Drug Resistant Bacteria-Part III of a III Part Article
(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
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
By Allan Rubin and Harold Rubin, MS, ABD, CRC, Guest Lecturer
updated March 1, 2010
To e-mail: hrubin12@nyc.rr.com or rubin@brainlink.com