Doctors at a North Carolina hospital report that about 160 patients were exposed to staph infection when surgical instruments weren’t properly sterilized.

Surgical instruments used on patients Oct. 5-7 were cleaned, disinfected, and packaged but hadn’t been sterilized with steam, said chief medical officer Dr. Eugene Wright.

Dr. Wright said the instruments were believed free of blood borne diseases like HIV and Hepatitis B and C.

Officials also said surgical patients routinely get antibiotics.

Dr. Chuck Chima, physician adviser to infection control at the hospital, said steam sterilization is the third step of the disinfection process and without it the instruments could be contaminated.

“Most of the cleaning process had gone through,” Chima said. “The steam sterilization is sort of an insurance.”

Symptoms of staph infection include redness, swelling, pain, and warmth at the surgical site as well as fever and drainage from the surgical area, swollen glands, and a red streak from the infection site.

Wright said the hospital discovered the problem Oct. 6 when a technician noticed that an instrument package hadn’t been steamed. Packages have chemical indicators that show whether they have been exposed to steam.

– by Gene J. Koprowski, Editorial Director

Infection protection measures needed.

Posted: October 16th, 2008 under Antibiotic Resistant, Diseases, Hand Hygiene.
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Doctors and researchers across the country are concerned by the increasing numbers of drug resistant microbes – called “super bugs” by some.

To fight the growing international threat of drug resistant microbes, the National Institute of Allergy and Infectious Diseases (NIAID), a division of the National Institutes of Health (NIH), is partnering with other federal agencies and public and private sector organizations to meet the challenge of finding ways to control drug resistant diseases. According to a recent paper released by NIAID addressing this issue, director Anthony S. Fauci, MD, reports that NIAID invested more than $800 million in 2007 researching the etiology of drug resistant microbes, and the means needed to deal with them.

In an interview with N. Kent Peters, PhD, program officer, Antibacterial Resistance Bacteriology and Mycology Branch, NIAID, Infection Protection asked what NIAID was now doing to address the growing concern about drug resistant microbes. Dr. Peters said that the government research institute is engaged in a multifaceted research program, centered on the “basic cell function within the bacteria.”

From what we are told, if the center, or soft underbelly, so to speak, of the bacterial cell can be identified, it can then be attacked directly with antibiotics. That will kill the pathogen. 

NIAID is also interested in the following:

* Furthering research that will develop new drugs, including anti-microbial therapies and antibiotics.

* Developing those drugs quickly to replace those that mutant microbes now resist.

Further, NIAID is researching the possibility of a more rapid diagnostic method for clinicians, reducing the time — currently twenty-four to forty-eight hours for culture growth — to discover whether or not a diagnosed disease will eventually be resistant to the drugs used to overcome it.

The current clinical practice of prescribing a series of antibiotics for a patient in hopes that one will attack and kill the presenting infection, while sometimes successful, may have the serious side effect of creating more drug resistant microbes, researchers said. But, the faster diagnostic tool would help physicians narrow the choice of antibiotics to the one or ones that would affect only the causing bacteria.

These microbes have in recent decades mutated to resist current antibiotics, and because of this resistance many diseases thought to be under control worldwide are now breaking out again in alarming numbers. TB, malaria and cholera to mention only three are no longer only medical problems of the past – they have become increasingly prominent as the drug resistant disease roll is complied, researchers said.

Added to the above, other well-known infectious diseases – HIV/AIDS, influenza and hepatitis – are becoming more and more difficult to treat due to drug resistance.

Doctors said another mutating drug resistant disease that is increasing at an alarming rate is the long-known Staphylococcus aureus. Staph infection has been around in hospital settings for many decades. In the 1940s Staph infection was brought under control by the use of the then “wonder-drug” penicillin. However, by the end of the 1950s S. aureus had developed a resistance to penicillin to the point that a new drug Methicillin was developed to treat common hospital staph infection. But Staphylococcus aureus has continued to evolve and mutate, becoming more resistant to Methicillin, and even beginning to resist vancomycin, the one drug that seemed to effectively control the infection and combat resistance.  

The key personnel at NIAID working on this program are: Anthony S. Fauci, MD, N. Kent Peters, PhD, Dennis M. Dixon, PhD, and Steven M. Holland, MD.

 With the intent focus of NIH and NIAID on discovering new antibiotics and new drug therapy procedures to overcome drug resistance in microbes, it appears that the scientific research will be successful. Naiad’s quest for success in combating microbial resistance is enhanced by the cooperation of federal agencies and non-governmental organizations making up the Federal Interagency Task Force on Antimicrobial Resistance: the Centers for Disease Control and Prevention, the Food and Drug Administration, the Lily Not-For-Profit Partnership for TB Early Phase Drug Discovery, and the Novaris Institute for Tropical Diseases.      

– by Dr. Herb Marlow, PhD, National Correspondent

  Dr. N. Kent Peters of the NIH says bacterial research project is “multi-faceted.”

Posted: April 1st, 2008 under Antibiotic Resistant, HIV, Tuberculosis.
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Silicon Valley-based KaloBios Pharmaceuticals, Inc., a privately held bio-pharmaceutical company, this week announced the initiation of a clinical trial of KB001, a high-affinity antibody fragment that the firm is developing for the treatment of P. aeruginosa lung infections. The trial is being conducted in conjunction with the Cystic Fibrosis Foundation, and others

The blind, placebo-controlled trial is being conducted at over 10 sites across the U.S., and will enroll up to 48 patients with cystic fibrosis who will receive either one of two dose levels of KB001 or placebo. Goals for the trial include determination of safety, reduction of P. aeruginosa bacteria, and inflammatory markers.

“KB001 is a very novel approach that targets the principal mechanism by which P. aeruginosa becomes pathogenic,” said Geoffrey Yarranton, chief scientific officer.

Researchers demonstrated in both laboratory and rodent studies that KB001 is active against drug resistant strains of this bacterium.

P. aeruginosa is an opportunistic pathogen that rarely causes disease in healthy people, but is a significant problem for critically ill or immunocompromised individuals. These include the approximately 70,000 worldwide patients with cystic fibrosis where P. aeruginosa is a major causative agent in the progressive loss of lung function resulting from recurrent and chronic respiratory tract infections.

This is a phase 1/2 clinical trial, which means that the data from a small previously conducted human trial of healthy volunteers indicated that there were limited or no side effects, and so KB001 is now being tested in cystic fibrosis patients between 18 and 45 years of age with P. aeruginosa in their lungs. KB001 is a fragment of a monoclonal antibody — a biologic drug.

The drug must be given intravenously or as an injection, but its effects may last for weeks.

The technology developed by KaloBios is a proprietary method for converting non-human antibodies into engineered human antibodies.

– by Gene J. Koprowski, Editorial Director

P. aeruginosa infection can be quite harmful for those with CF.

Posted: March 31st, 2008 under Antibiotic Resistant, Feature Stories.
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The mysterious, Iraqi War illness, acinetobacter infection, has become an “increasingly common problem” in hospitals and other health care facilities, according to a report in this week’s New England Journal of Medicine. The infection is being brought back to the U.S. by veterans of the Iraqi war, some suspect. Others suspect far worse than that cause as the source of the illness.  “Dramatic multihospital outbreaks have been described in Brooklyn, Chicago, northwestern Indiana, Detroit, and cities in Europe, South America, Africa, Asia, and the Middle East. Infections with Acinetobacter baumannii tend to occur in debilitated patients, mostly in ICUs,” the NEJM reported. 

Residents of long-term care facilities, particularly facilities caring for ventilator-dependent patients, with wounded veterans, are at increased risk, the medical journal reported.  Additional risk factors for colonization and infection are recent surgery, central vascular catheterization, tracheostomy, mechanical ventilation, enteral feedings, and treatment with third-generation cephalosporins, fluoroquinolones, or carbapenem antibiotics, the journal reported.

Common treatments recommended by physicians, according to NEJM:

* Antibiotic-susceptible acinetobacter strains have been treated with broad-spectrum cephalosporins,  (beta)-lactam-(beta)-lactamase inhibitor combinations — a combination that includes sulbactam, a drug marketed only in intravenous products in the U.S.

*  Carbapenems — including imipenem or meropenem, although there are reports of discordant susceptibility to carbapenems –  used alone or in combination with an aminoglycoside.

The lengthy of treatment is generally similar to that for infections caused by other gram-negative bacilli, is largely empirical, and depends mostly on the site of infection. In vitro studies have demonstrated either synergy or additive effects when polymyxins were used with imipenem, rifampin, or azithromycin against multidrug-resistant acinetobacter.

– by Gene J. Koprowski, editorial director

Acinetobacter infection may soon rival MRSA in hospitals.

Infection Protection has covered this emerging disease extensively, and will continue to monitor it. See,

Maryland hospital now mum on extent of bacterial infection from Iraq war
http://www.care-mates.com/blog/?p=106

Rare bacterial infection, known to attack military personnel, emerges in civilian patients
http://www.care-mates.com/blog/?p=72

Antibiotics accelerating evolution for lethal microbial population, report indicates
http://www.care-mates.com/blog/?p=124

Posted: March 20th, 2008 under Anti-Bacterial Resources, Antibiotic Resistant, Feature Stories, Hand Hygiene, MRSA.
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A drug-resistant bacterial infection has been increasingly found in a number of patients who have plastic surgery, particularly face-lifts, doctors reported on Monday.

The report published in the current issue of the Archives of Facial Plastic Surgery said doctors who perform face-lifts may want to start screening patients to track down those who may be at risk.

According to Dr. Richard Zoumalan of Lennox Hill-Manhattan Eye, Ear, and Throat Hospital in New York and the New York University School of Medicine and Dr. David Rosenberg also of the Lennox Hill center, a review of 780 U.S. face-lift patients from 2001 to 2007 found five — 0.6 percent — with infections at incision sites. Four were confirmed as MRSA. 

Two patients appeared to have been exposed to the bacteria before surgery — one who had spent time with her spouse in a cardiac intensive care unit four months earlier, and another who had frequent contact with her brother-in-law, a cardiologist, the report said.

MRSA was blamed for an estimated 19,000 deaths in 2005 in the U.S., and has become the most common cause of all infections at surgical incision sites, and about 85 percent of cases happen in hospitals where the infection can kill the ill and infirm.

“It’s not surprising that it has been found in cosmetic surgery,” Rosenberg said, according to press reports.

Since patients enter hospitals with the bacteria, he said, “the emphasis has to be on pre-treatment.”

– by Gene J. Koprowski, editorial director

Source of Image: http://www.plasticsurgeryhumour.com/img/bad_face_lift.gif

Posted: March 18th, 2008 under Anti-Bacterial Resources, Antibiotic Resistant, Feature Stories, MRSA.
Comments: 1

A new, European study says that physicians are over-prescribing antibiotics to treat sinus infections.

An inflammation of the nasal passages and sinus cavities, called rhinosinusitis, is a common illness that can be either bacterial or viral in nature.

Since it’s hard for doctors to tell which form a patient has, they turn to antibiotics an estimated 80 percent of the time, according to media reports.

Researchers from Switzerland found antibiotics offer only little relief for the symptoms and may contribute to the rising problem of bacterial resistance to these medicines.

Though Western medicine seems baffled as to how to treat sinus infections, traditional Chinese medicine (TCM) physicians have for centuries used the so-called “nasal pot” therapy. Saline solution — salt water — is warmed. Then the patient irrigates both of his nostrils, using a device that looks like a tea kettle, and  is commonly called a nasal pot. The patient lets the solution pass through the sinuses. The therapy is repeated every two to three hours and is found to be effective in reducing the symptoms of rhinitis.

– by the Editors

A coronal CT scan of a patient with sinus infection. Source: Mayo Clinic.  

Posted: March 17th, 2008 under Antibiotic Resistant.
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A team of University of Washington (UW) researchers who study the mechanisms of cell destruction have discovered that microorganisms have their own “alarm-ringing” signal that goes off when a potentially dangerous cell, such as a cell infected with Salmonella, approaches. Dying cells spill chemical signals and get a protective response. But, the resulting inflammation, which the body launches in self-defense, can at times backfire and damage vital tissues.

Researchers led by Dr. Brad T. Cookson, an associate professor of microbiology and laboratory medicine, described this type of cell death “pyroptosis,” from the Greek for “going down in flames.”

Cell death that does not cause inflammation is called “apoptosis”: to drop gently like leaves from a tree, according to researchers.

An enzyme, called caspase-1, enjoys a critical role in both harmful inflammation and in resistance to infection, Cookson says.

The capsase-1 enzyme is not just responsible for cell death, but also for the production of inflammatory proteins that are released from the dying cell. “Mice deficient in caspase-1 are susceptible to infection, yet resistant to toxic shock, tissue injury from lack of oxygen, and inflammatory bowel disease,” researchers say.

The scientists have done several studies of caspase-1 and how it mediates the pathway of pro-inflammatory programmed cell death. The lab’s most recent study is being published this week in the online Early Edition of the Proceedings of the National Academy of Sciences.

The study examined how two different noxious stimuli, anthrax toxin and Salmonella infection, trigger the caspase-1-mediated cell death pathway. UW graduate students Susan Fink and Tessa Bergsbaken conducted this study.

– by Gene J. Koprowski, director of scientific communications

This graphic shows the cell death pathway called pyroptosis. When activated by a toxin or an infection, the enzyme caspase-1 initiates several reactions inside of the cell, some of which lead to DNA damage, others to the release of chemical distress signals called cytokines, and others to the formation in the cell membrane of tiny pores that let water flood in until the cell swells, bursts and spills its contents.

Posted: March 11th, 2008 under Antibiotic Resistant, Feature Stories.
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Drug-resistant infections are now a “major public health threat” globally, according to Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID), a branch of the National Institutes of Health (NIH).

“Extensively drug-resistant tuberculosis and invasive methicillin-resistant Staphylococcus aureus (MRSA) infections are just two recent examples of this problem that pose serious threats to domestic and global health,” he says.

The ability of microbes to evade drugs through rapid reproduction and genetic mutation is exacerbated by the overuse and misuse of existing antimicrobial drugs, Dr. Fauci notes, in a posting at the NIH web site. Additional factors contributing to the upswing in drug resistance include a dearth of rapid diagnostic tests that could allow physicians to better determine whether a particular infection is drug-susceptible or drug-resistant, and a dearth of clinical trial data.

Last year, NIAID invested more than $800 million to support basic and translational research on antimicrobials, more than $200 million of which was devoted to understanding the causes, consequences and treatments of antimicrobial drug resistance.

Basic research projects underway nationally include the following:

* Investigations of mechanisms of resistance and how these traits are acquired and passed on by microbes.
* Research on factors that contribute to the virulence of pathogens such as MRSA.
* Efforts to better understand and ultimately prevent biofilms — slimy coatings made by communities of bacteria that are impervious to the effects of antibiotics.
* Creation of computer-based virtual microbial metabolic pathways that allow quick identification of potential drug targets.

According to the NIH, clinical trials, including one assessing the need for antibiotics in children with acute middle-ear infections, and two trials designed to test off-patent oral antibiotics for treating uncomplicated community-associated MRSA, are now underway. 

“With antimicrobial resistance, we face the perpetual challenge of maintaining a favorable balance between microbes and humans,” says Dr. Fauci. “The efforts of NIAID and all our partners from the public health, research and pharmaceutical sectors are critical to addressing this challenge and thus keeping us at least one step ahead of our microbial foes.”

In addition to Dr. Fauci, the other authors are N. Kent Peters, Ph.D., program officer for antibacterial resistance, NIAID Division of Microbiology and Infectious Diseases (DMID); Dennis M. Dixon, Ph.D., chief, Bacteriology and Mycology Branch, DMID; and Steven M. Holland, M.D., chief, Laboratory of Clinical Infectious Diseases, NIAID Division of Intramural Research.

NIAID is a component of the National Institutes of Health. NIAID supports basic and applied research to prevent, diagnose and treat infectious diseases such as HIV/AIDS and other sexually transmitted infections, influenza, tuberculosis, malaria and illness from potential agents of bioterrorism.

– by The Editors

NIH’s Dr. Fauci says government must better handle research on drug-resistance.

Posted: March 10th, 2008 under Antibiotic Resistant, MRSA, Malaria, Tuberculosis.
Comments: 2

The National Institutes of Health (NIH) is moving forward with additional measures, as part of a “comprehensive plan” to address public safety concerns regarding a national biocontainment research laboratory now under construction at Boston University Medical Center.

Research in the laboratory will focus on the development of diagnostics, treatments, and vaccines for an array of infectious diseases.

“Our number one concern is the safety of the people working in the laboratory and those living in the surrounding communities,” Elias A. Zerhouni, M.D., NIH director, says.

NIH has established an internal Coordinating Committee to guide the agency’s efforts to address safety concerns raised by community representatives and other members of the public.

NIH also has established a blue ribbon panel, chaired by Adel Mahmoud, M.D., Ph.D., of Princeton University, that will review current risk assessments and provide independent technical expertise and guidance. The panel includes experts in infectious diseases, public health and epidemiology, risk assessment, environmental justice, risk communications, biodefense, biosafety, and infectious disease modeling. “The biomedical research conducted in facilities such as the one under construction at Boston University Medical Center is essential for developing vaccines, therapies, and diagnostics to protect the American public against infectious diseases that may occur naturally or be deliberately introduced,” says Anthony S. Fauci, M.D., Director of the National Institute of Allergy and Infectious Diseases (NIAID).

“Through a transparent process, we will thoroughly examine any potential risks to the community associated with this project and continue to promote open communication and mutual understanding,” he adds.

In accord with NEPA, NIH completed a Final Environmental Impact Statement and issued a Record of Decision in February 2006 that affirmed the safety of the laboratory. Supplementary risk assessments were drafted in response to concerns raised in a federal court proceeding regarding a challenge to NIH’s previous review.

– by The Editors

A new biocontainment laboratory being built in Boston is generating national controversy.

Posted: March 7th, 2008 under Anti-Bacterial Resources, Antibiotic Resistant, Droplet Precautions, Hand Hygiene, Infection Protection, Masks Control Transmission, Parasites and Lice.
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Scientists may have finally found the answer to the persistent problem of getting doctors and nurses to wash their hands — a loud, annoying, and repeating beep.

A new technology developed by Toronto researchers, on the market as early as a year hence, equips health care officials and others involved in direct patient care, with a small sensor attached to their identification badge or lanyard.

Medical personnel who approach patients with “unwashed hands” will hear a beep, reminding them it is time to clean up. By squeezing a hand gel sanitizer taken from a wall dispenser, also outfitted with a sensor, the sound is turned off.

According to Geoff Fernie, vice president of research for the Toronto Rehabilitation Institute,  the device, which costs roughly $300 a hospital bed, may reduce MRSA and other infections, as it will constantly remind busy health care workers to cleanse their hands.

– by The Editors

For more information, see

http://www.theglobeandmail.com/servlet/story/LAC.20080303.HAND03/TPStory/National

Animation. Stern warnings. Now beeping sounds used to remind docs, nurses to wash their hands.

Posted: March 4th, 2008 under Anti-Bacterial Resources, Antibiotic Resistant, Droplet Precautions, Hand Hygiene, Infection Protection, Masks Control Transmission.
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