Posts tagged: MRSA

Ventilator Acquired Pneumonia: A Large Problem for Hospitals

Although hospitals are centers of refuge for those who need care, an unfortunate reality is that the number of people coming in and leaving these facilities inevitably results with the spread of disease and infections between patients, doctors, and other health care workers. These unintentionally transmitted diseases, born in hospital settings, are collectively known as Hospital Acquired Infections (nosocomial infections in medical literature). This class of disease results in over  99,000 deaths each year in the United States alone.

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.

The Underreporting of Pneumonia Infections In Hospitals

Ventilator-Associated Pneumonia (VAP) is a type of lung infection that occurs in individuals receiving mechanical intubation. In intensive-care units, VAP is one of the leading causes of healthcare-associated infections, however there is currently no reliable definition of a VAP patient. Preventing VAP continues to be a priority, as it is associated with increased healthcare costs, longer hospital stays, and increased mortality and morbidity.

Defining a VAP infection is based on subjective elements and will need further standardization. A new system that is currently scheduled for implementation in 2013 will categorize VAP into 4 levels:

  1. Ventilator-associated condition (VAC)
  2. Infection-related complications (IVAC)
  3. Possible VAP
  4. Probable VAP

Like other healthcare-associated infections, the underreporting of infection rates continues to be a general trend. With healthcare-associated infections being the most common type of hospital-related complication, this fact is even more alarming. In a recent review of over 100 hospitals in California concluded that approximately 1/3 of all healthcare-associated infections go unreported. Read more »

Two-Time Cancer Survivor Fights Off Deadly MRSA Infection

In April 2003, while the budding and blossoming of new life surrounded the springtime air, Sally would soon be left fighting for her life. Sally, a two-time cancer survivor, was sent to the hospital to undergo reconstructive surgery on her breasts. After a few hard years of treatment for breast cancer, Sally was fortunate to have won the battle against cancer and hoped to put her struggles behind her.

The surgery was a success, but as with any surgical procedure, nothing could have prepared Sally for the pain she was about to endure. Numerous stitches held Sally’s incisions together. She was told not to move without assistance from medical personnel. One nurse entered Sally’s room to turn her and make her more comfortable, but this required further medical staff. While Sally was waiting for the medical staff to arrive, she took the initiative to attempt to turn over on her own. This caused several stitches to detach from the incision, which slowed down the healing process.

Sally subsequently developed severe, swollen blotches on her body. Such manifestations caused her more pain than the actual incisions from the procedure. Her incisions soon became infected as well, although Sally’s doctor neglected to disclose the type of infection she had acquired. According to Sally, the doctor assumed the infection was MRSA. Methicillin-resistant Staphylococcus aureus, or MRSA, is a superbug that does not get better with first-line antibiotic treatments, thus considered “resistant.”

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Photodisinfection Kills MRSA Superbug Quickly and Safely

It is fair to say there are no microorganisms that cannot be killed by PDT (photodisinfection). It is a relatively non-specific formation of reactive oxidant species which, by and large, will kill anything. The way to optimize is to target the {‘photosensitizer’} to the species you want to kill – Richard Hamblin, Harvard Medical School.

One important application of photodisinfection is “nasal decolonization”, the elimination of all or almost all of the MRSA (Methicillin-resistant Staphylococcus aureus , one of the superbugs) that thrive inside of the nose. This is an important application because a number of studies have demonstrated that removing the harmful bacteria in the nose (called ‘decolonization’) results in a significantly lower incidence of surgical site infections. Patients who are colonized with bacteria are at risk of self contamination after surgeries when their bodies are weakened. By reducing all or substantially all of the harmful bugs in the nose prior to surgery, fewer patients will die and fewer patients will become infected with resistant and susceptible forms of staphylococcus (‘Staph’).

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How Ondine Biomedical Addresses A World Of Growing Antibiotic Resistance

In 1969, the US Surgeon General William Stewart declared that the human race had won the war against bacteria. It was thought that bacteria would never be able to figure out how to develop resistance to the new complex antibiotics that had been created and that scientific researchers would always be able to stay well ahead of the bacteria. Today, it is well known that bacteria have reversed this situation and that the antibiotic resistance war is far from being over.

It is estimated that there are about 17 million people in the US alone annually suffering from painful and potentially harmful biofilm infections. To me and my colleagues at Ondine, we understand that certain bacteria have become dangerous and remain a threat to all of us. Every single one of us knows of a person who died, or nearly died, of an infection. Many of these people have died from infections acquired while in hospitals, a place where most of us think is safe. This just was not the case 20 years ago. This prevalence of deadly infections could not have been expected in 1969.  Our society’s overuse and misuse of antibiotics (over 25 million pounds of antibiotics are given to livestock every year) have led to greater threats to humanity. At the same time, the enormous costs and regulatory burdens have led to fewer new antibiotics being developed. Clearly the battle rages and we as humans have not been very strategic about our critical weapons. Read more »

A Silent Epidemic: A Documentary That Could Save Your Life

In August of 2008, I lost my father to a number of healthcare-associated infections including C. diff, MRSA, and pseudomonas. As I began my freshman year at Providence College the following week, I started doing research to learn more about what happened to my dad, and what I learned astonished me. HAIs infect approximately 1.7 million individuals annually in the United States alone, killing nearly 99,000 of those who become infected. I also learned that these infections are largely preventable.

As I learned more about healthcare-associated infections, I knew I had to do something to help bring that information to others. The perfect opportunity arose when I became a film minor, with the hope of eventually making a film to raise awareness. In January of 2012, I contacted Pat Mastors, who I had met the winter after my dad passed away. Pat lost her father in 2007 as a result of C. diff, and has since become a huge advocate for patient safety and awareness, creating the Patient Pod, which is a tool to help keep patients safe in hospitals, nursing homes, and other related environments. She has also been an immense help in the production of this film, as she put me in contact with a number of individuals across the country, and also set up my interview with Dr. David Lowe, an infectious disease specialist who saved the life of one of her close friends. Dr. Lowe’s interview was also immensely helpful, as he explained complicated scientific information in a way that the average person can easily understand.

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Healthcare-Associated Infections: A Silent Epidemic That Took My Father

In July of 2008, my father, Richard G. Croke Jr., went into the hospital for a surgery to remove a piece of his esophagus after being diagnosed with esophageal cancer the previous winter. While the initial chances of survival for this type of cancer were slim, six weeks of chemotherapy and radiation treatments left my dad cancer free. Although the esophagealectomy was an invasive procedure, we were told that the surgery would be the easy part of his journey now that he was cancer free.

The day after his surgery, I went to the hospital to visit him. He was up talking and cracking jokes in his usual manner. Everything seemed fine. Until we received a phone call from the hospital in the middle of the night saying that my dad was extremely ill and might not make it through the night. That was the beginning of the six weeks that changed our lives forever.

Upon entering his ICU room that night, my dad was full of almost 100 pounds of excess fluid, was attached to a number of IVs, and had a ventilator breathing for him. We were told that my dad was in septic shock, which was caused by MRSA entering the bloodstream through the contaminated central line on his foot. He spent six weeks in the hospital, and for a while was getting better until he caught C. diff about a month after the initial bout with sepsis.

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The Growing Temptation to Underreport Healthcare-associated Infections

Over the past decade, there has been much written about the rise of antibiotic resistant pathogens and the growing numbers of serious healthcare-associated infections. Some statistics have put the total cost of healthcare-associated infections at around $35-$45 billion dollars1. Infections associated with MRSA have been estimated to cost about $3-$4 billion2 and ventilator-associated pneumonia costs another $3 billion3. The truth is that we really do not know the extent of the problem or the associated costs, and this in itself is a problem. Whatever the number, we can all agree that the costs of healthcare-associated infections are an enormous drain on the economy, and this is prior to factoring in any of the socio-economic multiplier effects of HAIs due to death, loss of employment, impact on families/companies etc.

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Antibiotic Resistance: How A Global Health Problem Develops

The public sphere has been pumped full of information about how unnecessary use of antibiotics contributes to the development of resistant bacterial strains. Just take a look at this news article suggesting that more than 25 million pounds of antibiotics are given to livestock every year. However, what is less often explained is how this works at the molecular level. How does bacteria develop antibiotic resistance?

The World Health Organization has called antibiotic resistance one of the greatest global health concerns to date.

Before answering that question it is important to understand how bacterial cells work. Bacterial cells look and work differently than say a cell from our body. They have a genetic code (within DNA) but some of that code floats freely within the cell in circular structures called plasmids. One of the particularities of bacterial cells is their ability to pass plasmids amongst each other (plasmid transfer), allowing them to share traits on an extremely rapid scale. Furthermore, one bacterium can divide into two cells without the need for sexual reproduction between two parent cells.

Like us, bacteria survive on chemical based processes, which allow them to grow and replicate. Protein molecules are essential to these processes. They allow for three things:

  • Destroy/change other molecules
  • Form physical structures and barriers
  • Help build new molecules

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Ondine Study Shows Reduction of Endotracheal Tube Biofilm Using Photodisinfection

Ventilator-associated pneumonia is one of the most common and deadliest forms of healthcare-associated infections.  In the U.S alone, more than one million patients in healthcare facilities require mechanical ventilation every year. Up to 1 in 4 of these patients are reported to develop ventilator-associated pneumonia and up to half of them will die.1

Antimicrobial photodynamic therapy (aPDT), commonly known as Photodisinfection, is a non-invasive technique that used to study the reduction of biofilm in the lumen of an endotracheal tube. When patients undergo mechanical ventilation, an endotracheal tube is inserted into their throat to assist with breathing. This tube has long been recognized as a major factor in a patient’s risk for developing biofilm infections. For patients that require mechanical ventilation, such as those in ICUs, the biofilm can dislodge from the endotracheal tube and enter the lungs directly, often resulting in difficult-to-treat pneumonia.

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