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CRE Bacteria: The Next Superbug Threat in Your Hospital

Apr 2, 2013, 8:30 AM, Posted by Brian C. Quinn

Klebsiella pneumoniae bacteria illustration Klebsiella pneumoniae bacteria illustration courtesy of the CDC

“Bacteria are becoming resistant to antibiotics faster than we can stop them. This problem is now a public health crisis: Infections caused by drug-resistant bacteria contribute to more than 99,000 deaths per year in the U.S. alone – more than AIDS, traffic accidents, and the flu combined.

At RWJF, we believe today’s health care problems demand innovative solutions. Pioneer grantee Extending the Cure takes a unique approach, looking at this public health problem through an economic lens. They propose comprehensive, incentive-based solutions, such as creating incentives to discourage unnecessary antibiotic use and encourage the development of new drug therapies. ETC also recognizes that while we can't beat the bacteria, we can slow them down if we start to view antibiotics differently. Just like water or trees, we must treat these drugs as a natural resource that can be depleted with overuse.

We all have a role to play in making sure antibiotics are around when we need them. In this post on KevinMD, Dr. Daniel J. Morgan tells us what it’s like to face superbugs in the health care system and points out the critical role that hospitals can, and should, play in the effort to stop them.”  — Brian C. Quinn

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Positive Deviance Research Continues to Impact Health Care System

Mar 23, 2012, 9:53 AM, Posted by Pioneer Blog Team

We are proud to see that an earlier grant supporting research into how positive deviance can be applied to methicillin-resistant Staphylococcus aureus (MRSA) prevention in hospitals continues to influence the way health care systems approach and solve challenges.

An article in last week’s Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report profiles the AtlantiCare Regional Medical Center, which participated in the CDC Hemodialysis BSI Prevention Collaborative to reduce bloodstream infections (BSIs). The medical center implemented the positive deviance method, identifying individuals within an organization who have overcome seemingly intractable problems and spreading their solutions throughout, to engage staff members in BSI prevention interventions. For example, a nurse developed a mnemonic device to meet the hand hygiene compliance that she then shared with other nurses. The program found that collaborative interventions and the use of positive deviance were associated with significant reduction in BSIs. 

Curt Lindberg, project director on a 2006 Pioneer grant to Plexus Institute to study the effect of using positive deviance to prevent hospital-acquired infections, recently served as a positive deviance coach at AtlanticCare. In his earlier research, Lindberg and other investigators developed a pilot program at six hospitals to control and reduce the rate of MRSA, one of the most virulent hospital-acquired infections in the United States. The study showed that MRSA infections rates declined by 73 percent in four of the six pilot units.

Read more about the results of the grant and learn about Pioneer’s work researching the growing problem of antibiotic resistance.

New Data Reveals High Death Rates From Clostridium Difficile (C. diff)

Mar 8, 2012, 11:35 AM, Posted by Pioneer Blog Team

A new Vital Signs report issued March 6 by the Centers for Disease Control and Prevention shows rates of infection with Clostridium difficile (C. diff) are at historic highs and must be curtailed. C. diff can cause cramps, severe diarrhea and, in some cases, death.

Also on March 6, Extending the Cure—a project funded by the Pioneer Portfolio that studies antibiotic resistance—released a new analysis showing high C. diff death rates in parts of New England. In fact, the Extending the Cure analysis shows that as of 2007 Rhode Island, Maine, and Connecticut had the highest death rates for C. diff in the nation.

These top three states had death rates that were more than double the national average of 2.15 deaths per 100,000 people.  The trend is visualized using the interactive mapping platform of ResistanceMap, Extending the Cure’s online tool that tracks antibiotic use and drug resistance in North America and in Europe.

At the same time, the mapshows that most Southern and Western states had death rates from C. diff that were below the national average. For example, Georgia, Colorado, and Idaho reported less than one death per 100,000 people from these infections in 2007. “The geographical variation points to the need for additional research to better understand the epidemiology of C. diff infections and highlight the most effective ways of preventing their spread,” says Ramanan Laxminarayan, director of Extending the Cure, the D.C-based research project funded in part by the Robert Wood Johnson Foundation’s Pioneer Portfolio.

While C. diff has long been linked to hospitals, the CDC report finds that patients can acquire the infection in all medical settings, including nursing homes and outpatient clinics. Those most at risk are patients who take antibiotics, which can wipe out the good bacteria living in the gut, allowing C. diff to thrive.

C. diff infections can be reduced by judicious use of antibiotics, according to the CDC, which notes that about 50 percent of all antibiotics prescribed are not necessary. Reducing unnecessary antibiotic use will not only help prevent C. diff infections, but also curtail the growing problem of antibiotic resistance.

Addressing the rising rates of C. diff infections will require a multifaceted approach.  In addition to promoting antibiotic stewardship, health officials must work towards better infection control and early diagnosis at hospitals and other facilities where C. diff and other health care-associated infections can spread from patient to patient or from one facility to the next.

 In addition, policymakers, researchers, and others can use visualizations, like the map from Extending the Cure, to identify regions of the country with the most serious problems and look for targeted solutions to the rising tide of C. diff and other disease-causing bacterial pathogens.

Check out the new data and let us know what you think: Do you have a story to tell about a solution to the problem with C. diff?

Follow @ExtendgtheCure on Twitter to track coverage of this study.

Shorter Antibiotic Regimens Might Counter Antibiotic Resistance

Jan 12, 2012, 9:05 AM, Posted by Pioneer Blog Team

Antibiotics on the shelf today are increasingly losing their potency against resistant microbes or “superbugs” like the potentially lethal methicillin-resistant Staphylococcus aureus, or MRSA.

Extending the Cure researchers published an analysis this week that questions the conventional wisdom regarding antibiotic dosing practices and suggests rethinking the guidelines to minimize the growing public health crisis posed by antibiotic resistance. Ramanan Laxminarayan, director of Extending the Cure, and his colleagues, used mathematical models to study antibiotic treatment guidelines, the regimens physicians follow for the standard dose and duration of antibiotic treatment for common infections.

While antibiotic dosing regimens have typically been designed to cure bacterial infections, rarely have these guidelines taken antibiotic resistance into account.  All antibiotic use contributes to the development of antibiotic resistance, and the new research suggests dosing guidelines could be optimized to both treat infections and limit the spread of resistant microbes. The analysis, published January 11 in the online scientific journal PLoS ONE, indicates that in many cases, a shorter regimen of antibiotic treatment could work just as well as a longer course yet still reduce the risk of resistance.

Dosing strategies for antibiotics are not set in stone.  For example, many physicians have switched from the traditional 10-day course of antibiotics and now effectively prescribe a three-day regimen to treat otitis media, or middle ear infections. In some cases, the authors argue, shorter dosing regimens like this one could limit the selection pressure for resistant bacteria and thus reduce the threat of resistance.

Extending the Cure, a project of the Center for Disease Dynamics, Economics & Policy sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio, is working to change how we think about antibiotics, a resource that can be depleted with overuse. This study suggests that shorter treatment regimens, in some cases, may help us preserve the power of the antibiotics we still have left.

Let us know what you think:  Are there any risks to shortening current treatment regimens? Are there any other benefits? Leave a comment here or tweet at @ExtendgTheCure and @PioneerRWJF #SaveAbx to tell us what you think.

Warm Weather Brings Risk of Resistant Hospital Infections

Oct 19, 2011, 1:19 AM

Two new articles from Extending the Cure, a Pioneer-supported project that examines solutions to the growing problem of antibiotic resistance, advance our understanding of the growth and spread of certain lethal hospital infections and pose policies to address the long-term challenge of antibacterial resistance.

The first article, which appeared Sept. 26 in the online journal PLoS One, describes a new study that found certain potentially lethal hospital infections are more prevalent in warmer weather. In the study researchers examined 211,697 infections reported by 132 hospitals across the nation from 1999 to 2006. The warmer the temperature, the more hospitals reported certain hard-to-treat infections. The problem was particularly severe in the summer: For example, the researchers identified a 52 percent summer spike in bloodstream infections caused by Acinetobacter baumannii, a highly resistant “superbug.”

Hospitals should be on alert during warm weather in any season in order to identify and stop the spread of these resistant infections, the authors say.

In the second article Ramanan Laxminarayan, the director of Extending the Cure at the Center for Disease Dynamics, Economics & Policy, and John H. Powers, associate clinical professor of medicine at George Washington University School of Medicine, argues that we need incentives to crank out newer, more powerful antibiotics and at the same time, preserve the efficacy of antibiotics we have left.

Writing in October issue of the journal Nature, they say that we must start treating antibiotics as a valuable resource, one that can be depleted with overuse and nurtured with public private partnerships(PPPs).  “In our view, government intervention through PPPs that are focused on the development of antibacterials with desirable properties, in combination with incentives to encourage the conservation of antibacterials and the achievement of resistance targets, is the best way to tackle the increasingly serious public health threat of antibacterial resistance.”

Leave a comment to tell us what you think public policy should focus on in the research, development and preservation of antibiotics.