Drug Resistant Bacteria-Part III of a III Part Article

(7/26/21)-In a finding that was released last week by the Centers for Disease Control and Prevention (CD), the deadly fungus Candida auris has been spreading to nursing homes and hospitals. The fungus was first discovered in Japan in Japan in 2009 and has been spreading worldwide since then.

C auris has been resistant to all drugs and continues to be a growing menace. Nearly one third of infected patients have died within 30days.

The fungus thrives on medical equipment and cleaning carts.

(2/8/21)-Drug resistant bacteria have been a major problem for a long time, as shown by these series of articles which go back to 2008.With the heavy and steady usage of steroids to treat patients with the Covid-19 infection can mean the immune system is compromised in a way that allows other bacteria to easily enter the bodies system.

Particularly troublesome the increased cases of Candida auris in Florida, New jersey and California, as well as India, Italy, France and Peru.

Noxious drug resistant bacteria, such as Carbapenem baumannii have caused havoc in a nursing home in New Jersey.

(1/19/20)- The antibiotic medications that are used to treat drug resistant bacteria are usually taken by a patient for a relatively short period of time, i.e. one to two weeks, and therefore deemed non-repetitive drugs. From a pharmaceutical companies perspective, this type of drug isn’t as financially enriching as a regular drug.

The World Health Organization has issued two reports detailing this problem and calling for urgent action from the drug companies to do more and better research in this area because the United Nations estimated that about 10 million people will die from drug resistant bacteria by 2030.

About 700,000 humans die each year because medicines that cured these diseases are no longer effective, and of the 60 new antiviral drugs in development the vast majority are variations of existing products and few of these target the most dangerous drug resistant infections.

Recently there has been several bankruptcies reported of some of the smaller companies that were developing promising new drugs in the battle against drug resistant bacterias.

(11/17/19)- Both the Wall Street Journal and New York Times had recent articles about a report from the Centers for Disease Control and Prevention (CDC) that warned of the spread of bacteria that are resistant to anti-bacterial drugs.

The Journal article “CDC Warns on Superbugs” by Betsy McKay that “nearly 3.1 million infections with 48,700 deaths a year in the U. S. “The NY Times article “More Are Dying From Infections That Foil Drugs “ by Matt Richtel and Andrew Jacobs states: “Nearly 35,000 people in the United States are dying each year from drug-resistant infections”

Whichever number is correct, it shows that this is now a serious health problem for all of us. The data in the CDC report is an update from its last report issued in 2013.

An anti-biotic infection occurs every 11 seconds in the U. S. resulting in a death every 15 minutes. The new estimates include 223,900 cases, including 12,800 deaths a year from Clostrid-foldes difficile (C-diff). The other major problem arises from the Candida auris (A-auris) bacterial infection.

(5/5/19)- In a recent report issued by a panel of public health experts, government ministers and industry officials that comprised the U.N. Interagency Coordination Group on Antimicrobiolog Resistance , it was stated that a crisis was at hand as the drug resistant problem continues to worsen.

Drug resistant infections already claim about 700,000 lives a year worldwide, including 250.000 from drug resistant tuberculosis..

Overuse of antibiotics and antifungal medications in humans, livestock and agriculture is accelerating the crisis. One of the recommendations made in the report called for a worldwide ban  on the use of medically important antibiotics for promting growth in farm animals

(2/1 5/19)- The results of a recent study that was published in the New England Journal of Medicine concluded that patients infected while in the hospital, can cut their risk of  a full blown Methicilin-resistant Staphyloccoccus aureus (MRSA) infections were less likely to develop a full-blown infection by using antiseptic soap, a medicated mouthwash and an antibiotic ointment.

For more information on this topic please see our item dated4/2/11 below

(12/19/18)- The results of a study by researchers that was published in the New England Journal of Medicine concluded that hospital-acquired infections had declined to 3.2 percent of patients in 2015, from 4 percent in 2011 for the almost 200 hospitals caring for 12,000 patients across the country.

Most of the reductions were in urinary tract and surgical site infections. There were no declines in pneumonia and infections with C.difficle.

Dr. Shelley S. Magil, a medical officer with the Centers for Disease Control and Prevention (CDC) was the lead author of the study

(2/21/18) The Centers for Disease Control and Prevention (CDC) determined that the number 1 hospital acquired infection is pneumonia. That includes both ventilator and non-ventilatorinfections.

In an article that was published in the January edition of the American Journal of Infection Control, Dian Baker, the lead author of a recent study on this issue, warned that American hospitals are not addressing this issue.

Investigators from the CDC and the Pennsylvania Department of Health found that about 31% of adult patients with hospital acquired pneumonia died

At NYU Langone Health in New York City patients are asked to brush their teeth and gargle before the surgery, whether the individual is having complex surgery or not.

(2/21/17)- Merck & Co. will begin marketing its brand name drug Zinplava (bezlotoxumab) in March, which has been shown to reduce C.diff recurrences. A study in The New England Journal of Medicine (JAMA) reported recently that the drug reduced the recurrence to 16 to 17 percent. Using a placebo, the recurrence took place 26 to 28 percent.

The drug costs $3,800 for a one-time intravenous infusion The Centers for Disease Control and Prevention (CDC) did an analysis in 2011 that estimated that there were 453,000 cases a year, resulting in 29,300 deaths from C diff. infections.

The French drug company Sanofi began recruiting 15,000 volunteers in about 20 countries for a Phase 3 trial of its experimental vaccine for the disease

(9/23/16)- World leaders agreed at the United Nations General Assembly in New York City to develop national action plans to strengthen regulations and improve reporting systems that track how drugs are used, in an effort to curb the spread of drug resistant bacteria.

The overuse of antibiotiotics in both animals and humans is leading to the superbugs that have been the cause of over 700,000 deaths a year worldwide, according to Jim O’Neil chairman of the British review on antimicrobial resistance.

About 2 million fell ill to the superbugs in the U.S. last year, and that led to at least 23,000 deaths.

The agreement is nonbinding and did not require countries to commit to specific targets.

(7/30/16)- The U.S. Department of Health and Human Services (HHS) will invest $250 million over the next five years in a public-private endeavor, which will be known as CARB-X, for Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator.

The project will focus on providing monetary help to small companies and labs that are in the earliest stages of developing new drugs, vaccines or medical devices to combat “superbugs”.

Britain’s AMR Center, a public-private partnership; Britain’s Wellcome Trust, a global charitable foundation; and other scientific and academic groups will be included in the project.

(6/16/16)- Dr. Richard J. Hatchett, acting director of the government’s Biomedical Advanced Research and Development Authority, or BARDA, said that there are now 7 drugs in advanced testing that may prove effective against drug resistant bacteria (Gamma Negative bacteria).

BARDA has shared the costs of the new drugs being tested with pharmaceutical companies in the program started in 2014 by President Barack Obama to combat drug resistant bacteria. The agency has borne the clinical and manufacturing costs of the companies that make the 7 drugs.

(5/29/16)- Officials at the Centers for Disease Control and Prevention (CDC) have confirmed the findings of American military researchers who identified the first patient in the United States to have been infected with bacteria that are resistant to an antibiotic that was considered the last resort against drug-resistant bacteria.

The 49-year old woman has recovered, but according too Dr. Beth Daniel of the CDC: “We have that genetic element that would allow for bacteria that are resistant to every antibiotic.

The bacteria are resistant to the drug colistin that was held in reserve in this country to treat dangerous infections.

The drug is in a class of drugs known as carbapenems. The woman had gone to a military clinic in Pennsylvania for a urinary tract infection. Test showed that she had E coli bacteria resistant to colistin. She was treated successfully for the superbug with other antibiotics.

(5/6/16)- With antibiotic overuse driving the rise of antibiotic-resistant infections, authors of a large study find that during 2010 to 2011, antibiotics were prescribed for outpatients across all conditions at a rate of 506 per 1000 population.

Only an estimated 353 of these, however, were likely appropriate, suggesting that 30% of these antibiotics may have been unnecessary. (These findings, published in the May 3 issue of JAMA)
Harold Rubin

(3/16/16)- Fifteen of the 18 largest drug companies have abandoned the antibiotic market. 19 new antibiotic drugs were approved by the Food and Drug Administration (FDA) from 1980 to 1984, only 13 were approved from 2000 to 2014.

Antibiotics, as a class of drugs provide a poor return on investment for pharmaceutical companies. The National Institute for Health (NIH) received $100 million for antibiotic resistant research. The Biomedical Advanced Research and Development Authority received an additional $96 million to do research in this area.

(3/5/15)- Recent data released by the Centers of Disease Control and Prevention (CDC) shows that 1 out of 7 drug resistant infections are caught in hospitals. The CDC estimates that 1 in 25 patients in a hospital will pick-up an infection.

The data was compiled by the agency from examining the records of thousands of hospitals from 2008 through 2014, focusing on infections caused by certain surgical procedures and the use of catheters.

(2/17/16)- A study from the Centers for Disease Control and Prevention (CDC) estimated that about 453,000 people were infected with the C.difficile bacteria, and almost 29,000 of them died from the infection in 2011, the latest year for which these figures are available. The study results were published last year in the New England Journal of Medicine.

The elderly are at particular risk from the C.difficile bacteria since they have weakened immune systems.

Hospitals and nursing home now take over 1 ½ hours to properly cleanse a room where a previous patient or resident became infected with the bacteria. The spore is fueled by overuse of antibiotics and spreads readily when medical professionals do not properly cleanse their hands. It can survive on doorknobs or bedrails for up to 5 months.

(11/10/15)- The Centers for Disease Control and Prevention (CDC) estimated that about 75,000 patients died from infections acquired during their hospital stay. Infectious disease experts continue to try to reduce that number through rigorous cleansing methods, including washing of hands, and also by publicizing the need to cut back on the over-usage of anti-bacterial drugs.

There were an estimated 722,000 cases of hospital acquired infections in the U.S. in 2011, according to the CDC, which breaks down to 1 in 25 hospital patients will be infected with this very serious bacterial infection.’

(4/3/15)- Based on the recommendations that President Obama received from the task force he created to investigate the drug resistant bacteria problem that we discussed in our item dated 9/23/14 below, the president announced that he would ask Congress to allocate $1.2 billion towards fighting the superbugs.

The plan, formally known as the National Action Plan for Combating Antibiotic Resistant Bacteria, sets goals to reduce by 50% to 60% illnesses caused by these bacteria .It is estimated that about 2 million Americans suffer from this problem annually, and that over 23,000 deaths result from these bacteria.

Although certain aspects of the plan can be formalized through agency regulations, the bottom line is that for the plan to be effective, he will need funding for the plan from  Congress.

The plan calls for eliminating the farming practice of fattening animals with antbiotics to help them grow bigger and faster. This practice, in turn, means the consumer will become more resistant to drugs that fight these bacteria. One of the other factors involved in the problem is the administration of antibiotics by medical professionals to their patients who have viral problems, not bacterial issues.

(3/2/15)- The Centers for Disease Control and Prevention (CDC) estimated that the deadly bacteria infection Closridium difficile afflicted almost half a million Americans and caused about 29.000 deaths in 2011, according to a recently published study in the New England Journal of Medicine.

The estimate studied lab testing and reporting in 10 states. C.difficile causes severe diarrhea and colon damage and is linked to overuse of antibiotic.

The study estimated that 24% of the cases occurred in hospitals, and 40% began in nursing homes or community health care facilities. Please see our item dated 12/5/05 below for more information on these bacteria

(9/23/14)- An executive order signed by President Obama creates a task force that must submit a detailed plan by February 15, 2015 to combat the growing problem of drug resistant bacteria.

Latest figures from the Centers for Disease Control and Prevention (CDC) estimated that as much as 50% of all antibiotics prescribed in this country are either unnecessary or uncalled for in fighting an infection. The CDC also estimates that 23,000 deaths occurred in the U.S. last year due to drug resistant bacteria.

The Food and Drug Administration has called for drug companies to phase out antibiotics used to promote growth in animals. So far 26 pharmaceutical companies have voluntarily agreed to phase usage of these drugs in animal feed and water to speed up the growth of the animals.

The task force will be led by the secretaries of health and human resources, defense and agriculture, and are aimed at phasing in the recommendations within 5 years.

(6/23/14)- The Food and Drug Administration has approved a new antibiotic from Cubist Pharmaceuticals to treat common skin infections often acquired in hospitals, including Staphyloccus aureus (MRSA), Streptococcus species and Enterococcus facalis.

The medication, named Sivextro, can be taken as a pill or intravenous solution for adults with skin infections caused by bacteria. Last month, the FDA approved a similar drug from Durata Therapeutics.

The Centers for Disease Control and Prevention estimated last year that MRSA infections kill about 11,000 people annually.

(2/25/14)- As noted in our item dated 9/18/13 below, about 250,000 people become infected in their gastro intestines with clostridium difficile (C.diff.) infection. About 14,000 Americans die each year from the infection. The bacterium is increasingly difficult to fight with ordinary drug treatments.

Researchers have come up with an alternative type of treatment that has been more effective in fighting the bacteria than through the usual drug treatments. A healthy donor’s stool can be transplanted in the intestines or colon of an infected patient with an enema, colonoscopy or nasogastric tube. The healthy bacteria fight off C.diff. and re-establishs a healthy environment in the gut.

About a year ago, Mark Smith, a 27-year old doctoral student, and 3 colleagues established OpenBiome, the nation’s first stool bank.

(9/18/13)- Data from a report that was recently issued by the Centers for Disease Control and Prevention (CDC) estimated that at least 23,000 people in the U.S. died last year as a result of developing a drug resistant infection, while more than 2 million came down with the problem last year.

About 250,000 more people develop a clostridium difficile bacterial infection annually, and about 14,000 of those cases die each year.

The report stated: “Up to half of antibiotic use in humans and much of antibiotic use in animals is unnecessary and inappropriate, and makes everyone else less safe.”

The report ranked 18 drug-resistant bacteria and fungi by threat levels. Three are ranked “urgent” meaning they have few treatment options.

(7/29/13)- Approximately 1.7 million Americans incur hospital-acquired health care-associated infections annually, with 45% of them aged 65 and older, according to a fact sheet released by the Alliance for Aging Research.

(6/6/13)- In a novel approach to dealing with drug resistant bacteria in hospital intensive care units, some institutions are treating every patient in the ICU with a regimen called "universal colonization). The older practice had been to test the patients in the ICU for the bacteria's presence.

In a study of nearly 75,000 patients at 74 adult ICUs in 43 Hospital Corporation of America facilities, it was estimated that this procedure resulted in a reduction of all bloodstream infections, including those caused by other germs by 44%, and reduced the incidence of MRSA-positive cultures in the ICU by 37%.

Patients were washed with cloths containing antimicrobial soap chlorhexidine and received a nasal antibiotic ointment, mupirocin.

(3/14/13)- As noted in our item dated 2/12/13 below, the drug resistant carbapenem-resistant Kebsiella or CRK, which is a member of the family of the bacteria known as enterobacteriaceae family, continues to kill patients throughout various medical facilities in this country.

The Centers for Disease Control and Prevention (CDC) issued a report, which concluded with the evaluation that the germ is becoming increasingly drug-resistant, but that aggressive detection and prevention methods can be effective in halting outbreaks of the disease.

The study showed that the proportion of enterobacteriaceae resistant to the antibiotics known as carbapenems (CRE), has risen to 4.2% in 2011 from 1.2% a decade earlier. The increase for the most worrisome type of organism, Klebsiella, was even greater, with 10.4% resistant to treatment versus 1.6% a decade earlier.CRE infections have killed about 1/2 of the patients who became infected with the disease.

Close to 4% of short-stays hospitals had at least one patient with CRE in the first half of last year, while almost 18% of long-term acute care facilities had one, with a total of 200 hospitals reporting at least one CRE infection.

CRE infections occur in patients with weakened immune systems, especially if they have had catheters inserted into them. The infection has now been reported in 42 states. The infection spreads if the health worker don't wash his/her hands, between contact with different patients

(2/2/13)- The battle against drug resistant bacteria is a never-ending fight. As you make gains against one type of the bacteria, along comes another type to set you back. The latest of the drug resistant bacteria, carbapenem-resistant Kebsiella or CRK, exploded on the hospital scene in 2011 at the National Health Medical Center in Bethesda, Md.

6 patients have died at that medical facility recently, including a 16-year-old boy. A recent edition of the journal Infection Control and Hospital Epidemiology had an article with data indicating that this relatively new drug resistant bacteria is now sweeping through our medical facilities.

It was first discovered in New York City in 2000, but it now has spread throughout the country. Los Angeles County detected 356 cases of CRK in the 2nd half of 2012.

Extra precautions now are being taken at hospitals to try and prevent the bacteria from spreading. The first precaution being utilized is the screening by the medial facility of all incoming patients for signs of CRK. The second step is the extra cleansing of the room of a patient who contacted the disease.

Rooms of patients are double-cleaned with bleach and then misted with a hydrogen peroxide sprayer.

(9/18/12)- The four-year results of a program to reduce the rate of a potentially deadly type of blood-steam infection in hospital intensive-care units seems to be succeeding.

The project, which is known as the Comprehensive Unit-based Safety Program was implemented in more than 1,100 adult ICU units in 44 states over a four-year period of time. It was instituted because of the death of an 18-month old baby due to an infection of a catheter that caused a deadly blood stream infection.

The catheter in question that caused the blood stream infection was a central line catheter that is used to deliver drugs and other liquids directly into the patients' major veins.

The preliminary result of the national effort was a reduction in the rate of infections to 1.137 per 1,000 days of central-line catheter use, from 1.903, over the first 18 months that hospitals implemented the program. The Centers for Disease Control and Prevention has estimated that there were around 18,000 such infections in ICU units in 2009 down from 43,000 in 2007.

The program is built on a checklist of key medical practices such as hand-washing, properly covering up care-givers and patients when a catheter is inserted, and using the right disinfectant at the site of insertion. Nurses are instructed to make sure that the physicians adhere to these proper practices.

(9/5/12)- We know that drug resistant bacteria thrive on the over-usage of antibiotic pills or injections given to humans. Many medical professionals assert that another breeding ground for this same problem is the feeding of antibiotics to chickens, pigs, cows and other animals that people eat at the dinner table.

The antibiotics are fed to the animals to speed and increase their growth.

Eighty percent of the antibiotics sold in this country goes towards animal consumption, yet producers of meat and poultry are not required to report how they use these drugs are being used. A government report indicated that a particularly virulent drug resistant bacteria has increased tenfold from chicken breasts, which is the most commonly eaten meat in the United States.

In 1977, the Food and Drug Administration (FDA) announced that it would begin banning some agricultural uses of antibiotics in animal feed, but due to congressional opposition that was led by the drug and farming industry, the agency dropped the matter.

(8/2/12)-The number of people who die as a result of drug resistant bacteria continues to climb to higher and higher levels. Congress in passing the FDA funding bill added the Generating Antibiotics Incentive Now (GAIN) provision to help in the battle.

The provision cuts the FDA drug review period of time down from 12 months to 8 months. To further encourage scientists and pharmaceutical companies with a financial reward, marketing exclusivity was extended by up to 10 years.

(6/12/12)- It is often stated that hospitals will cure you, if they don't kill you. According to the latest figures from the federal Department of Health and Human Services, about one in 20 patients entering a hospital will acquire a potentially deadly infection from the hospital.

Recent studies have shown that room door knobs, remote TV access devices and even bathroom faucet handles can harbor some of the deadliest bacteria.

(3/20/12)- Deaths from gastrointestinal infections more than doubled in the U.S. in the ten year period from 1997 to 2007 according to the latest data from the Centers for Disease Control and Prevention.

Of the 17,000 deaths recorded in 2007 from these infections, 83% were over the age of 65. Two-thirds of the deaths were caused by a bacterium, Clostridium difficile, which is most often contracted in hospitals and nursing homes. Please see our item dated 5/30/11 below in connection with the approval by the FDA of Optimer Pharmaceutical diarrhea and bowel infection drug Dificid to deal with the problem.

The second leading cause of death from gastrointestinal infections was from the highly contagious norovirus, which has been plaguing cruise ships, prisons, dorms and hosptials.

(5/30/11)- The Food and Drug Administration approved Optimer Pharmaceutical's diarrhea and bowel infection drug Dificid, also known as fidaxoicin, for sale for the treatment of diarrhea caused by Clostridium difficile. Dr. Sherwood I. Gorbach, the company's chief scientific officer was the main developer of the drug.

Dificid is the first new drug approved to treat diarrhea caused by C. difficile in 25 years. For more information on C. difficile please see our item dated 5/27/10 below.

Presently there are two drugs used to treat C. difficile. One is Vancocin, an oral form of the antibiotic vancomycin, which is sold by Viro-Pharma that was approved by the FDA in 1986. The other medication used to treat patients with the affliction is Pfizer's Flagyl, which is also known as metronidazole.

About 1,100 patients were enrolled in the clinical trial of Dificid as compared to Vancocin. Both drugs cleared the diarrhea in more than 85% of patients by the end of the 10-day treatment period, but in the ensuing weeks, about 25% of the Vancocin users had a recurrence of their diarrhea, compared to only about 15% of the Dificid users.

After 25 days of ending the Dificid treatment, about 70% of the Dificid patients were free of their diarrhea versus only 57% of those treated with Vancocin.

The main side effects are nausea, vomiting, abdominal pain and gastrointestinal hemorrhage. Dificid will be taken in tablet form twice a day and will be marketed in conjunction with Cubist Pharmaceuticals. Optimer has not revealed the cost of the medication yet.

(4/21/11)- Two different studies, two different results on the effectiveness of pre-testing patients for drug resistant bacteria before admission to a hospital. The results of both studies were published in a recent edition of The New England Journal of Medicine.

Incidentally, the U.S. Department of Health and Human Services announced that it plans to spend up to $1 billion as part of the health care act that was passed in 2010 to improve patient safety at hospitals aimed at preventing hospital infections and other medical errors.

The first study of 153 Veterans Affairs hospitals nationwide found a 62% drop in the rate of infections caused by methicilin-resistant Staphyloccoccus aureus (MRSA), in intensive care units over a 32-month period, and a 45% drop in MRSA infections when a "bundle" of measures were used to prevent the spread of the bacteria.

The measures included screening of all patients with nasal swabs, isolating those who test positive for MRSA, requiring that staff treating those patients to wear gloves and gowns and take other contact precautions and encouraging rigorous hand washing.

Dr. Rajiv Jain, an official with the Veterans Health Administration was the lead author of this study.

On the other hand, a study lead by Dr. W. Charles Huskins of the Mayo Clinic in Rochester, Minn., that focused on MRSA and vancomycin-resistant enterococcus bacteria, found no significant difference in infection and colonization rates between intensive care units that tested patients as a matter of course and those that did not.

This latter study of 9,000 cases in 2005 and 2006 found that in units that did not conduct universal testing, and where doctors simply ordered screening if symptoms presented, there were similar rates of infection. Doctor Huskins stated that he was surprised by the results of his study.

The Centers for Disease Control and Prevention in Atlanta still estimates that one of every 20 patients will acquire an infection while hospitalized. It concluded that hospital infections were associated with 99,000 deaths and costs of $28 billion to $34 billion a year.

(4/10/11)- British researchers reported in August that infections involving the New Delhi metallobetalactamase NDM-1 had been found in patients in Bangladesh, India, Pakistan and Britain. A team from Cardiff University in Britain made the determination of the finding of this new superbug..

The World Health Organization issued a plea for collective action to fight this new emerging superbug. The British researchers first published their findings in the journal The Lancet Infectious Disease. They determined that NDM-1 had been found in sewage and 2 of 51 tap water samples outside the hospital and in dozens of puddles and pools that children are playing in the city of Delhi, India.

There has not been any reported finding of the bacteria in the U.S.

(9/2/10)- The following is a copy of an email that we recently received concerning the possibility of a drug to fight MRSA. We wish to point out, that as the email states, the drug is entering Phase 2 study and so it still has years to go before the safety and effectiveness of the drug can be proven:

Original Message -----

Saturday, August 28, 2010 9:08 AM

"Your article on drug resistant bacteria did not mention a drug developed at the Univ of Penna that is presently entering Phase 2 testing. PMX 30063 has proven to destroy MRSA bacteria within 30 minutes of contact.

PMX-30063 is an antibiotic that mimics natural host defense proteins. Phase 2 studies of this product is planned to commence during 2010. This small molecule protein breaks thru the cell wall thus killing the bacteria with no chance of resistance buildup."

Dr Shelly Greene

Many thanks to you Dr. Greene for taking the time to forward this email to us.

(8/13/10)- The results of a study that was published in a recent edition of the journal Lancet Infectious Disease found the presence of a new bacteria called NDM-1 that allowed certain kinds of bacteria to produce a chemical that made antibiotics useless. The initials stand for New Delhi metallo-beta-lactamse.

This new superbug was identified in 3 patients in the U.S. recently, according to the U.S. Centers for Disease Control and Prevention (CDC). All three of the patients had undergone medical treatment in India. A total of 180 patients from India, Pakistan and the U.K. who were treated medically in India were found to have the new superbug.

Although infection from this new bacterium has not proven to be deadly, as is the case with methicilin-resistant Staphylococcus aureus (MRSA), which caused 278,203 hospitalization from 1999 through 2005, medical professionals fear that this may worsen in the coming years.

Health experts have attributed the over usage of antibiotics as the leading cause for the mutations that cause the evolution of superbugs

Bacteria with the NDM-1 gene are resistant even to the antibiotics called carbapenems, which are used as a last resort when other antibiotics have failed.

(5/27/10)- British researchers have warned that the Clostridium difficile bacteria(C difficile), which we discussed in our item dated 11/24/08 below may spread through the air in hospitals, and then land in places that cause the disease to spread if touched.

The bug is commonly spread by contact with infected feces from patients with diarrhea in a hospital. Dr. Mark H. Wilcox, a professor of medical microbiology at the University of Leeds was the senior author for the paper about the study.

Dr. Wilcox emphasized that soap and water is the best preventative from spreading the disease.

(5/21/10)- The incidence of Methicilin-resistant Staphyloccoccus aureus (MRSA) infections among children has increased over ten-fold in the last 10 years according to a study involving 25 children's hospitals. Jason Newland who is an infectious-disease physician at Children's Mercy Hospitals and Clinics and the University of Missouri-Kansas City was the lead author of the study.

The results of the study appeared in a recent edition of the journal Pediatrics.

From 1999k to 2008, MRSA disease incidence rose from two cases per 1,000 hospital admissions to 21 cases per 1,000 hospital admissions. Recent evidence indicates that hospital-acquired MRSA cases may be declining, while community-acquired cases are rising.

Almost 30,000 children were hospitalized with MRSA infections at the hospitals in the 10-year period. Most had skin or muscle infections, with 374 having died from the MRSA infection.

The study found a coinciding rise in the use of the antibiotic clindamycin, but Dr. Newland said that in some regions MRSA is already becoming resistant to the drug.

(4/24/10)- In addition to drug resistant bacteria that occur in hospitals, there are other types of infections that a patient can acquire while under the care of medical professionals while in a hospital.

Under the new health-care law, Medicare payments to hospitals will be reduced for preventable readmission and for certain infections that can be prevented with good nursing care.

The country's hospitals are not doing a good job in this area, according to the Health and Human Services Department's 2009 quality report to Congress. The report found "very little progress" in eliminating hospital-acquired infections and called for "urgent action" in this area.

According to the report:

Rates of bloodstream infections following surgery increased 8%. Urinary infections from the use of a catheter following surgery increased 3.6%. Overall incidence for a series of common infections due to medical care increased by 1.6%.

The number of bloodstream infections due to central venous catheters was unchanged, while the rate of pneumonia following surgery dropped by 12%..

(3/1/10)- In Andrew A. Pollack's article entitled "A Rising Hospital Threat", in the N.Y. Times dated February 27, 2010, he wrote about another drug resistant bacteria, known as Gram-negative bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is a gram-positive bacteria.

There is a Gram stain test that determines whether a bacterium is deemed negative or positive. Gram-negative bacteria have a double cell membrane, while Gram-positive bacteria have only one cell membrane.

There are no known drugs that have been effective in fighting the Gram- negative baceria, although there are two older antibiotics that were developed in the 1940s that are currently being used in the battle. Those two are colistin and polymyxin B, but they can cause severe kidney and nerve damage.

The Centers for Disease Control and Prevention (CDC) estimates that roughly 1.7 million hospital associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.

The two most common Gram-negative bacteria are Acinetobacter and Klebsiella pneumoniae. Acinetobacter infections arose in many of the solders who were wounded in Iraq. The bacteria can cause severe pneumonia, and infections of the urinary tract, bloodstream and other parts of the body.

(2/26/09)- The Journal of the American Medical Association recently published the results of a study involving nearly 600 hospitals showed that significant progress is being made in the battle against Methicillin-resistant Staphylococcus aureus (MRSA). We believe that a lot of this improvement has to do with the guidelines that have been emphasized in fighting this disease as shown in our item dated 10/14/08 below.

The government report indicated that the rate in improvement in the decline of ICU unit IV tube-related infections of MRSA has declined by almost 50% between 1997 and 2007.

Now, hopefully, we can see this type of improvement in the battle against Clostridium difficile (C diff) related infections also.

(11/24/08)- A new survey, based on a one-day snapshot taken this year at 648 hospitals in 47 states found that more than 1% of U.S. hospital patients are infected with Clostridium difficile. The Association for Professionals in Infection Control and Epidemiology, a national professional society whose members include doctors, nurses and epidemiologists commissioned the survey.

The survey determined that 13 out of every 1,000 hospitalized patients tested positive for C. diff. The one day snapshot technique is different from methods used in other analyses, so that may explain why its conclusion of the prevalence of the bacterium is greater than other studies have shown it to be.

Use of a bleach solution to clean rooms of infected patients is important in trying to prevent the spread of the disease in the hospital. Proper hand washing is also essential, because the spores aren't always killed by alcohol-based disinfectant gels.

(11/17/08)- The results of a Phase 3 trial which involved only 629 patients in the United States and Canada indicated that there might be another drug that is useful in treating the bacterium Clostridium difficile. The drug was developed by Optimer Pharmaceuticals The company has another Phase 3 study of the drug that it expects to complete next year. If that trial is successful, the company said it would than seek approval from the FDA to market the drug.

The usual treatment for C. difficile infection is the generic antibiotic metronidazole. More serious cases are treated with Vancocin or vancomycin, which is marketed by ViroPharma which is based in Exton, Pa. Virapharma acquired Vancocin from Eli Lilly & Co. in 2004..

In the clinical trail both Optimer's drug OPT-80 and Vancocin were nearly 90% effective in initially clearing the infection. Only 15.4% of those treated with OPT-80 suffered a relapse within four weeks, compared with 25.3% of those treated with Vancocin.

The longer term cure rate without recurrence was 74.6% for OPT-80 compared with 64.1% for Vancocin.

C. difficile infection occurs when patients are treated with antibiotics for other problems. Although this treatment kills many of the other bacterium, it does not kill off the C. difficile bacerium. For more information on the C. difficile bacterium please see our article dated 9/21/08 in Part I of this series of articles.

(10/14/08)- The Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America of America, the Association for Professionals in Infection Control and Epidemiology have joined with the American Hospital Association and the Joint Commission (which accredits hospitals) to issue a compendium of guidelines for preventing six lethal conditions.

These guidelines do not vary significantly from guidelines that have been announced over the last two decades, but the authors said that they had been written more clearly and concisely, with advice not only on what hospitals should do, but also on what they should not do.

Most epidemiologists contend that the problem lies in the fact that health professionals and hospitals had not been adhering to these guidelines. The Leapfrog Group, a combine of various corporations that hope to improve the quality of health care in this country found that 87% of the health-care facilities do not adhere to infection-control guidelines. For more on the Leapfrog Group, please see out item dated 11/22/04 in Part II of this series of articles.

As a prime example of this failure to adhere to the guidelines is the fact that many hospitals do not oversee visitors to intensive care units to make sure that they wash their hands before entering the room.

The federal Centers for Disease Control and Prevention, which also endorses the new guidelines, estimates that there are 7 million infection cases a year in hospitals, and that 99,000 patients die after contracting them (although the infection alone may not be the cause).

Medicare and other health insurers do not pay for the added cost of treating patients who develop certain infections while in a hospital or clinic.

The six conditions covered in the new guidelines are:

Central-line-associated bloodstream infections
Ventilator-associated pneumonia
Catheter-associated urinary tract infections
Surgical site infections
Methicillin-resistant Staphylococcus aureus (MRSA)
Clostridium difficlie, an intestinal bacteria.

Dr. David C. Classen, an epidemologist at the University of Utah, and lead author of the study, said his team surveyed existing recommendations and research before deciding which practices were based on solid science.

The guidelines did include a recommendation that newly admitted patients be tested for MRSA on admission, while accepting the fact that more frequent washing of hands by the employees in medical facilities can do much to prevent the spread of the bacteria.

See also Drug Resistant Bacteria-Part I
Drug Resistant Bacteria and The Importance of Cleanliness-Part II



By Allan Rubin and Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated July 25, 2021

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