MRSA Infection

MRSA infection falling in Ireland but still high

Rate of MRSA infection now at its lowest level - Health News, Health - Independent.ie.

The latest figures are for the first half of 2011 but they show that there were 140 cases reported compared to 177 for the same period in 2010. These numbers are only a proportion of the people who have MRSA in their bloodstream but they are a good measure of how much of a threat the infection is. The rate of MRSA infection in Irish hospitals fell to its lowest level in 2010. Bloodstream infections with MRSA dropped to 304 and contrasted with 2006 when 592 cases were recorded. Despite this drop in numbers, figures for Ireland are still relatively high and compare with the UK and southern European countries.

Why Telavancin Faltered in Search for MRSA Drugs

Antibiotics - The Perfect Storm: Telavancin, Astellas and Theravance - Implications?.

Both sets of trials indicated that telavancin was non-inferior to vancomycin in these indications. But telavancin was associated with increased toxicity risk and, for the treatment of skin infections, a risk management strategy was required in the US and in Europe because of the risk to pregnant women and to those with pre-existing renal insufficiency. In the middle of the development of telavancin, the FDA changed its mind about what an appropriate endpoint should be for hospital-acquired pneumonia (HAP). Until that point it had been clinical outcome – cure or failure. But suddenly it was to be mortality. Theravance’s trials were well under way if not completely enrolled at that point and were not designed (no trial can be designed like that anyway) to assess mortality. The FDA rejected telavancin for HAP on this basis. Europe, where clinical outcome is still considered a valid endpoint, accepted the telavancin marketing application and approved the drug for HAP, but only for those cases where another alternative was not suitable.

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e-Therapeutics to trial MRSA Drug

e-Therapeutics says four drugs will enter clinical trials this year - Proactiveinvestors (UK).

Biotech firm e-Therapeutics (LON:ETX) is looking forward to an important year - as it advances several of its drugs into clinical development. In a statement this afternoon, the firm said four drugs would be entering clinical trials this year and it is looking forward to receiving the first data. Anti-cancer drug ETS2101 will undergo a phase 1 programme beginning in the first quarter of this year. In Q2, the phase 1 trial for ETX1153c concerning C. difficile infection will begin. A phase IIb trial for anti-depressant ETS6103 will begin in the third quarter, while, for MRSA, the phase 1 trial for ETX1153a will start in the fourth quarter, the company told investors.

Vancomycin and cefazolin - a safe prophylactic regimen against MRSA in open fractures

Vancomycin and cefazolin seen as a safe prophylactic regimen against MRSA in open fractures.

Researchers from the University of Colorado School of Medicine in Denver discovered higher rates of methicillin-resistant Staphylococcus aureus in patients with open fractures and that the addition of vancomycin to cefazolin is a safe prophylactic method against the organism. “Staphylococcus aureus is the number one cause of surgical site infection,” Carla C. Saveli, MD, said in her presentation at the 2011 Annual Meeting of the Orthopaedic Trauma Association. “Therefore, it should be the main target for prophylaxis. The current standard of care for patients with open fractures is to administer a first-generation cephalosporin […] from presentation and for 24 to 48 hours after wound closure.” “The benefits of antibiotic prophylaxis in open fractures have been clearly demonstrated in several randomized controlled trials, but the choice of antibiotic remains controversial since the current guidelines do not recommend agents with [methicillin-resistant Staphylococcus aureus] MRSA activity,” the authors wrote in their abstract.

MRSA Fast Test Recalled

Controversies in Hospital Infection Prevention: The long road to fast and accurate resistance detection.

Even MRSA, a bug with a relatively simple resistance mechanism (simple relative to, say, MDR Acinetobacter), is proving to be a tough nut to crack. Remember this post of mine, about Cepheid’s recall of their Xpert SA/MRSA blood culture assay? Well, another “valued customer” notice went out last week, informing users that this product requires “additional test optimization” and “clinical re-validation”—so it will be unavailable until at least the end of 2012. Labs and hospitals that have come to rely on this test to improve their antimicrobial management of S. aureus bacteremia will now have to find another approach.

When pacemakers cause infection

Complete removal as a routine treatment for any cardiovascular implantable electronic device-associated infection -- Pichlmaier et al. 142 (6): 1482 -- The Journal of Thoracic and Cardiovascular Surgery.

Pacemaker and implantable cardioverter defibrillator lead endocarditis mandates removal of all foreign material. In supposedly limited (pocket) infections, such a radical approach is still controversial. Thus, some patients are potentially exposed to persistent and recurrent infection because of retained material. Procedural risks and the success of eradicating infection were examined if involvement of the complete system was assumed in any cardiovascular implantable electronic device infection and complete removal was thus mandatory. Methods: A 12-year experience with 192 consecutive cases of bacterial pacemaker (152) or defibrillator (40) infections is presented. Complete removal of all prosthetic material was always aimed for. This was followed by antibiotic treatment for 4 to 6 weeks under temporary pacing if required, and then the new system was implanted. A total of 104 parameters concerning patient characteristics and operative and postoperative treatment were examined for their influence on outcome. Results: Infection was eradicated in 92.8% of patients. Recurrence was predominantly caused by failure to remove all prosthetic material (P < .001). If the protocol was strictly followed, infection was eradicated in 97.4% of patients. Conversely, 71.4% of patients with retained material showed recurrence. Further risk factors were poor dental hygiene and evidence of chronic subclinical infection. Morbidity and mortality of the interventional and open procedures were low. Open lead extraction was performed primarily in 34 patients (17.7%) and secondarily in 3 patients (1.9%). Temporary pacing and long-term antibiotic treatment were well tolerated. Conclusions: Complete removal of prosthetic material in any cardiovascular implantable electronic device infection is safe and associated with low morbidity and mortality. Success of eradicating infection is high if all system components are removed. Temporary pacing in dependent patients may be performed safely on an outpatient basis.

Saving Lives audits: do they improve infection prevention and control practice?

Saving Lives audits: do they improve infection prevention and control practice?.

Aretrospective audit evaluation was conducted to determine whether the introduction of two clinical skills trainers for four months in a district general hospital improved compliance with infection prevention and control practices. Saving Lives (Department of Health, 2010) peripheral venous cannula and urinary catheter high impact intervention audit data were analysed for six months before, four months during and six months after the clinical skills training was implemented for six control wards and seven intervention wards. Findings showed that although the control wards did not improve compliance significantly over the study period, the intervention wards improved compliance with the high impact intervention care bundles studied and that this practice was sustained for six months after the clinical skills training. The findings suggest that education is required to improve clinical skills surrounding cannulation and catheterisation, which can then be sustained by Saving Lives audits to reduce the risk of infection to patients.

Astellas returns MRSA drug to Theravance

Astellas returns superbug-fighting drug to Theravance - San Francisco Business Times.

Astellas Pharma Inc. ended its partnership Friday with South San Francisco’s Theravance Inc. around the antibiotic Vibativ. The decision ends an up-and-down partnership between the companies, including production problems at a contractor manufacturer in Ohio in November that halted manufacturing and caused a shortage of the drug. Rights to Vibativ, a once-daily injectable drug that was approved in the United States in September 2009 to treat serious skin infections caused by the MRSA “superbug,” will return to Theravance.

MRSA Drug Doses, Strain Types and Patient Illness

An Association Between Bacterial Genotype Combined With a High-Vancomycin Minimum Inhibitory Concentration and Risk of Endocarditis in Methicillin-Resistant Staphylococcus aureus Bloodstream Infection.

MRSA BSIs decreased by ∼90% during the 11 years. Typing placed isolates into 3 clonal complex (CC) groups that had different population median V-MICs (CC30, 0.5 μg/mL [n = 349]; CC22, 0.75 μg/mL [n = 272]; non-CC22/30, 1.5 μg/mL [n = 199]). There was a progressive increase in the proportion of isolates with a V-MIC above baseline median in each clonal group and a disproportionate fall in the clone group with lowest median V-MIC (CC30). In contrast, there were no increases in teicoplanin MICs. High V-MIC CC22 isolates (1.5–2 μg/mL) were strongly associated with endocarditis (odds ratio, 12; 95% confidence interval, 3.72–38.9) and with a septic metastasis after catheter-related BSI (odds ratio, 106; 95% confidence interval, 12.6–883) compared with other clone type/V-MIC combinations. Conclusions. An interaction between clone type and V-MIC can influence the risk of endocarditis associated with MRSA BSI, implying involvement of both therapeutic and host-pathogen factors.

ST398 MRSA - What farming methods help stop spread

Absence of LA-MRSA CC398 as nasal col... [Appl Environ Microbiol. 2011] - PubMed - NCBI.

Livestock associated MRSA ST398 was reported so far from pigs raised in conventional farms. Here we report a study on 25 farms adhering to an alternative system. LA-MRSA ST398 was not detected in nasal swabs from 178 pigs and also not from 89 humans working and living on these farms.

LCB01-0371 showing promise against MRSA

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Dream Pharma Corp., a Korean drug maker, will develop new treatment for superbugs to cater to soaring demand for drugs against the fatal bacteria. The Hanwha-affiliate said Wednesday it clinched a deal with LegoChem Biosciences Inc. for joint research and commercialization of the bioventure’s novel product. The drug candidate known as LCB01-0371 has been proven superior to Pfizer Inc. Zyvox in treating superbugs, which are resistant to nearly all existing antibiotics, Dream Pharma said. Clinical trials in the U.S. also showed that the product had almost no side effects like bone marrow suppression, and its high solvency could make it injectable, the company added.

Oritavancin to rival Voncomycin?

Targanta-Cubist Rivalry Brews on FDA Review of Targanta Drug | Xconomy.

As Luke reported last month, an FDA advisory committee is scheduled to meet tomorrow to review Targanta’s application for approval of oritavancin as a treatment for complicated skin infections caused by antibiotic-resistant bacteria including notorious MRSA. Yesterday the agency posted a lengthy briefing on the drug, saying it was as effective and safe as the standard treatment, vancomycin.

Untreatable MRSA in Greece?

AllAboutFeed - Weblog: Antibiotics lead us into death.

In most countries the situation is still manageable, but has already become critical in Greece and Turkey where it is almost impossible to treat infected patients with antibiotics that work. In Greece a MRSA-type has emerged that is resistant to all antibiotics. The situation is also critical because no new antibiotics are to be expected in the short term.

Basilea want authorization of ceftobiprole for the treatment of pneumonia in Europe

Basilea to file application for marketing authorization of ceftobiprole for the treatment of pneumonia | Reuters.

Basilea Pharmaceutica Ltd. (SIX:BSLN) today announced that it will apply in the second half of 2012 for approval of its antibiotic ceftobiprole in Europe. In addition, reporting of topline data for the alitretinoin U.S. phase III study for chronic refractory hand eczema will occur in the first quarter of this year. Basilea thus has the potential for two regulatory submissions in 2012. Basilea has completed investigator site audits of two international double-blind randomized controlled phase III studies of ceftobiprole for the treatment of severe community-acquired and hospital-acquired pneumonia. The audits included 26 investigator sites, covering more than one third of patients of both trials. On the basis of these audits and following health authority feedback on potential filing strategies, Basilea has decided to apply in the second half of 2012 for the approval of ceftobiprole in Europe for pneumonia treated in the hospital setting.