Friday, April 8, 2011

14 The Friday Four

In this week's edition of the Friday Four, we look at the IDSA's plan to combat antibiotic resistance with a brief recap of highlights of the STAAR Act, using artemisinin and hyperbaric oxygen as a potential cancer treatment, a dangerous new tickborne virus identified in China, and creating a new antibiotic using marine bacteria.

1) Lifesaving antibiotics face doubtful future

Source link: http://www.sciencedaily.com/releases/2011/04/110407121435.htm

ScienceDaily (2011-04-07) -- To head off a health care disaster, the Infectious Diseases Society of America has developed a plan to combat deadly antibiotic-resistant "super bugs" and is rolling out the multi-pronged plan today, on World Health Day 2011.

Comments: I don't know why this is considered the latest news on ScienceDaily... this plan is basically a repeat of all that is found in the STAAR Act.

I wrote about the IDSA's 2010 testimony to the House Committee back in early January. I posted about it on Lymenet, too.

Did anyone notice back then? I sure hope people notice now.

I'll repeat here what I wrote back in January:
This act should be more familiar to you all, because the STAAR Act stands for "Strategies to Address Antimicrobial Resistance".


Taken from the final 2010 report from the IDSA to the House Committee on Energy and Commerce Subcommittee on Health:


"The STAAR Act strengthens existing efforts by establishing an Antimicrobial Resistance Office (ARO) within the HHS Office of the Assistant Secretary of Health. The Director of ARO will serve as the director of the existing interagency task force. The Act also establishes a Public Health Antimicrobial Advisory Board (PHAAB) comprised of infectious diseases and public health experts who will provide much-needed advice to the ARO Director and task force about antimicrobial resistance and strategies to address it. The STAAR Act will strengthen existing surveillance, data collection, and research activities as a means to reduce the inappropriate use of antimicrobials, develop and test new interventions to limit the spread of resistant organisms, and create new tools to detect, prevent and treat drug-resistant “bad bugs.”" 
And that's just part of it, really - you ought to read the entire report.

One of the IDSA's broader goals beyond this act is to institute a special fee called "the Antibiotic Innovation and Conservation Fee" on every course of antibiotics used by doctors and veterinarians in the future - both to acquire money for funding new antibiotic development - and to encourage restricted and judicial use of the antibiotics remaining in use. And then there is also the proposal for an "antibiotic stewardship program" which will be intended to track and reduce usage of antibiotics as well as lower medical cost.

This is one of the reasons I mention the issue of needing more research into the issue of persistence, and that it can't wait. It already couldn't wait, but now it becomes a more important issue. If persistence is proven, then long-term use of antibiotics to treat Lyme disease beyond the standard minimum would be accommodated - but if it isn't, then with the passage of the STAAR Act, if the proposed antibiotic stewardship program passes along with it - could affect Lyme disease patients on long-term antibiotics a lot.

How far will this act go, and how does one determine what the "inappropriate use of antimicrobials" actually is?

I'm in support of stopping antibiotic use on healthy livestock and think antibiotic use can be cut back for ear infections and acne. I'm in support of hospitals practicing more safe hygiene controls and using UV irradiated keyboards - if not UV-C doused rooms between patients - to reduce the spread of potentially deadly MRSA and C. difficile. I see the value of the STAAR Act  - especially in reducing the spread of resistant organisms and funding new antibiotics - the world desperately needs new antibiotics, including Lyme disease patients. Even better, I'd like to see development of technology that stops infection in its tracks without the use of antibiotics - thus avoiding the concern over resistance entirely. In the meantime, though? I have concerns this act could potentially be a strike against Lyme disease patients in getting ongoing treatment. It all depends on the implementation.

2) Kill Cancer Naturally - With Hyperbaric Oxygen and Artemisia Annua L. aka Artemisinin

Artemisia Annua or
"Sweet Annie"

ScienceDaily (Apr. 4, 2011) — An environment of pure oxygen at three-and-a-half times normal air pressure adds significantly to the effectiveness of a natural compound already shown to kill cancerous cells, researchers at the University of Washington and Washington State University recently reported in the journal Anticancer Research.




Link: http://www.sciencedaily.com/releases/2011/04/110404142813.htm

Comments:  And you thought Artemisinin was just for Babesia and Malaria treatment... In the future it might be used to treat cancer - only time will tell.

Seriously, someone needs to do more research using hyperbaric oxygen chambers. This could be something useful - and it should be easy enough to test on human volunteers under the supervision of a medical professional.

Note, though, that this study wasn't on actual people with cancer - it is a study in which the researchers used artemisinin or high-pressure oxygen alone on a culture of human leukemia cells. Results on cancer cells in vivo in people who sit in hyperbaric oxygen chambers may differ - this is something that needs to be tested in the future.

They found out that using either the artemisinin or the oxygen reduced the cancer cells' growth by 15 percent. But if they used them in combination - over a 48 hour period after 90 minutes of high-pressure oxygen - the cancer cells' growth was reduced by 38 percent. That's an over 50 percent increase in artemisinin's effectiveness.

Henry Lai, UW research professor of bioengineering, said that, "Artemisinin is a promising low-cost cancer treatment because it's specific, it's cheap and you don't have to inject it. It's 100 times more specific than traditional chemotherapy. In breast cancer, it's even better."

Is that true? A 100 times more specific? How? Where is he getting this information from? I want to know.

At any rate, it would be interesting to hear more about this and see further studies.

[ Side note: Science Daily's write up mentions that the FDA has approved the use of hyperbaric oxygen therapy chambers for Lyme disease - when that is not true. HBOT has only been approved for the use of 13 indications, and Lyme disease is not one of them - treatment with HBOT for Lyme disease is considered an off-label use or experimental. ]

Publication source:
Yusuke Ohgami, Catherine A. Elstad, Eunhee Chung, Donald Y. Shirachi, Raymond M. Quock, Henry C. Lai.Effect of Hyperbaric Oxygen on the Anticancer Effect of Artemisinin on Molt-4 Human Leukemia Cells.Anticancer Research, 2010; 30: 4467-4470 [link]

3) New Tickborne Virus In China Has High Mortality Rate

Source link: http://www.scienceagogo.com/news/20110222214117data_trunc_sys.shtml

Writing in the New England Journal of Medicine, scientists explain how a previously unknown and dangerous virus carried by ticks has been responsible for seasonal outbreaks of the disease in six of China's most populated provinces.

The newly discovered pathogen has been dubbed 'Severe Fever with Thrombocytopenia Syndrome virus'. It has been placed in the Bunyaviridae family, along with the hantaviruses and Rift Valley Fever virus.

Symptoms include high fever and gastrointestinal disorder; the mortality rate was initially estimated at 30 percent.

Comments:  This is scary. I think between the TBE in Europe and this, my next vacation will be at McMurdo station.

4) New Drugs From Bugs

Source Link: http://www.sciguru.com/newsitem/7751/New-drugs-from-bugs/

bioluminescent marine
bacteria on agar
This is interesting news from the UK... Chemists from Bristol and microbial geneticists from Birmingham determined the sequence of the complete DNA content of a marine bacterium that produces the new antibiotic, thiomarinol (owned by Daiichi-Sankyo). They then identified the genes responsible for making the antibiotic on the basis of their similarity to genes that make the related but less potent antibiotic, mupirocin, which is currently used to combat MRSA (methicillin resistant Staphylococcus aureus).

They found the genes are on a relatively small, separate DNA molecule called a plasmid, which is just big enough to carry the genes for making the antibiotic plus genes to allow the plasmid to replicate autonomously in the bacterium. The plasmid thus carries genes that make both the mupirocin-like antibiotic as well a second antibiotic, holomycin, and a gene responsible for joining both antibiotics together, forming a more potent molecule.

Tests showed that by joining the antibiotics together the resulting chemical is able to inhibit the growth of MRSA strains that have become resistant to mupirocin.

Comments: Read more at the link. I think it's pretty interesting to learn about how new antibiotics are made, even though I would like to find a way to fight infection using other medications and other technologies. We really need antibiotics that don't eventually become resistant and don't cause C. difficile infections (or imbalances that lead to infections, in a number of cases) - or we need an entirely different infection-fighting approach. This development of new antibiotics in the meantime is something desperately needed worldwide, and I'm glad to see it happening - I just wonder how long it will take before clinical trials are on the horizon...

Related Publications:
A natural plasmid uniquely encodes two biosynthetic pathways creating a potent antibiotic.
D. Fukuda, A. S. Haines, Z. Song, A. Murphy, J. Hothersall, E. R. Stephens, R. Gurney, C.
Riemer, R. Marshall, R. J. Cox, J. Crosby, C. L. Willis, T. J. Simpson and C. M. Thomas,
PLoS ONE, 2011, 6, in press.

Nature Reviews Microbiology 8, 281-289 (April 2010) | doi:10.1038/nrmicro2278
Resistance to and synthesis of the antibiotic mupirocin
Christopher M. Thomas, Joanne Hothersall, Christine L. Willis, Thomas J. Simpson
http://www.nature.com/nrmicro/journal/v8/n4/full/nrmicro2278.html

14 comments:

  1. From Wiki:

    In the United States and Canada, the Centers for Disease Control and Prevention issued guidelines on October 19, 2006, citing the need for additional research, but declined to recommend such screening.[31][32]

    In healthcare environments, MRSA can survive on surfaces and fabrics, including privacy curtains or garments worn by care providers. Complete surface sanitation is necessary to eliminate MRSA in areas where patients are recovering from invasive procedures. Testing patients for MRSA upon admission, isolating MRSA-positive patients, decolonization of MRSA-positive patients, and terminal cleaning of patients' rooms and all other clinical areas they occupy is the current best practice protocol for nosocomial MRSA.

    A June 2008 report[citation needed], centered on a survey by the Association for Professionals in Infection Control and Epidemiology, concluded that poor hygiene habits remain the principal barrier to significant reductions in the spread of MRSA.

    Another study led by the CDC and published in the October 17, 2007 issue of the Journal of the American Medical Association estimated that MRSA would have been responsible for 94,360 serious infections and associated with 18,650 hospital stay-related deaths in the United States in 2005.[66][67] These figures suggest that MRSA infections are responsible for more deaths in the U.S. each year than AIDS.[68]

    85% of all invasive MRSA infections were from healthcare facilities with patients contracting infections after their stay ( two-thirds) and one-third while in the facility.

    14% of all infections occurred in the community with no exposure to healthcare and this number is continuing to grow.

    The ID Society has, on their web page, a small list of people who either died or had a serious MRSA infection. I didn't read through all of them, but the ones I did told the stories of people who seemed to be in that 14% mentioned above. Non from the 85% that became infected after a stay in a health care facility! Hmmm.

    http://www.idsociety.org/STAARAct.htm (C.O. Can you make my urls 'live'?)

    http://www.mrsasurvivors.org/statistics

    This group's opening statement seems to infer that data about MRSA has been 'massaged' for many years. I, with admittedly just a brief look, couldn't find more recent data than 2007. Perhaps someone else can?

    Here's what the MRSA Survivors think:

    "No updated data is available from the CDC and MRSA infections have proliferated in the US from 2005-2010. Many hospitals in the US are switching over to the CDC’s NHSN reporting system as before MRSA was reported to CMS ( centers for Medicaid and Medicare).

    Other organizations estimate the true numbers to be over one million infected in the US with MRSA and over 100,00 deaths. US hospitals use ICD9 coding and many MRSA infections were not included in statistics. Also, MRSA infections have grown rampant in the community causing an alarming rise in CA-MRSA (community-acquired MRSA)."

    Do we dare think that hospitals, health care facilities are 'hiding' the incidence of MRSA and that perhaps the 'overuse' of antibiotics for a disease (like Lyme) isn't the real culprit? (Excluding the use of antibiotics in animal/farm use, of course)

    ReplyDelete
  2. ORGANIZATIONS ENDORSING THE STAAR ACT
    As of June 14, 2010, the following organizations have endorsed the STAAR Act:
    • Alliance for the Prudent Use of Antibiotics (APUA)
    • American Academy of Family Physicians (AAFP)
    • American Academy of Pediatrics (AAP)
    • American Association of Critical-Care Nurses (AACN)
    • American College of Physicians (ACP)
    • American Dental Association (ADA)
    • American Medical Association (AMA)
    • American Pharmacists Association (APhA)
    • American Public Health Association (APHA)
    • American Society of Health-System Pharmacists (ASHP)
    • Association for Professionals in Infection Control and Epidemiology (APIC)
    • Council of State and Territorial Epidemiologists (CSTE)
    • Food Animal Concerns Trust (FACT)
    • Infectious Diseases Society of America (IDSA)
    • International Society of Microbial Resistance (ISMR)
    • Michigan Antibiotic Resistance Reduction Coalition (MARR)
    • National Association for Sport and Physical Education (NASPE)
    • National Athletic Trainers Association (NATA)
    • National Foundation for Infectious Diseases (NFID)
    • National Parent-Teacher Association (PTA)
    • Pediatric Infectious Diseases Society (PIDS)
    • Premier, a healthcare alliance serving 2,100 nonprofit hospitals and 58,000 healthcare sites
    • Society for Healthcare Epidemiology of America (SHEA)
    • Society of Infectious Diseases Pharmacists (SIDP)
    • Trust for America’s Health (TFAH)
    • Union of Concerned Scientists (UCS)

    ReplyDelete
  3. Hey cave76,

    You said, "A June 2008 report[citation needed], centered on a survey by the Association for Professionals in Infection Control and Epidemiology, concluded that poor hygiene habits remain the principal barrier to significant reductions in the spread of MRSA."

    This was the point I was bringing up in my mention of studies on using UV-C on hospital equipment and on entire rooms inbetween patients in order to eliminate the spread of MRSA (see the links in my post, next to the Superbug comic). Using UV on hospital surfaces is incredibly effective - within 15 minutes of exposure it will kill something like 99.9% of the MRSA, and nearly that much C. difficile
    after 50 minutes of exposure.

    The other thing that would help is if doctors and nurses simply washed their hands and got a fresh set of gloves before examining each patient and handling their bodily fluids or excretions. Which is something they should be doing *already*, but scarily, they are inconsistent about this simple, low cost practice.

    If they UV'ed the rooms, had staff wash up and clean glove up more, and additionally, had doctors and nurses UV their stethoscopes and clipboards... a lot more people would be alive now that otherwise are not.

    This is one reason why I hate going to the ER... every time you go, you put yourself at greater risk of getting one of these infections. I don't like living with Lyme, but if I got MRSA that couldn't be beat down - or worse, VRSA - that would be worse than Lyme disease, based on everything I know.

    ReplyDelete
  4. cave76,

    The above anonymous poster was me, testing a hypothesis. It turns out I was right - you can include tags in your post so that your links are live. You just have to use HTML markup to get there.

    If you've never made tags live from scratch without an editor, here's how you code them:

    1) Copy and paste your link. Say "http://www.idsociety.org/STAARAct.htm"
    2) Add an a href tag to it. You do so this way - just follow the example:
    <a href="http://www.idsociety.org/STAARAct.htm"> http://www.idsociety.org/STAARAct.htm </a>
    3) Click the "Preview" button below, to see if it looks like a colored, highlighted link.
    4) If the answer is 'yes', click "Post Comment".

    You have just posted your first live link on Camp Other.

    ReplyDelete
  5. cave76 said,

    "Do we dare think that hospitals, health care facilities are 'hiding' the incidence of MRSA and that perhaps the 'overuse' of antibiotics for a disease (like Lyme) isn't the real culprit? (Excluding the use of antibiotics in animal/farm use, of course)"

    Well, that's just it - I don't think the 'overuse' of antibiotics for a disease such as Lyme disease *is* the real culprit. Resistance is more of a problem if you stop a course of antibiotics too *early* - which is less likely to occur with Lyme disease patients or TB patients or those with leprosy aka Hansen's disease who are on courses long-term. And no one would even think of shortening their courses of antibiotics or not giving them any antibiotics at all... The same goes for syphilis.

    The spread of MRSA in hospitals is a serious issue (as is VRSA and other diseases) and most of it does happen in hospitals - although community
    acquired MRSA is a problem, too (esp. in sports complexes and gyms). The need for new antibiotic development is strong. These are aspects of the STAAR Act I agree with. But there isn't enough information there to say that the aims of the act won't be used to try to place more pressure on LLMDs and their patients and get them to reduce if not stop long-term antibiotic use for treating Lyme disease. This is my concern. Is it warranted or not? The IDSA guidelines panel for Lyme disease treatment has been a strong advocate of upholding the current standard shorter course - and a recently published a paper by Wormser and O'Connell stated they would like to reduce the length of the standard treatment even more.

    If some people need longer treatment - if some have undertreated neuroborreliosis - this would be a huge blow if treatment were cut back dramatically.

    Even before I get to the issue of whether Lyme disease can persist or not, I'd like researchers and doctors to look at the fact that neuroborreliosis can and does happen early in the course of infection with Lyme disease, and that it will require a longer and stronger course of treatment than 21 days (or less) of oral antibiotics.

    ReplyDelete
  6. ****Well, that's just it - I don't think the 'overuse' of antibiotics for a disease such as Lyme disease *is* the real culprit. ****

    Of course you don't, C.O. And neither do I. But the IDSA has put that 'overuse' crap out in very close juxtaposition to their guidelines for Lyme. And that's NOT a coincidence ---- you can bet the ranch.

    Not only will 'unknowing' people believe that but it will get the rabble rousers on certain forums going bat shit proving, yet again, how Lymies are perceived as nutjobs. (Yeah, I drifted off the topic a little, but...... that's what I do!)

    ReplyDelete
  7. Another 'slight' detour.

    A while back, when colloidal silver (ingested) was being touted in most of the forums, I looked into the claims. The people who even bothered with a citation about 'how great CS is' seemed to have only read a sentence or two.

    As in: 4 New Studies Prove Colloidal Silver Kills MRSA

    What they didn't read was that CS was being tested as an antibacterial spray or wipe-down for hard sufaces NOT for ingestion.

    http://www.suvida.com/Products/ColloidalSilver.asp

    So, back on topic------ do hospitals use CS for control of MRSA or have they found a cheaper, maybe better, control?

    ReplyDelete
  8. cave76,

    There's a difference between ingesting colloidal silver and using it topically in wounds. Taking colloidal silver internally on an ongoing basis not only turns a person's skin blue or gray (argyria) but over time can lead to kidney damage, seizures, skin irritation, and fatigue... If anyone thinks I'm just reading from an FDA warning docket about this, I'm not -I just took the warning from Dr. Andrew Weil, a popular integrative doctor. He and the The National Center for Complementary and Alternative Medicine (NCCAM - who do some clinical research at Bastyr University) are both pretty much in agreement that the use of silver internally is a bad idea.
    The action of silver when digested is different from that on a wound and less gets absorbed into the body that way.

    This paper is from 2007, but it offers an analysis on the use of silver dressings to combat MRSA and other infections on the skin and deep wounds:

    The increasing use of silver-based products as antimicrobial agents: a useful development or a cause for concern? Ian Chopra. J. Antimicrob. Chemother. (2007) 59 (4): 587-590. doi: 10.1093/jac/dkm006

    http://jac.oxfordjournals.org/content/59/4/587.full

    In the above analysis, it's shown that hospitals do use dressings and ointments with silver in them and for the most part, very few develop resistance - but getting the right concentration of silver on the wound that's going to kill bacteria off has been challenging and it's not standardized. Having a highly bactericidal - but safe concentration - right off the bat is important for effective treatment.

    There is some research that has been done to show that silver might be used in replacement joints in surgery to combat MRSA - but it's less bioavailable over time than ingesting it even with subcutaneous embedding:

    In vivo antibacterial and silver-releasing properties of novel thermal sprayed silver-containing hydroxyapatite coating
    Takafumi Shimazaki1,*, Hiroshi Miyamoto2, Yoshiki Ando2,3, Iwao Noda3, Yutaka Yonekura1, Shunsuke Kawano1, Masaki Miyazaki1, Masaaki Mawatari1, Takao Hotokebuchi1 Journal of Biomedical Materials Research Part B: Applied Biomaterials. Volume 92B, Issue 2, pages 386–389, February 2010

    http://onlinelibrary.wiley.com/doi/10.1002/jbm.b.31526/full

    (more)

    ReplyDelete
  9. (cave76 - more)

    It's basically one thing to be ingesting colloidal silver on an ongoing basis and another to have an implant with some silver spray on it inserted under one's skin. With the implant, a lot of silver is in the serum right away then the serum returns to baseline over time - returns to normal. The silver does its MRSA killing up front and is done with it, in the area that is at greatest risk for MRSA infection.

    That's the thing with these treatments using silver *effectively* - they are localized. Silver coated catheters have been used to good effect in preventing infection/biofilms and silver in burn dressings. One generally needs only a few days of antibacterial protection to prevent infection in implants. This is different from treating an entrenched systemic infection.

    One important item of note about using silver in sprayed compounds or embedded into, say, stethoscopes and bed railings is that it won't be much good in hospitals in preventing infection. The reason is that silver compounds only work effectively under high humidity and elevated temperatures in preventing infections on surfaces. Copper, on the other hand, has been shown to work well under a wider variety of temperature and humidity levels, and would be better used on surfaces indoors.

    See:http://onlinelibrary.wiley.com/doi/10.1111/j.1472-765X.2009.02637.x/full

    A combination of copper surfaces such as bed railings and silver topical ointments, increased hygiene, and UV-C room "baths" would go a long way to combatting MRSA. The question to ask next is "Why isn't every hospital already using all of these things?"

    ReplyDelete
  10. Oh and one more thing? Isolation is needed for improved containment of MRSA and preventing spread to other patients - therefore single rooms for certain patients are needed.

    The answer to the above question may involve not only the fact that implementation is something that takes time, but it takes $$$.

    ReplyDelete
  11. ****implementation is something that takes time, but it takes $$$.****

    Ah, yes! I'm just guessing here but a hospital's top bean counter has probably done a computer model on whether or not the money and time spent to implement a safe and fairly effective way to control MRSA vs the possible death of a future patient.

    ReplyDelete
  12. cave76,

    Financial analysis is ongoing on all fronts in hospitals, but one would have to provide evidence that profits and savings really are being prioritized over preventing and reducing patient mortality... The thing I truly don't understand is why even the simplest solutions which would cost less aren't implemented on a larger scale. *That's* something that puzzles me.

    Sometimes, though, what you initially think will help prevent infection can be the very solution that causes it:

    Hands free electronic water faucets found to be hindrance to hospital infection control

    ReplyDelete
  13. *****Hands free electronic water faucets found to be hindrance to hospital infection control*****

    LOL Well THAT sure comes under the heading of "damned if you do, damned if you don't!"

    Or----- "There are more things in heaven and earth, Horatio,
    Than are dreamt of in your philosophy."

    C.O. commented:
    **** but one would have to provide evidence that profits and savings really are being prioritized over preventing and reducing patient mortality****

    Well, where IS that darned Erin Brockovich???? Perhaps we need a sophisticated bug device to put in the boardrooms and golf carts of the bean counters/CEOs/Members of the Board?

    ReplyDelete

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