News From The Road: No Drugs, Few Strategies, But A Little Good News On Antibiotic Resistance

So, hi, constant readers. Sorry, didn’t mean to disappear for quite that long. I’ve been on the road, first teaching for a week at the University of Wisconsin as their Science Writer in Residence, and then in New York to attend the annual meeting of the American Society of Journalists and Authors, where I received the June Roth Memorial Book Award for Superbug. (Plus, in between those two, I recorded an episode of the Virtually Speaking Science podcast with Tom Levenson, which you can find here, about the looming post-antibiotic disaster; and an episode of Skeptically Speaking with Marie Claire Shanahan, which you can find here, about the emerging story of H7N9 flu; and got tangentially involved in the Boston bomber manhunt.)

While I was offline, a far amount of news happened. In the next few days, I’ll do my best to catch up. Here’s a start, all on infections and antibiotic resistance.

First: Eli Perencevich, infectious-disease physician and blogger at Controversies in Hospital-Associated Infection Prevention, has a new paper out in Pediatrics which asks whether hand-hygiene programs should be rethought. If you’ve been reading for a while, you’ll remember that getting health care personnel to wash their hands is the basis, and bane, of all hospital-infection prevention: It seems so easy, and yet it’s so consistently missed. In just one example, one attempt in a number of hospitals over one year got compliance up to 50 percent. Meaning, health care workers were washing their hands only half of the times they were supposed to — adding up to a lot of possible infections, including resistant infections, which would not otherwise exist.

Perencevich and his colleagues, including PhD student Jun Yin, looked at this persistent failure — of handwashing, and also of keeping infections from happening in patients — and asked: What would happen if the focus were changed from keeping hands washed to keeping hands clean? To answer it, they examined what happens when hospitals get serious about using gloves, which, as with handwashing, keep disease organisms from being passed to patients. It happens that University of Iowa, where Perencevich works, mandates glove use during the season for RSV, a wintertime respiratory infection that can be very serious in the very young and very old. The team looked at the hospital’s data over 9 years and found that, during those mandatory glove months, the risk of patients contracting any hospital infections went down by 25 percent. (The risks of some infections, such as hospital-acquired pneumonias, went down by more more: 80 percent.)

So, that’s an intervention which might work to reduce infections, if studied and adopted more broadly. Other news from the Centers for Disease Control and Prevention indicates that some practices already in use must be working — because the rates of one important hospital infection, MRSA, are trending down. In a presentation at the CDC’s annual Epidemic Intelligence Service Conference (effectively, the graduation ceremony for its outgoing class of disease detectives), EIS officer Raymund Dantes reported that serious MRSA infections occurring in hospitals declined by half between 2005 and 2010. There were smaller drops in community MRSA infections (occurring outside hospitals) and a mixed category that the CDC calls “hospital-acquired, community onset,” indicating that the infection was transmitted within the hospital but symptoms did not develop until after the person was discharged. Overall, there were an estimated 29,300 fewer invasive MRSA infections in 2010 than in 2005, based on data from a CDC surveillance project which covers 9 metro areas populated by 19 million people — a sign that increased hospital efforts and public awareness may be working.

Which is a fortunate thing — because an additional piece of news from last week suggests that there won’t be new drugs to cure resistant infections anytime soon. The Infectious Diseases Society of America published a report on its “10 x 20” initiative — that stands for getting 10 new antibiotics to market by 2020 — and was forced to conclude the prospects aren’t even close to promising. At the moment, they said, there are seven drugs in phase 2 or 3 trials in the United States. However, six of the seven are based on existing drugs, meaning they act in a “me-too” manner which bacteria quickly recognize. None of the seven work against the full range of the CRE “nightmare bacteria” which the CDC and its British counterparts have recently raised the alarm over. And none of them carry any guarantee of making it through licensure by the FDA. For a quick recap of the data, look at the table below, which lists the seven candidates. Especially take a look at all the “No”s.

So that’s the major recent news on antibiotic resistance. Up next: Back to food policy.

Flickr/Chris-Havard Berge/CC


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