One in 25 patients battling hospital-acquired infections: CDC

By Gene Emery

NEW YORK (Reuters Health) - On any given day, one in 25 hospitalized patients - 4 percent - is battling an infection picked up in a hospital or other healthcare facility, according to a new survey by the Centers for Disease Control and Prevention (CDC).

That translates to more than 600,000 hospital patients each year. Roughly 74,000 of them have to fight more than one hospital-acquired infection, researchers found.

About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery.

Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002.

"The trend, in magnitude, seems to be going in the right direction," Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health.

Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.

The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility.

Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively.

The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular.

Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.

The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year.

The new report "validates the work we've been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures," Bell said.

To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says.

SOURCE: http://bit.ly/1rzGOHe New England Journal of Medicine, online March 26, 2014.

View the original article here

'Dramatic' drop in global HIV infections

23 September 2013 Last updated at 09:10 ETBy Tulip Mazumdar Global health reporter

The number of HIV infections and Aids-related deaths has fallen dramatically, according to a UN report.

Death rates fell from 2.3 million during its peak in 2005 to 1.6 million last year, says Unaids.

The number of new HIV infections fell by a third since 2001 to 2.3 million.

Among children, the drop was even steeper. In 2001 there were more than half a million new infections. By 2012 the figure had halved to just over a quarter of a million.

The authors put the fall down to better access to antiretroviral drugs which help suppress the virus.

Without treatment, people with HIV can go on to develop Aids which makes simple infections deadly.

By the end of 2012 almost 10m people in low and middle income countries, including South Africa, Uganda and India, were accessing antiretroviral therapy, according to the report.

The improved access is being attributed to drugs being more affordable and available in communities, as well as more people coming forward for help.

Way to go

According to Unaids, the world is "closing in" on its Millennium Development Goals to stop and reverse the Aids epidemic by 2015.

But it says the world can go beyond its target of getting 15m people on HIV treatment by 2015. The World Health Organization has now revised its guidelines making even more people eligible for treatment.

The report also found that progress has been slow in providing HIV services to people who are most at risk of infection, like those who inject drugs.

And it highlights the need to do more to deal with sexual violence against women and girls. They make up a key group of people vulnerable to infection.

Bev Collins, Health Policy Advisor at Medecins Sans Frontieres/ Doctors without Borders said: "Huge leaps forward have been made to make sure that millions of people - especially in the developing world - can access lifesaving HIV treatment at an affordable price.

"But this is no time for complacency. We need to keep on rolling out access to better treatment strategies, expanding access to accurate, cost-effective testing, and to care"

View the original article here

New test aims to better detect viral infections

WASHINGTON (AP) — It happens too often: A doctor isn't sure what's causing someone's feverish illness but prescribes antibiotics just in case, drugs that don't work if a virus is the real culprit.

Now Duke University researchers are developing a blood test to more easily tell when a respiratory illness is due to a virus and not a bacterial infection, hoping to cut the dangerous overuse of antibiotics and speed the right diagnosis.

It works by taking a fingerprint of your immune system — how its genes are revving up to fight the bug. That's very different from how infections are diagnosed today. And if the experimental test pans out, it also promises to help doctors track brand-new threats, like the next flu pandemic or that mysterious MERS virus that has erupted in the Middle East.

That viral "signature could be quite powerful, and may be a game-changer," said Dr. Geoffrey Ginsburg, Duke's genomic medicine chief. He leads the team that on Wednesday reported that a study involving 102 people provided early evidence that the test can work.

Today, when symptoms alone aren't enough for diagnosis, a doctor's suspicion guides what tests are performed — tests that work by hunting for evidence of a specific pathogen. Fever and cough? If it's flu season, you might be tested for the flu virus. An awful sore throat? Chances are you'll get checked for strep bacteria. A negative test can leave the doctor wondering what germ to check for next, or whether to make a best guess.

Moreover, rapid in-the-office tests aren't always accurate and can miss infections. So patients may have blood or other samples sent to labs to try to grow any lurking bacteria and tell if it's to blame, additional testing that can take days.

"This is something we struggle with every day," said Dr. Octavio Ramilo, infectious disease chief at Nationwide Children's Hospital in Columbus, Ohio, who wasn't involved in the new study. Particularly with children, a respiratory virus and a bacterial infection "in the beginning look completely alike," he added.

Hence researchers at a number of universities are trying to harness a fairly recent discovery: As your immune system detects an invading bug, different genes are activated to fend off a viral infection than to fight a bacterial or fungal one. Those subtle molecular changes appear to be occurring even before you feel any symptoms. And they form distinct patterns of RNA and proteins, what's called a genomic fingerprint.

The Duke team discovered 30 genes that are switched on in different ways during a viral attack. The test essentially is a freeze-frame to show "what those genes are doing at the moment in time that it's captured," explained Duke lead researcher Dr. Aimee Zaas, an infectious disease specialist.

Small studies spotted that viral signature in people who volunteered to be infected with different influenza strains for science.

For a more real-world simulation, the researchers then analyzed blood samples stored from feverish people who had come to the emergency room — and who were eventually diagnosed, the old-fashioned way, with either some type of virus or a bacterial infection.

The genomic test proved 89 percent accurate in sorting out who had a virus, and did even better at ruling out those who didn't, Zaas reported Wednesday in the journal Science Translational Medicine.

It took 12 hours to get results. The researchers hope to speed that up so that it might work as quickly as some in-office tests.

Still, "it's a promising tool," said Ramilo, an Ohio State University professor who is doing similar research. He called the Duke study an important step toward creating a commercial test, and predicts one might reach the market within five years.

Why would a doctor want to know merely that a virus is present and not which virus? That's enough information to rule out antibiotics, Zaas said. Unnecessary antibiotic use is one factor in the growing problem of drug-resistant germs, which the government blames for more than 23,000 deaths a year.

Plus, if a dangerous new virus begins spreading, like MERS, this approach could help avoid quarantining people unnecessarily by telling right away which ones are virus-free, Ginsburg added.

In Ohio, Ramilo is exploring a more immediate need: When young infants have high fevers, they're often hospitalized while doctors run a battery of tests to find the fraction who have a serious bacterial infection. He is leading a study involving 22 pediatric emergency rooms to see if a genomic fingerprint approach could separate which babies really need all that testing.

But the virus-or-not question is just the beginning, Ramilo said. His research suggests genomic fingerprints also can distinguish a flu strain from other common viruses. And the Duke team is analyzing a huge study of students living in dormitories, to see if the genomic test detected who was incubating the flu before their first sniffle — and thus might be useful in stemming outbreaks.

Copyright c 2013 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

View the original article here

Could E. Coli Vaccine for Cows Cut Human Infections?

TUESDAY, Sept. 17 (HealthDay News) -- Vaccinating cattle against E. coli bacteria could cut the number of human infections by 85 percent, far higher than previous estimates, British scientists say.

The researchers reviewed the way that E. coli is transmitted from cattle to humans, noting that the risk of infection is particularly significant during the brief periods when cattle are "super-shedding" extremely large amounts of the bacteria in their feces.

"As far as we can assess, the major risk to humans is from those animals that are shedding the bug heavily," said Stuart Reid, senior study author and a principal at the Royal Veterinary College at the University of London. "If the vaccine has an impact on these animals at that time, the risk to humans is disproportionately reduced."

Previous research has predicted that vaccination of cattle could reduce E. coli risk by 50 percent, but those studies did not take into account the effect of vaccination on "super-shedding," the researchers said.

The new study of Scottish cattle appeared in the Sept. 16-20 issue of the journal Proceedings of the National Academy of Sciences.

E. coli infection causes severe gastrointestinal illness in humans, in some cases leading to death. It is spread by consuming contaminated food or water, most often ground beef.

Nearly 1,100 confirmed cases of E. coli infection occurred in the United States in 2012, according to the U.S. Centers for Disease Control and Prevention. They led to 275 hospitalizations and two deaths. The CDC said that for every reported case of E. coli, there are probably 26 more that go undiagnosed.

Vaccines against E. coli have been approved for cattle in the United States and Canada, but farmers have not shown much interest in using them, the study authors said.

Farmers aren't vaccinating cattle against E. coli because cattle don't get sick from the bacteria, said Mike Doyle, a distinguished professor of food microbiology and director of the Center for Food Safety at the University of Georgia.

"The farmer doesn't get any bang for the buck from a production perspective," Doyle said. "The vaccine doesn't help the animal grow more healthy."

Government intervention likely would be required for widespread vaccination to occur. "Unless all farmers were required to vaccinate by the government, it wouldn't be cost effective or cost competitive for them to do that," Doyle said.

Such intervention should be seriously considered, said lead study author Dr. Louise Matthews, a senior research fellow in the Institute of Biodiversity, Animal Health and Comparative Medicine at the University of Glasgow.

"Treating cattle in order to reduce the number of human cases [of E. Coli] certainly makes sense from a human health perspective, and, while more work is needed to calculate the cost of a vaccination program, the public health justification must be taken seriously," Matthews said.

The researchers started their work first by identifying the genetic marker associated with E. coli super-shedding in cattle. They then studied the relationship between cattle predisposed to super-shed E. coli and human outbreaks of the illness, concluding that the types of E. coli linked to super-shedding cause the vast majority of cases.

The researchers now are working to develop even more effective vaccines that would further reduce the risk of E. coli outbreaks.

Doyle warned against generalizing the Scottish results to the United States, however, noting that farming methods are very different between the two. For example, Scottish beef is mostly grass fed.

"You can't automatically extrapolate what they find over there to what we have here," he said. "There's probably more research that would need to be done to see how useful or relevant this information is to American farmers."

Dr. Georges Benjamin, executive director of the American Public Health Association, said the results are intriguing. He said, however, that he's concerned that a vaccine might reduce emphasis on the common-sense food-safety methods that now provide effective protection against foodborne illness.

"I do want to emphasize [that] it does not replace careful monitoring of animal health and surveillance of the food-safety process as animals move through the pipeline to become our food," Benjamin said. "It also doesn't replace good food safety. You're still going to have to wash your hands. You're still going to have to make sure your food is prepared properly."

More information

For more about foodborne pathogens, visit the U.S. Centers for Disease Control and Prevention.

Copyright c 2013?HealthDay. All rights reserved.

View the original article here