Monday 11 March 2013

Antimicrobial Resistance poses 'catastrophic threat', say Chief Medical Officer - my take on the story.



There is an important medical need that must be confronted and tackled to prevent modern medicine slipping back in time. This need is to address the specter of antimicrobial resistance which is potentially reaching catastrophic proportions. This has been highlighted in the recent report by the chief government medical officer Prof Dame Sally Davies. Dame Sally reports on the ‘discovery void’ that appears to be present  with very few antibiotics being developed in the past twenty years and this contrasts new infectious diseases that have been described nearly every year in the last thirty years!
Dame Sally’s report highlights the importance of looking after the antibiotics we currently have and supporting their use with improved hygiene and better prescribing policies making sure we only use antibiotics when there is a need. It is important to remember that antibiotics do not work against infectious agents such as viruses and it is vital to target the correct bacteria with an appropriate antibiotic.
This sort of action will help us tackle the next generation of hospital acquired infections  including the newly described strains of pneumonia causing Klebsiella strains.
The report indicates that, Antimicrobial resistance now needs to be put on the national risk register as a major concern and bought to the attention of politicians and policy makers. There needs to be better surveillance across the NHS and around the world to monitor the situation as it develops further. There needs to be collaboration between healthcare and pharmaceutical companies to tackle the so called ‘discovery void’ and create new drugs and preserve the current ones.
We need to monitor antibiotic usage and policy globally in both human and animal healthcare to help develop new drugs and re-enforce the need for good antibiotic stewardship so that what are currently referred to as routine infections do not become life threatening.

Please also consider signing the petition on the Antibiotic action Website (http://antibiotic-action.com/) and follow Antibiotic action on Twitter  @theurgentneed
 
Further information on this story can be found:

http://www.bbc.co.uk/news/health-21737844
http://www.bbc.co.uk/news/health-21702647
http://www.standard.co.uk/news/health/chief-medical-officer-antibiotic-resistance-as-dangerous-as-terrorism-8528556.html
http://www.guardian.co.uk/society/2013/jan/23/antibiotic-resistant-diseases-apocalyptic-threat

Wednesday 6 March 2013

Impending catastrophe with antibiotic resistance- The Importance of Antibiotic Action: the arms race!

CDC has reported upon the importance of the emergence and subsequent control of the so called CRE (Carbapenem-Resistant Enterobacteriaceae) strain of drug resistant organisms. These organisms are now a major concern worldwide and the CDC reports that urgent action is needed to halt the spread of these organisms and indeed control them!

The HPA website reports that the Carbapenems such as imipenem, meropenem as well as ertapenem show the most consistent activity against have the most consistent activity against Enterobacteriaceae. These drugs are not inactivated by AmpC or extended-spectrum ß-lactamases which contrasts with the 3rd and 4th generation cephalosporins.

It is clear we need to closely monitor the development of this type of resistance and its subsequent spread. Strong prescribing diligence is a must to help preserve these drugs and their use.

In the UK, Antibiotic Action supported by the British Society for Antimicrobial Chemotherapy is taking a leading role in highlighting the Importance and indeed danger of losing effective antimicrobial therapy in general medicine. Indeed the WHO stated in 2009 that antimicrobial resistance is one of the greatest threats to human health - sadly this has not improved but actually worsened in the intervening time. We really do need to act and act now. As Margaret Chan from the WHO has stated, even current routine surgical procedures could become life threatening without the support of effective antibiotic treatment.

Please join Antibiotic Action and pledge your support (http://antibiotic-action.com/) - we need you!

Relevant articles;

http://www.cdc.gov/media/releases/2013/p0305_deadly_bacteria.html

http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1248854054416

CDC warns of drug-resistant Enterobacteriaceae

This article has been reproduced entirely from the website below via the excellent Jo Tarrants Infection Update website.

This is a really interesting article and worth a read, article originated by Lisa Schnirring on the 5th March

http://www.cidrap.umn.edu/cidrap/content/other/resistance/news/mar0513resistant.html

CDC warns of drug-resistant Enterobacteriaceae Lisa Schnirring Staff WriterMar 5, 2013 (CIDRAP News) – Federal officials today warned of a new type of antibiotic-resistant threat that is more dangerous than methicillin-resistant Staphylococcus aureus (MRSA), but could be curbed now with prompt action from health leaders, healthcare workers, and even patients, they say.Carbapenem-resistant Enterobacteriaceae (CRE), seen primarily in patients who have been exposed to hospital settings, are "nightmare bacteria" that pose a triple threat, according to the US Centers for Disease Control and Prevention (CDC).CRE, which include two common digestive system organisms, Klebsiella pneumoniae and Escherichia coli, are resistant to nearly all antibiotics, have a high mortality in invasive infections, and can spread resistance genes to other bacteria in patients' bodies, CDC officials said.Tom Frieden, MD, MPH, the CDC's director, said in a briefing today, "It's not often that scientists come to me and say we need to sound an alarm. The good news is we have an opportunity to prevent further spread."CDC officials said they're basing their warnings on data from three surveillance systems, including one that showed the proportion of CRE among all Enterobacteriaceae increased from 1.2% in 2001 to 4.2% in 2011. Another showed an increase from 0% in 2001 to 1.4% in 2010. The agency published the findings today in a Vital Signs report in Morbidity and Mortality Weekly Report (MMWR).The CDC saw the percentage of CRE infections increase most for Klebsiella, which spiked from 1.6% in 2001 to 10.4% in 2011 in one database. "That's a very troubling increase," Frieden said.The CDC also found that almost 200 hospitals and acute-care long-term care facilities treated at least one patient infected with CRE from a catheter-associated urinary tract infection or a central-line–associated bloodstream infection.Risks appear to be highest in patients with complex medical problems or who are in long-term care settings, according to the agency. The rate of CRE-affected facilities varied from 3.9% among short-term-care facilities to 17.8% among long-term-care facilities.So far 42 states have reported at least one case, and as yet there's no sign that CRE has spread beyond patients who had extensive hospital exposure, Frieden said. "It's not as widespread as MRSA, and it's important we keep it that way," he said.He said, however, that CDC officials are encouraged by dramatic reductions in CRE rates in facilities that are using a toolkit the CDC released in 2012 aimed at preventing the infections."Doctors, hospital leaders, and public health must work together now to implement CDC’s 'detect and protect' strategy and stop these infections from spreading," Frieden said.Steps include identifying patients who have CRE infections through lab alerts, keeping healthcare teams informed when patients who have CRE infections are transferred in and out of facilities, observing contact precautions during care, setting aside special rooms to care for CRE patients, removing temporary devices such as catheters as soon as possible, and carefully monitoring antibiotic use.Frieden urged patients and their loved ones to insist that health workers wash their hands and to ask if catheters and intravenous lines can be removed as soon as possible. Two other approaches could include chlorhexidrine baths for patients and the development of advanced molecular detection systems, he added.Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, said though active CRE surveillance is under way, its presence can vary by region, so there is no one-size-fits-all strategy. New York City, for example, has been battling CRE for several years, he said.The Vital Signs report said the percentage of hospitals reporting CRE was highest in the Northeast and among larger and teaching hospitals.Health departments can play a vital role in reducing the CRE threat by bringing health facilities together to keep providers informed about disease patterns and ways to detect and prevent the infections, Srinivasan said. "We're all in this together."Frieden said so far six states mandate reporting of CRE cases: Colorado, Minnesota, North Dakota, Oregon, Tennessee, and Wisconsin. Others are considering mandatory reporting.