One significant form of nosocomial infection is Ventilator Acquired Pneumonia (VAP) which, as the name suggests, is pneumonia (an inflammatory condition of the lung) transmitted to patients while they are on mechanical ventilator breathing support. The incidence of this disease is between 8% and 20%, and mortality rates are between 20% and 50%. As a result, VAP has a critical impact on morbidity, length of stay, and cost of ICU care.

A significant contributor to such high rates of incidence and morbidity is the fact that patients on mechanical ventilation systems are often sedated and are rarely able to communicate or cough up the biofilm that grows in the tubes and drains down into the lungs. Typical symptoms of pneumonia may be absent or unobservable, leading to delays in detection and therefore treatment.  Under these conditions, the medical signs that a patient has acquired pneumonia are increased number of white blood cells on blood testing and new shadows (infiltrates) on chest x-rays. Other important signs are fever, low body temperature, purulent sputum, and hypoxemia (decreasing amount of oxygen in the blood).

If any of these symptoms are suspected by care takers, two conventional methods of diagnosis are deployed. The first is to collect cultures from the trachea while also scanning the chest with an x-ray to detect new or enlarging infiltrates. The other method is more invasive and involves a bronchoalveolar (where fluid is squired out small areas of the lung and recollected for examination), as well as a chest x ray.

Treatment regimens depend on the specific bacteria causing the inflammation, although a widely used first step is the prescription of empiric therapy (broad spectrum antibiotics) until the particular bacterium and its sensitivities are determined. Once the specific microorganisms implicated in generating pneumonia are known, more antibiotics are prescribed. The use of antibiotics raises the issue of resistance from the bacteria, and the related decrease of efficacy of the antibiotic in the years to come.

Photodisinfection is a non antibiotic approach under development by the research and development teams at Ondine Biomedical Inc., for the decolonization of the tubes of long term intubated patients. Pre-clinical studies have demonstrated proven effects of Photodisinfection directed toward the inner surface of the endotracheal tubes. The Exelume™ Photodisinfection system is currently being tested in NIH funded clinical trials in the US. Other Photodisinfection applications under development by Ondine include:  periodontitis, chronic sinusitis, burns & wounds, UTI, vertical transmission of HIV, nasal decolonization to reduce SSI, GI infection protection, etc.

When in the right concentrations and when the body’s natural immune system is healthy, bacteria are an important part of us. In fact, there are 10 times more bacteria cells in us than there are human cells.⁵ Human cells and bacteria have developed a symbiotic relationship over time. In order to answer the question of whether harming the good bacteria is harmful to us in the long run, we need to understand more about bacteria.  So how are bacteria beneficial to us?

Firstly, in our stomach, intestines and colon, we have “good” bacteria that play a major role in breaking down our food into nutrients to be absorbed by our body and into waste material that is eventually eliminated.  Along the way, these good bacteria take up colonization sites thereby preventing harmful bacteria, and other pathogens, from taking residence where they do not belong.

Secondly, bacteria can also play a major role in the production of key elements in our body. For example, Bacteroides species of bacteria live in our colon and help us produce Vitamin K, needed for blood clotting. Helicobacter pylori (H. pylori) is another example of the body needing a bacteria to function properly. H. Pylori, while responsible for stomach ulcers in some people when in overabundance, seem to play a major role in the generation of key hormones that control our appetites. H. Pylori appears to affect the regulation of the two hormones, ghrelin and leptin, involved in human energy homeostasis and implicated in the control of food intake such as controlling hunger. Leptin signals to your body it is full while ghrelin stimulates appetite. In one study, it was determined that fewer than 6% of children’s stomachs in the United States, Sweden, and Germany now carry H. Pylori. The lack of Helicobacter pylori has been thought to be linked to the increase in gastroesophageal reflux, Barrett’s esophagus, and esophageal cancer. Interestingly, those lacking H. pylori are also more likely to develop asthma, hay fever or skin allergies.1 Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center, suggests ‘that antibiotics may permanently alter your gut bacteria and interfere with important hunger hormones secreted by your stomach, leading to increased appetite and body mass index (BMI)’.³

Our bodies have been living in balance with our bacteria for thousands of years. It is a symbiotic relationship that is now being permanently altered by the use, overuse and misuse of antibiotics. No one knows at this point how seriously antibiotics are harming our long term health prospects. It will take decades worth of research and the resolve of governmental forces to undertake this large scale investigation. However, for today, it is worth asking the question; “By harming our good bacteria, are we not also harming ourselves in the long run?”

^{References: 1} http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2435636/

² http://articles.mercola.com/sites/articles/archive/2011/11/24/antibiotics-promote-obesity.aspx

³ http://www.jpp.krakow.pl/journal/archive/11_06_s5/articles/05_article.html

⁴ http://en.wikipedia.org/wiki/Bacteria

Antibiotics Sold to Livestock Industry vs. Sold for Human Consumption.

The proportion of antibiotics fed to livestock is not a recent issue, it has been growing and the problems that arise from it have accumulated for over 50 years. An alarming development of bacteria that had grown drug resistant due to antibiotics in the livestock industry is MRSA (short for methicillin-resistant Staphylococcus aureus) which is a persistent threat to human health. Estimates indicate that MRSA kills 19,000 Americans each year, hospitalizes 370,000, and results in billions of dollars of additional health care spending. The intent of these statistics is not to frighten, but to raise awareness concerning administering millions of pounds of antibiotics annually to artificially boost animal growth. Maryn McKenna wrote a book chronicling the rise and danger of these superbugs (http://superbugthebook.com/).

What is important to note is that a vast majority of the provided antibiotics is not to target infections or better animal health. It is administered at a herd or flock wide basis through the animals water source or feed to promote growth and weight gain, as well as to preventatively help livestock survive harsh farm and living conditions. This is one reason why antibiotics are used, another is for therapy. Therapy is used when farm animals exhibit clinical diseases, and drugs can be an effective way to prevent catastrophic health risks that could be detrimental to the agricultural sector.

Administering antibiotics to animals is not an inherently bad thing to do, although it can become detrimental if done without caution and concern. The FDA’s report on the application of antimicrobial drugs in industry warns that “the development of resistance to this important class of drugs, and the resulting loss of their effectiveness as antimicrobial therapies, poses a serious public health threat”. In this article, the main point is not to suggest entirely eliminating antibiotic consumption in the livestock industry, but to manage it judiciously by targeting specific diseases. Another significant argument is that farmers and food corporations should “voluntarily” withdraw from using drugs which have a functional similarity to drugs used in humans, since this would reduce the concern for transmitting resistive bacteria on to humans through our food. Use of antibiotics for livestock growth promotion has been banned by many European countries, as they have determined that similar investment in more food resulted in the same growth yields without the additional antibiotic resistance generation.

It is evident that we can no longer take how our food is produced for granted. The expression food for thought is no longer some overused metaphor, it is a reality.

The main theme of this Scientific Meeting will be to discuss the basic science and clinical advances in cancer, antimicrobial and other photodynamic therapeutic applications with the declared focus of improving the scientist/clinician interface.  The PanAmerican Photodynamic  Therapy Association is soliciting abstracts for oral presentations and posters.  Please submit your abstract using the ASLMS online system for submission.  You will need to select “Photodynamic Therapy” as the presentation category.  Important to note, you must either email Michelle directly at michelle@aslms.org so that she knows the abstract is for the PanAmerican Photodynamic Therapy Association.  Students and young researchers are especially welcome.

Abstract Link:  http://www.aslmsabstract.org/login.php

The Scientific Program will include the Chairman’s lecture and other invited lectures covering the recent advances in photodynamic therapy.  One half day session will focus on basic science and clinical photodynamic therapy of cancer and the other half day session will focus on basic science and clinical photodynamic therapy of antimicrobial and other applications.  A business meeting of the PanAmerican Photodynamic Therapy Association will be held during the course of the meeting for election of new officers and committee chairman.

Attendees of the PanAmerican Photodynamic Therapy Association will be able to register for the ASLMS Annual Conference at the “member” rate. CME credits will be offered.

Preliminary Program can be downloaded here.

For information about ASLMS registration, hotel reservations and the meeting venue please click here.

We look forward to your participation in this exciting meeting.  Please share this announcement with our fellow scientists and clinicians.  Also, please contact us if you have any questions – info@papdt.org

It takes a certain kind of person to be a great clinician and caregiver. In a world full of opportunities for education, talent and hard work, it takes a special kind of person to dedicate their lives to the pursuit of better patient outcomes.

It is a life of service, long hours, and often, lack of appreciation.

The personal sacrifice is always greater than anyone truly understands, and yet doing more for people in their hour of need is the greatest reward.

We at Ondine salute the dedicated clinician and caregiver.

We honour your spirit of service to humanity, and your desire to do good for your fellow man when he is at his weakest.

In this age of economic hardships, budgetary constraints, unsympathetic bureaucracy, and the usual challenges of every day life, it is comforting to know that you are out there trying to do your very best.

You make the world a much better place.

• Surgical site infections were reduced by 39%
• Vancouver General Hospital saved ~$1.9 million
• Readmissions due to surgical site infections decreased from 4 to 1.25 cases/month
• 553 patient bed days were freed up
• 138 more surgeries could be performed

We are grateful for the amazing work Dr. Elizabeth Bryce and her team at Vancouver General Hospital team has done to integrate MRSAid into their workflow. Check out these videos:

In fact, lining up for the bathroom after eating a partially cooked turkey has been known to scar even the most diehard Santa fans.  So, in the true spirit of Christmas prevention, we’ve come up with a short list of health tips, so you and your loved ones can avoid a less than ideal holiday experience.

1. Hand Sanitization: Washing your hands with plain soap— not even the antibacterial kind— has been shown to reduce the incidence of childhood disease.  Because these same diseases affect adults—even those with strong Christmas cheer—it’s important to note: hand washing saves lives.  A 2005 study, published in the Lancet, details the positive health effects that hand washing has on poorer children in Karachi, Pakistan.  In the assigned groups that washed regularly with plain soap, serious diseases such as pneumonia and diarrhea were reduced.  Interestingly, plain soap was as just as effective as antibacterial soap.
2. Avoid Undercooked Poultry: While not everyone will go the traditional route and cook a festive turkey for the holidays, for those who do, there are a few things to keep in mind.  Firstly, raw poultry is teeming with bacteria: campylobacter, salmonella, and e. coli.  Secondly, if your turkey is improperly cooked, you are exposing yourself and your digestive tract to potential disaster!   Remember, a food thermometer is your best friend.
   • According to the CDC, Turkey must be either thawed in conditions below 5 degrees Celsius, or defrosted in the microwave—otherwise bacteria may have the chance to multiply
   • Stuffing must be cooked separately from the bird
   • All portions must reach an internal temperature of 74 degrees Celsius, on the meat thermometer, to be safely cooked.

3. Don’t Share Eating Utensils: With family members and loved ones, we often let our guard down.  It’s easy to share a favourite desert with the same fork, or use personal utensils to serve ourselves from a shared bowl. Unfortunately, many viral infections—such as the common cold— are contagious before any symptoms develop— often up to 24 hours beforehand.  While all parties at the table may seem healthy, there’s a good chance that at least one of them is harbouring a secret germ that kill the yuletide mood.  Shared utensils are a ‘no-no’ at the best of times; at Christmas this rule is doubly important.

Getting Christmas right can be a lot of work, while getting it wrong can mean a lot of trouble!  On the more serious side of things, hospitals are usually filled to capacity during the holiday season; beds are often in short supply, due to increased patient demand, and obvious staff shortages.  For the average person, this means a longer stay time— not exactly a Christmas dream come true.  With a few simple precautions taken, Christmas can be everything it’s supposed to be: a magic holiday, filled with happy, lasting memories.

Happy holidays!

http://www.ncbi.nlm.nih.gov/pubmed/21117373
http://www.ncbi.nlm.nih.gov/pubmed/16023513
http://www.ncbi.nlm.nih.gov/pubmed/19343933
http://www.cdc.gov/features/turkeytime/

The last decade has been crucial in the battle against bacterial resistance.  Through ongoing education campaigns—for both doctors and patients— the American CDC (Centres for Disease Control and Prevention) and other groups have made small, but important, progress in curtailing the unnecessary use of antibiotics.  The good news is antibiotic prescriptions have decreased over the past decade or so.  This November, a joint assembly of the CDC and 25 other organizations released new data on the progress made between 1990 and 2010, noting a 17% decline in prescriptions.  The bad news is that as of 2010, antibiotic prescription rates are still very high in America, with 801 prescriptions per 1,000 people.

Areas with the highest prescription rates were West Virginia, Kentucky, Tennessee, Louisiana, and Mississippi.  The lowest rates were seen in California, Oregon, Washington, Alaska, and Hawaii.  Interestingly, most of the best behaved states— California, Washington, Hawaii and Oregon— have passed legislature to report infection rates, which could account for some of their success.  On the other hand, Tennessee and West Virginia—two of the worst behaved—also employ similar programs.

Also noted in the data was the increased use of broad-spectrum antibiotics among practitioners — that is, antibiotics that cover more species of bacteria at the same time.  The more species, or classes, of bacteria affected by an antibiotic, the more likely resistance or tolerance will be encountered down the road.  Broad-spectrum antibiotics also increase the risk of secondary super infections, such as c. difficile among patients, as they wipe out more of the body’s protective bacterial flora.

Similarly concerning was the decreasing effectiveness of antibiotics to treat urinary tract infections, or UTIs.  Ineffectively treated UTIs have the ability to spread to the kidneys, causing life-threatening infection or permanent kidney damage.

Because resistance is evolving much more rapidly than new drugs are being created, the only way to ensure that antibiotics are useful in the future is to a) Use them more appropriately in the present and b) Devote more resources to newer, replacement drugs.  Currently, neither of these requirements are being met.  If something isn’t done quickly, humanity may lose one of its most important scientific achievements—the ability to fight serious, life-threatening bacterial infections.

http://www.medpagetoday.com/InfectiousDisease/GeneralInfectiousDisease/35933

http://www.cdc.gov/hai/stateplans/required-to-report-hai-NHSN.html

http://www.umm.edu/patiented/articles/how_serious_a_urinary_tract_infection_000036_5.htm

In the agricultural world, most major classes of human antibiotics are well represented—that is everything from penicillins, cephalosporins, macrolides, to aminoglycosides are available for animal use.  These drugs, in their human forms, are used to treat the majority of bacterial illnesses—from strep throat to C. difficile infections.  Considering bacteria’s handy-dandy ability to swap resistance factors, it’s hardly surprising that antibiotics are beginning to lose potency among human patients.  As a 2003 Danish study put it, ‘humans and animals share overlapping reservoirs of resistance [to antibiotics]’.  The same study demonstrated the idea that resistant strains could jump from animals fed antibiotics to humans.  The bacterial strain of choice, an enterococci, which was isolated from human beings was able to demonstrate resistance to one of the strongest, last line antibiotics available to medicine: vancomycin.  Interestingly, after the EU banned the offending feed product, levels of resistance in animals, food, and people began to decrease. 

Likewise, raw, store-bought meat is another important source of resistant strains within the human community.  In a Maryland-based study, 378 samples of Campylobacter from retail meats were analysed.  The majority showed at least some resistance to several major, mainstream antibiotics.  Campylobacter is a major source of food poisoning—resulting in severe, often bloody, diarrhea and painful cramps.  Similar data exists for other common food-bourne bacteria, such as e. coli and salmonella.

Although the exact numbers are unknown, it’s estimated that approximately 80% of all antibiotics manufactured, today, are used in livestock—a number that far out-strips any legitimate medical usage.  In response to this truly frightening precedent, many major medical organizations, including the American Nurses Association, have been intensely lobbying the American government to change current policies.  In their own words: “The American Nurses Association has established policies that call on Congress, the U.S. Food and Drug Administration, and meat producers to promptly phase out the agricultural practices that promote antibiotic resistance.”

Fortunately, a recent series of successful lawsuits, have been putting pressure on the FDA (American Federal Drug Administration) to ban the non-medical use of antibiotics outright.  A US district court judge, as of 2012, for example, has ordered the governmental organization to move towards ending the use of antibiotics as an additive in animal feed.  Although it remains to be seen if the FDA cooperates with these rulings, it’s a good symbolic step in the right direction—and a good precedent for further lawsuits.  For the time being, however, the status quo seems to remain.

While most people don’t really think about it, the loss of antibiotic effectiveness is one of the most significant issues of our time—with the potential to shape hundreds of millions of lives.  Under the current agricultural business model, we may be involuntarily entering into a post-antibiotic era, where simple illnesses like strep throat may, once again, lead to death and disability in children, or pneumonia is completely untreatable in the elderly.  Clearly, the time to act is now.

Curtailing antibiotic use in agriculture
FDA Anti biotic usage statistics
Nursing organizations call for phase-out of agricultural practices that promote antibiotic resistance.
Antimicrobial-resistant Campylobacter species from retail raw meats.
Antibiotics in animal feed and their role in resistance development.