Antibacterial drug use appears to have soared at academic medical centers between 2002 and 2006, driven primarily by increased use of broad-spectrum agents and the antibiotic vancomycin.

Use of antibacterial drugs dramatically increases the risk that pathogens will become resistant to their effects.

Infection with drug-resistant bacteria is linked with greater illness and death and higher health care costs than infection with bacteria susceptible to antibiotics. “Many professional societies and national agencies have recommended monitoring antibacterial use and linking patterns of use to resistance,” the authors of the new study, funded by Bayer.

Amy L. Pakyz, Pharm.D., of Virginia Commonwealth University, Richmond, and colleagues measured antibiotic use documented in claims data from university teaching hospitals between 2002 and 2006.

Statistics available from 35 hospitals in 2006—that year, a total of 775,731 patients were discharged, with 492,721, 63.5 percent, receiving an antibacterial drug.

The average total antibacterial use at the 22 hospitals providing five-year data increased from 798 days of therapy per every 1,000 days patients were in the hospital to 855 per 1,000 patient-days in 2006.

When doctors examined the drugs by class, fluoroquinolones were the most commonly used, and their use remained constant. “The other change contributing to the increase in total use was the marked increase in the use of vancomycin,” the authors write. “During five years, the mean [average] vancomycin use increased by 43 percent.”

“With few new antibacterials in development, antimicrobial stewardship programs in concert with aggressive infection control efforts represent the best chance for control of resistant pathogens,” the authors write.

– by Gene J. Koprowski, Editorial Director, and Nancy Bruening, Executive Editor

Doctors, nurses and other personnel at academic medical centers continue to dole out antibiotics.

Posted: November 12th, 2008 under Clostridium difficile, Developing Diseases, Impaired Immunity, MRSA.
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A new study shows that Clostridium difficile (C.-diff.) infections rates at hospitals are soaring, and an increasing number of patients have developed antibiotic-resistant strains of the infection that are more difficult to treat.

The study, released by the Association for Professionals in Infection Control and Epidemiology (APIC), found that 13 out of every 1,000 patients or approximately 7,178 inpatients on any one given day were infected or colonized with C.-diff. That’s a total of 94.4 percent who were infected.

The rate is 6.5 to 20 times higher than previous incidence estimates that were based on more limited data. The study shows that on any given day these infections cost between $17.6 million to $51.5 million and kill between 165 and 438 patients.

The report is based on a survey of infection control professionals from 648 health care facilities throughout the country who collected data about all of their patients with C.-diff. infections on one day between May and August 2008.

“C-diff. infections are much too common in our nation’s hospitals and threaten the health of thousands of patients every year,” said Lisa McGiffert, director of Consumers Union’s stop hospital infections campaign, at www.StopHospitalInfections.org . “Most hospitals aren’t doing enough to protect patients from these deadly, preventable infections.”

The group called on hospitals today to take more aggressive steps to protect patients.

– by Gene J. Koprowski, Editorial Director, and Nancy Bruening, Executive Editor

C. Difficile infections.

Posted: November 12th, 2008 under Clostridium difficile, Developing Diseases, Impaired Immunity.
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Cases of the hospital superbug C. difficile fell in the U.K. during the second quarter of the year, encouraging public health officials as they strive to stop the deadly infection.

The Health Protection Agency (HPA) reported that there had been 8,683 cases of Clostridium difficile reported in patients aged 65 and over between April and June in England, an 18 percent decline from the first quarter.

The figures also represent a 38 percent decrease compared to the same period 12 months earlier.

There were similar drops in the level of infections recorded in kids under two years old.

Professor Mike Catchpole, director of the HPA’s Center for Infections, said the figures demonstrate there has been significant progress in controlling outbreaks of the bug.

“If numbers continue to drop in this way in future we are well on our way to seeing outbreaks of this unpleasant infection become fewer and fewer,” he said.

The C. difficile bacterium was discovered in 1935 and first associated with disease in 1978. Symptoms of infection include diarrhoea and abdominal pain.

– by Gene J. Koprowski, Editorial Director, and Nancy Bruening, Executive Editor 

The cause of intestinal infections.

Posted: October 23rd, 2008 under Clostridium difficile, Developing Diseases.
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The altruistic arm of Internet search engine pioneer Google, Inc. this week said it had given grants of more than $14 million to support physicians working in Southeast Asia and Africa to prevent the next pandemic.

Mountain View, Calif.-based Google.org’s Predict and Prevent initiative is supporting efforts to identify “hot spots” where infectious diseases may emerge, discover new pathogens in animal and human populations, and react to outbreaks before they become global crises.

New lethal infectious diseases crop up every year, Google said, including variants of HIV/AIDS, bird flu and SARS, as well as drug-resistant strains of ancient scourges malaria and tuberculosis.

Google said three-quarters of new diseases are “zoonoses, meaning they’ve jumped from animals to humans.”

– by Gene J. Koprowski, Editorial Director, and Nancy Bruening, Executive Editor

Posted: October 21st, 2008 under Avian Flu, Clostridium difficile, Developing Diseases, EV71, Ebola Virus, Flesh-Eating Bacteria, HPV, Hendra Virus, Impaired Immunity, Legionnaires' Disease, MRSA, SARS, West Nile Virus.
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Dropping dramatically in the polls, Democratic presidential nominee Barack Hussein Obama today trotted out an old standby line for struggling left wing pols — the false accusation that, if elected, the Republicans will cut the federal health care program for the aged and poor, Medicare.“Sen. McCain would pay for part of his plan by making drastic cuts in Medicare – $882 billion worth,” Sen. Obama (D-Ill.) told a crowd in Roanoke, Virginia, today. “Eight hundred eighty two billion dollars in Medicare cuts to pay for an ill-conceived, badly thought through health care plan that won’t provide more health care to people, even though Medicare is already facing a looming shortfall.”

As Infection Protection & Control’s San Francisco correspondent, Peter Menkin reported last month, Medicare has already been reformed during the last few years and the Bush administration is saving costs through new measures, for example, by reducing risk of nosocomial infection for patients whose health coverage is paid for by the program. If patients don’t get sick from an infection  from MRSA or C. Difficile when they are in the hospital for another reason, that saves the government money. A spokesman for Republican nominee, Sen. John McCain (R-Ariz.), called Obama’s charge about future spending cuts for Medicare an outright lie.“Unlike Barack Obama’s risky plan, John McCain’s plans for health care do not punish struggling businesses with fines and taxes, and they certainly do not cut a single benefit for Medicare or Medicaid – Obama is simply lying,” said Tucker Bounds, the spokesman. “It’s absurd for Barack Obama to label John McCain’s plans to trim spending for Medicare and Medicaid as ‘drastic cuts,’ only to then say that his own plans to make cuts will ‘strengthen’ those programs. For Barack Obama to talk about the hope of America and then proceed into misleading and hypocritical accusations only underscores what voters already know: Barack Obama is not who you think he is.”

Posted: October 17th, 2008 under Clostridium difficile, Developing Diseases, Diseases, MRSA.
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Patients at nursing homes and long-term care facilities (LTCFs) are at increased risk of developing Clostridium difficile infection (CDI), according to a new report.

Although the disease can be effectively managed with proper treatment and use of strategies that prevent transmission of spores, research indicates that CDI appears to be increasing rapidly in the U.S. and is disproportionately affecting older persons.

What’s more, 37 states and Washington, D.C., have reported outbreaks of a unique, hypervirulent strain of C. difficile that poses additional risks to LTCF residents.

To address the need for education on management of CDI in LTCFs, Robert Michael Educational Institute LLC (RMEI) and Postgraduate Institute for Medicine (PIM) are jointly sponsoring a complimentary continuing education virtual lecture titled Clostridium difficile Infection: Best Practices for Prevention and Treatment in Long-Term Care. This activity is supported by an educational grant from ViroPharma Incorporated.

“Quality continuing education is vital to developing and increasing knowledge and skills and enhancing patient care,” says RMEI President and CEO Robert M. Colleluori.

The information contained in this online lecture was originally presented as a live symposium on June 23, 2008, during the 2008 National Conference of the National Association Directors of Nursing Administration/Long Term Care (NADONA/LTC) in Nashville, Tennessee.

Nurses can download this virtual lecture at http://www.RMEI.com/LTCCDI059 .

– by Gene J. Koprowski, Editorial Director

Infection protection procedures need to be stepped up to help seniors.

Posted: October 17th, 2008 under Clostridium difficile, Developing Diseases.
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A new report indicates that the increasing incidence of nosocomial infections has generated interest in development of new infection protection and control strategies all around the world.

The study, Pipeline Insight: Nosocomial Vaccines Minefield or Goldmine, produced by Report Buyer, indicates that S. aureus is the most frequent pathogen present in the hospital setting in most western countries.

An estimated 292,000 hospitalisations with a diagnosis of S. aureus occur each year in the U.S.

The pathogen is the most frequent cause of skin and soft tissue infections and affects a wide range of different patient groups.

Infections are associated with a longer hospital stay, a poorer clinical outcome and high treatment costs.

With S. aureus emerging as an increasing problem, considerable efforts are being made to reduce infection rates.

Hygiene-improvement strategies, such as hand-hygiene programs, thorough disinfection of medical devices and isolation of infected patients have been implemented in many countries.

Though some success has been achieved with these strategies, their overall impact on infection rates has been limited thus far, and they are unlikely to remain efficacious in the long run, particularly considering the rapid spread of S. aureus in the community setting.

As the reimbursement status for the cost of hospital-acquired infections is under pressure by payors, interest in preventing these complications at the outset is growing.

– by Gene J. Koprowski, Editorial Director

Posted: October 10th, 2008 under Clostridium difficile, Developing Diseases, Impaired Immunity, MRSA.
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California Gov. Arnold Schwarzenegger this week signed two measures requiring California hospitals to strengthen their efforts at preventing staph outbreaks and to alert the public to their rates of infection.

The policy move was a shift for the governor, who vetoed similar legislation a few years ago. Since that time, however, worries about the growth of these bacteria have made halting infections a top public health priority.

Hospitals throughout the state have had a tough time combating methicillin-resistant Staphylococcus aureus, or MRSA. That bacteria can spread from patient to patient through unsterile clothing, ventilation systems, surgical equipment or room furnishings.

The Centers for Disease Control and Prevention (CDC) believes that 2 million patients nationwide contract an infection each year, and about 100,000 die.

California health officials estimate that between 5 percent and 10 percent of patients in California hospitals develop infections, often through catheters, IV lines, and ventilators or during surgery, increasing treatment costs by about $3.1 billion a year.

One of the new laws demands that high-risk patients should be tested for MRSA within 24 hours of admission.

The second bill strengthens the public health department’s surveillance efforts of hospitals and requires doctors and other medical professionals at hospitals to be trained in preventing the spread of infections.

Betsy Imholz, a spokeswoman at Consumers Union, said the laws will help public health officials get accurate statistics on these bacterial infections.

– by Gene J. Koprowski, Editorial Director and Nancy Bruening, Executive Editor

Schwarznegger wants to terminate MRSA.

Posted: September 26th, 2008 under Clostridium difficile, Developing Diseases, MRSA.
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Research by the Centers for Disease Control and Prevention (CDC) estimates that C. difficile sickens as many as 500,000 Americans a year and contributes to at least 15,000 deaths. “We’re seeing more cases, and we’re seeing more severe cases,” says the CDC spokeswoman Dr. Carolyn Gould.

The bacterium, Clostridium difficile, or C. difficile, has been around at least 30 years. But there’s been a sharp increase since 2000 in cases tied to an unusually toxic, antibiotic-resistant strain, NAP1. Experts blame the overuse of antibiotics for helping spread this latest super bug.

Dr. Stuart Johnson, a Loyola University Medical Center infectious disease doctor, says he sees two cases of C. diff for every one of MRSA, a drug-resistant staph.

Many other hospitals say they haven’t seen a big increase in serious cases, which typically occur in older people who’ve been on antibiotics.

– by Gene J. Koprowski, Editorial Director, and Nancy Bruening, Executive Editor

Hand-washing can stop the spread of C. Diff.

Posted: September 23rd, 2008 under Clostridium difficile, Developing Diseases.
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During the last five years, Clostridium difficile BI/NAP1 has caused a rapid and dangerous spread of infectious disease in many regions of North America and several countries in Europe.

The Association for Professionals in Infection Control and Epidemiology (APIC) this spring disclosed that the association was launching a study of CDAD, directed by Bill Jarvis, M.D., in an effort to better understand the rapid spread of the pathogen, and ways to combat it.

In an interview with Liz Garman, spokesperson for APIC, Infection Protection learned that the study was prompted by the seriousness of the global rise in the spread of CDAD. “The results of our study will be released at the Clostridium difficile: A Call to Action Conference beginning on November 10, 2008.” In the study APIC is searching for new and better ways to increase prevention of CDAD, as well as effective pharmacotherapy because “our arsenal of effective treatment agents is thin, and the organism is rapidly developing resistance.”

CDAD symptoms include fever, nausea, abdominal cramping, abnormal heart rhythm, and pseudomembranous colitis, which can become so severe as to require colectomy. The link to antimicrobial resistance is usually associated with the overuse of prescribed antibiotics: principally clindamycin, penicillin and cephalosporins.

When doctors suspect the presence of CDAD, use of these antibiotics should be stopped. Moreover, many anitdiarrheal medications, i.e., Lomotil and Imodium, should not be used as they can exacerbate the problem by increasing the severity of the symptoms, doctors say.  

The disease occurs at a point when normal intestinal flora is altered in some way. At special risk are those patients who have undergone gastrointestinal tract surgery, have been given repeated enemas, or are being treated for other illnesses by the prolonged insertion of a nasogastric device.

C. difficile is an anaerobic spore-causing bacterium that can be transmitted from patient to patient by healthcare professionals who practice poor care-device clean up and hand-cleaning techniques.

Spread of the pathogen can be prevented by thorough hand washing between patient contacts, and care in handling diapers, bed linens, containers, and other hospital/rest home materials contaminated with CDAD spoors. Over the past several years in many institutional settings hand washing with soap and water has been replaced by the use of alcohol-based hand cleaning products, which has contributed to the problem since alcohol has no effect on the CDAD spoors.

The patient’s stool should be immediately tested for the presence of C. difficile toxins. Once the disease is confirmed, if it is suspected that a prescribed antibiotic is a contributing factor the drug should be discontinued. Standard treatment for CDAD patients is isolation, strict cleanliness procedures, and the administration of metronidazole or vancomycin.

Like Staphylococcus aureus, Clostridium difficile can be far more easily prevented than treated. Perhaps the rising incidence of CDAD worldwide will result in more attention being given to cleanliness in patient handling in health institutions.

– by Dr. Herb Marlow, PhD, Dallas Correspondent

Posted: September 16th, 2008 under Clostridium difficile, Developing Diseases.
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