Infection Watch

40% surge in cases of superbug that is harder to tackle than MRSA

Link: Surge in cases of superbug that is harder to tackle than MRSA | the Daily Mail.

Stenotrophomonas maltophilia, or Steno, thrives in the black 'gunk' that lines shower heads and taps. It kills around 300 Britons a year.

Some strains of the bug are resistant to all available antibiotics, making it harder to treat than the highly-publicised MRSA and C diff infections.

Superbug

Cases of a hospital superbug more difficult to treat than MRSA have soared by 40%

With the number of cases in British hospitals rising by around 40 per cent between 2001 and 2006 to around 1,000 a year, scientists say there is an urgent need to find new ways to combat it.

Two other superbugs identified

Link: Cambridge scientists getting to grips with new superbug - News - Academia and Research - Business Weekly.

Dr Lisa Crossman from the Sanger Institute and first author on the paper explained how the research might address these questions: "The genome sequence should help us to combat these properties. For example, if we know which proteins allow it to stick to surfaces, we could try to develop biochemical compounds that interfere with this interaction. If we understand its antibiotic resistance mechanisms, we might be able to design inhibitors that block them."

While, fortunately, Steno infections are still relatively uncommon, they are on the increase. Furthermore, there are two other organisms that, like Steno, cause infections by colonising catheters and so on, but are more common.

Dr Avison added: "Genome sequences for these two also exist, and so now we can look at what they all have in common genetically that might explain why they all behave in a similar way in the hospital."

Warning over hospital infection

Link: BBC NEWS | Health | Warning over hospital infection.

Hospitals could face a growing threat from a deadly bacterial infection, warn scientists.

An analysis by the Wellcome Trust Sanger Institute found Stenotrophomonas maltophilia has the capacity to develop drug resistance rapidly.

There are currently less than 1,000 reports of Steno blood poisoning in the UK a year - a third of which are fatal.

But the Genome Biology study warns it may eventually prove harder to treat than superbugs such as MRSA.

The degree of resistance it shows is very worrying
Dr Matthew Avison
University of Bristol

At present, Steno infections are responsible for less than 1% of all healthcare acquired infections.

Most infections are in severely ill patients whose immune systems have already been weakened.

Multi drug resistant bacteria flourishes on catheters

Link: The Genome Of A Newly Emerging Superbug Reveals An Organism With A Remarkable Capacity For Drug Resistance.

Dr Matthew Avison from the University of Bristol, and senior author on the paper said: "This is the latest in an ever-increasing list of antibiotic-resistant hospital superbugs. The degree of resistance it shows is very worrying. Strains are now emerging that are resistant to all available antibiotics, and no new drugs capable of combating these 'pan-resistant' strains are currently in development."

Pan-resistant Steno infections are at least as hard to treat as MRSA and C.diff infections. But although it is common in the environment, Steno infections are rarer than MRSA and C.diff infections and are exclusively hospital-acquired.

Steno flourishes in moist environments, such as around taps and shower heads, and can be transferred to patients. It is distinct in the way it causes infection and can only get into the body via devices such as catheters or ventilation tubes that are left in place for long periods of time. Long-dwelling catheters are used most often for seriously ill patients and some undergoing chemotherapy.

Steno can stick to the catheter and grow into a 'biofilm'. When the catheter is next flushed, the Steno biofilm can enter the patient's bloodstream. If their immune system is impaired (which is often the case in the seriously ill and those undergoing chemotherapy) the organism can multiply and cause septicaemia. The gravity of this situation has been underlined by the new research, since these patients will be treated with antibiotics against which Steno is largely resistant.

Microbial Resistance Towards Antibiotics: Still A Critical Issue

Link: Microbial Resistance Towards Antibiotics: Still A Critical Issue.

ECCMID Opening Press Conference. "The problem of antibiotic resistance continues to grow and this is mainly a consequence of longstanding misuse and abuse of antimicrobial agents", said Prof. Fernando Baquero, Congress President (Hospital Ramón y Cajal, Madrid). Among all the pathogens, methicillin-resistant Staphylococcus aureus (MRSA) is a frequent culprit in infections (mainly respiratory, urinary or skin infections) in hospital settings and nursing homes. Despite this, the general public is unfamiliar with this threat (F. Verhoeven et al. - ECCMID abstract no.1387) and unaware that MRSA can contaminate not only patients' rooms and healthcare workers, but also the environment outside hospitals, including houses or workplaces.

"Bacterial resistance to antibiotics commonly used in children is already a critical problem because we cannot use all the antibiotics commonly available for use in adults for the treatment of children", pointed out Prof. Baquero. Clinicians are particularly concerned about the emergence of hyper-virulent and hyper-resistant strains of Pneumococcus (the pathogen more frequently responsible for ear infections among children), whose epidemiology and interactions with hosts have changed rapidly during recent years. "The relentless rise of resistant bacterial strains will be a critical issue for many years to come as innovative antibiotics are not likely to be developed and marketed, and industrial research facilities on antimicrobial agents are being increasingly shut down" - said Prof. Baquero. "We need to change our attitude towards the clinical use of existing antibiotics, as this has been the main factor in the emergence of resistant organisms". A recent study which analysed all the outpatients oral antibiotic prescriptions in Canada (F. Marra, S. Mak et al. ECCMID abstract no.254 ) seems to reveal a link between antibiotic use and socioeconomic determinants: "this is the proof that variables other than clinical appropriateness are now playing an unacceptable role in antibiotic prescription", concluded Prof. Baquero.

Research Priorities To Fight Drug-Resistant Tuberculosis

Link: Research Priorities To Fight Drug-Resistant Tuberculosis.

Tuberculosis (TB) has long been one of the world's great killers. Now, forms of drug-resistant TB--multidrug (MDR) and extensively drug-resistant (XDR)--are occurring at an ominous and accelerating rate. To help in the fight against drug-resistant TB, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has formulated an MDR and XDR TB research agenda.

A summary of the agenda, authored by NIAID Director Anthony S. Fauci, M.D., and members of the NIAID Tuberculosis Working Group, is now available online in The Journal of Infectious Diseases.

"The TB diagnostic tools in use today are antiquated, slow and insensitive; TB drug regimens are complex and lengthy; and the only vaccine available does not provide effective protection against adult pulmonary TB," says Dr. Fauci. "The challenge of TB control is further compounded by the rise of drug-resistant TB, and we anticipate that the NIAID Research Agenda for Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis will contribute substantively to the fight against this emerging threat."

30 seconds and plenty of soap needed in infection fight

Link: Using an alternative hand contamination technique to compare the activity of antimicrobial and non-antimicrobial soap under varying test conditions -- Fuls et al., 10.1128/AEM.02405-07 -- Applied and Environmental Microbiology.

Antimicrobial hand soaps provide a greater bacterial reduction than non-antimicrobial soap. However, the link between greater bacteria reduction and a reduction of disease has not been definitively demonstrated. Confounding factors such as compliance, soap volume and wash time may all influence the outcome of studies. The aim of this work was to examine the effects of wash time and soap volume on the relative activity and the subsequent transfer of bacteria to inanimate objects between antimicrobial and non-antimicrobial soap. Increasing the wash time from 15 to 30 seconds increased reduction against Shigella flexneri from 2.90 to 3.33 log10 (p= 0.086) for the antimicrobial soap while non-antimicrobial soap achieved reductions of 1.72 and 1.67 log10 (p> 0.6). Increasing soap volume increased bacterial reductions for both the antimicrobial and non-antimicrobial soaps. When normalizing the soap volume based on weight (~ 3 g), non-antimicrobial soap reduced Serratia marcescens by 1.08 log10 compared to 3.83 log10 by the antimicrobial soap (P<0.001). The transfer of Escherichia coli to plastic balls following a 15 second hand wash with antimicrobial soap resulted in a bacteria recovery of 2.49 log10 compared to a 4.22 log10 (p < 0.001) bacteria recovery on balls handled by hands washed with non-antimicrobial soap. This indicates that non-antimicrobial soap was comparatively less active and the effectiveness of antimicrobial soaps can be improved with longer wash time and greater soap volume. The transfer of bacteria to objects was significantly reduced due to greater reduction in bacteria following the use of antimicrobial soap.

Trimethoprim resistance could be e coli problem

Link: Don't include trimethoprim -- Howe 336 (7648): 787 -- BMJ.

The Medicines and Healthcare Products Regulatory Agency (MHRA) moves to recommend, for the first time, that a systemic antibiotic (trimethoprim) should have its licence reclassified from prescription only medicine (POM) to pharmacy (P) availability.1 For systemic antibiotics particular concerns exist that do not apply to other medicines.

The use of antibiotics may have an adverse effect not only on the specific patient but also on the public health of the community. Quantifying the relation between antibiotic exposure and resistance is difficult, but a case-control study of risk of an antibiotic resistant Escherichia coli urinary tract infection found that the risk of a trimethoprim resistant infection was significantly associated with a trimethoprim prescription in the preceding month (odds ratio 13.91 (95% confidence interval 3.32 to 58.31) if the prescription was for ≥7 days, and 4.03 (1.69 to 9.59) if the prescription was for <7 days).2

New superbug fears in Ulster

Fears in Ulster - News - Sunday Life.

Health Minister Michael McGimpsey (main picture) has already launched a multi-million pound programme to halt the spread of hospital-acquired infections like MRSA and C-dif.

But ESBL E.coli has re-emerged with a vengeance throughout the UK.

It is contracted by eating infected chicken and other food products.

Two years ago there were virtually no cases of ESBL E.coli — now some GPs are reporting SIX CASES A DAY.

Between 10 and 14pc of people who contract it die within 30 days, yet there is no known strategy to detect and treat it. According to the latest available statistics, there were around 50 cases reported in Northern Ireland in 2006.

Extended Spectrum Beta-Lactamase is a cousin of the E.coli bacteria found in the human gut.

XDR TB - A grave threat

Link: The Bug-Buster Blog.

Yesterday was World TB Day, and while you are pondering the infectious disease that seems to be a sleeping giant now being awakened, you may want to check out a thought-provoking story in today’s New York Times about a TB hospital in Port Elizabeth, South Africa that has more similarities to a prison – including the requisite razor wire and armed guards. Individuals who have contracted lethal forms of tuberculosis --  extensively drug-resistant tuberculosis (XDR-TB) --  are housed there, and most of the occupants say they believe the only way they will leave is in a coffin. Times reporter Celia Dugger writes, “The public health threat is grave. The disease spreads through the air when patients cough and sneeze. It is resistant to the most effective drugs. And in South Africa, where these resistant strains of tuberculosis have reached every province and prey on those whose immune systems are weakened by AIDS, it will kill many, if not most, of those who contract it.” And, as Dugger points out, “As extensively drug-resistant TB rapidly emerges as a global threat to public health — one found in 45 countries — South Africa is grappling with a sticky ethical problem: how to balance the liberty of individual patients against the need to protect society.”