to be reported to the CDC’s National Healthcare Safety Network surveillance program.

As they say, read the whole thing.

The authors of an article published in Clinical Microbiology and Infection  reported on a study that compared treatment with tigecycline to standard therapy in adult patients with severe C. difficile infection (sCDI).

The retrospective cohort study compared outcomes in patients with sCDI who received tigecycline alone to outcomes in patients who received standard oral vancomycin combined with intravenous metronidazole.

The primary study outcome was clinical recovery (as determined by European Society of Clinical Microbiology and Infectious Diseases guidelines); secondary outcomes were “in-hospital and 90-day all-cause mortality and relapse, colectomy and complication rates.”

A total of 90 patients with sCDI were treated (45 in each group). Patients treated with tigecycline monotherapy tended to do better in terms of cure rate, complicated disease, and CDI sepsis.

The authors reported that, compared to the group that received standard therapy, the tigecycline group had “significantly better outcomes of clinical cure (34/45, 75.6% vs. 24/45, 53.3%; p=0.02), less complicated disease course (13/45, 28.9% vs. 24/45, 53.3%; p=0.02) and less CDI sepsis (7/45, 15.6% vs. 18/45, 40.0%; p=0.009).”

Rates of mortality, disease relapse, and other measures were similar between the groups.

These results led the researchers to conclude that “tigecycline might be considered as a potential candidate for therapeutic usage in cases of sCDI refractory to standard treatment.”

Our good friends at Contagion Live recently reported on a study that has uncovered how the C. difficile bacteria produces toxins, which could aid the development of nonantibiotic drugs to fight C. difficile infection.

According to Contagion Live, C. difficile produces two toxins, toxin A and toxin B, that “cause life-threatening diarrhea as well as pseudomembranous colitis, toxic megacolon, perforations in the colon, sepsis and rarely death.”

Researchers at the University of Texas found that strains of C. difficile with a mutation in a particular Agr locus in their genome could not produce the toxins.

“Identifying a pathway responsible for activating the production of the toxins… opens up a unique therapeutic target for the development of a novel nonantibiotic therapy for C. difficile infections,” said the study authors.

The Contagion Live article includes a quote from author Charles Darkoh, PhD, on the potential implications of these findings.

“By crippling their toxin-making machinery, C. diff cannot make toxins and thus cannot cause disease. My laboratory is already working on this and was awarded a 5-year National Institutes of Health grant to investigate and develop an oral compound we have identified that inactivate the toxins and block the toxin-making machinery of C. diff by targeting this pathway,” he said.

 

 

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

 http://www.hcplive.com/medical-news/latest-news-and-updates-on-c-difficile-infection-management-and-treatment/P-4#sthash.iDm6FgAP.dpuf