“ESKAPE” pathogens, Trditional medicine, Truck transporting Broilers

“ESKAPE” pathogens dangerous
Infectious Diseases Society of America has produced a new report (a follow-up to the one published in 2004, “Bad Bugs – No Drugs”), pre-publishing in CID now available on-line, with focuses on the “ESKAPE” pathogens, which according to latest data from CDC are responsible for two thirds of HAIs in the US: Ent. Species, Staph. aureus, Klebsiella sp, Pseudomonas aeruginosa, Enterobacter species; and the lack of effective antibiotics against them – IDSA News
WHO congress backs traditional medicine
Published online 19 November 2008 Nature 456, 287-288 (2008) doi:10.1038/456287a
Web data predict flu
Search engines provide information about epidemics. Published online November 2008 Nature 456,
Two new studies hint at the public-health and research potential of mining the data created as people search the web. Both teams have successfully detected the onset of US seasonal flu epidemics, by extracting patterns of flu-related search terms from the billions of queries stored by Google and Yahoo.
New product
A new cleaning product “Byotrol” is said to be showed in a study to significantly reduce levels especially of C difficile, Compared to bleach it is also said to have some practical advantages, and not expensive also Channel 4 News:
Don’t Drive behind a truck transporting broilers
Driving behind a truck transporting broilers could be a risk of acquiring AMR bacteria, according to a study at Johns Hopkins Bloomberg School of Public Health, in JIPH, here cited by ScienceDaily

Antibiotic Awareness Day - 18th November 2008

Europe celebrates `Antibiotic Awareness Day` on 18th November 2008.
We offer our best wishes to all those in Europe who are fighting for prolonging the utility of present day antibiotics by advising practices that will keep at minimum the development of Antibiotic resistance in the infectious bacteria.
IIMAR offers best wishes particularly to ReAct, our supporters in Europe who have taken up the gauntlet of making all out efforts to minimise the problem of Antibiotic Resistance all over the world.
Eurosurveillance has the whole issue this week devoted to antibiotic resistance, with focus on many encouraging examples of success of countermeasures taken up in Europe to reduce development of resistance in infectious bacteria to the antibiotics.

Global Hand Washing Day

Global Hand-Washing Day is celebrated on 15 October every year to raise awareness about the role hand washing plays in public health.
"Hand washing is one of the most important ways of controlling the spread of infections, especially those that cause diarrhoea, vomiting, colds and flu.``
"Global Handwashing Day serves as a timely reminder that people should always wash their hands after using the toilet, before eating or handling food, and after handling animals. And remember to cover all cuts and scratches with a waterproof dressing."
The Norovirus - the winter vomiting bug - is the most common cause of gastrointestinal disease. "Norovirus is highly infectious and easily spread in settings where people are in close contact with one another so good hygiene, including frequent handwashing, is really important.
"Unfortunately there is no specific treatment for norovirus apart from letting the illness run its course. Most people will make a full recovery within 1-2 days but it is important to drink plenty of fluids during that time to prevent dehydration especially in the very young or elderly."
So No need to take unnecessary antibiotics, If you are washing your hands with soap and water frequently.

Minocycline and japanese encephalitis; ABR and Disinfectants

Two researchers from National Brain Research Center (NBRC) suggest that a common antibiotic -minocycline- may prevent children from death due to Japanese encephalitis (JE), commonly known as brain fever. Japanese Encephalitis virus is the causative agent for JE. Although there is no consolidated official figure for JE cases in India, a rough estimate would indicate a few thousands fatalities every year http://www.sciencedaily.com­ /releases/2008/02/080219093000.htm

Efflux pumps can make antibiotics resistant also to disinfectant chemicals in hospitals (BBC)

New tests make antibiotic monitoring easier

http://www.sciencedaily.com/releases/2008/05/080502172258.htm
Detecting antibiotics in the environment could become easier, thanks to portable field kits developed and validated by a team of scientists. The team conducted studies showing that the kits, called enzyme-linked immunosorbent assays (ELISA), accurately detected trace amounts of sulfonamides, also known as "sulfa drugs," in wastewater samples. When these drugs are excreted in urine, for example, they can persist in the environment unchanged or as metabolites.

An important British Medical Journal (BMJ) article

The article “Meeting the challenge of antibiotic resistance” stresses that vital components of modern medicine such as major surgery, organ transplantations, and cancer chemotherapy will be threatened if antibiotic resistance is not tackled urgently. Concerted global response is needed to address rising rates of bacterial resistance caused by the use and abuse of antibiotics.
The article is free to download from bmj.com.
(http://www.bmj.com/cgi/content/full/337/sep18_3/a1438?ijkey=CYxxcCjjzZzQxn4&keytype=ref)
Action on Antibiotic Resistance, or ReAct in Sweden has taken the initiative to publish this article. The authors lead by Dr. Otto Cars are members of ReAct`s international secretariat.

A new Antibiotic on the horizon

Medical News Today has an article about a new antibiotic, ready for phase 1 clinical trials: a new class, “a synthetic chemical mimic of host defense proteins”,
http://www.medicalnewstoday.com/articles/119228.php
International News
UK: The Independent says “Antibiotics to delay premature birth may harm babies”, and the CMO of the Government has written to all GP:s and obstetricians with a warning, after an article in the Lancet on the subject.
Gothenburg: A large campaign is launched at Sahlgrenska Hospital to convince the 2000 doctors to use ABs more prudently. MRSA has been a big problem, but now resistant gramnegatives is also more in focus.
US: An increase in the dangerous combination of MRSA colonization plus influenza leading to serious pneumonia is reported in Los Angeles Times – and a CDC Epidemiologist recommends influenza vaccination.
US: C difficile is noted as a “Rising Foe” in the Wall Street Journal

Novel ways to fight Resistant Bacteria

Novel ways to fight resistant bacteria are emerging due to the lack of effective antibiotics: Medical news presents a new combination of dye plus special light to fight MDR bacteria in /surgical/ wounds, and another machine seemingly working with stronger UV light

Antibiotic study in Orissa

Antibiotic use, environment and antibiotic resistance: A qualitative study among human and veterinary health care professionals in Orissa, India. http://www.uppsatser.se/uppsats/c80ba1404b/

Antibiotic cycling controls ICU Infectons

Doctors at the University of Virginia Health System have significantly reduced MRSA infections among surgical intensive care patients by using antibiotic cycling, a method of rotating drugs at regular intervals. They followed switching between linezolid and vancomycin in 3-months cycles in a Surgical Trauma ICU, and reduced the percentage of MRSA infections of all Staph aureus infections in the ICU from 67% to 36% (ScienceDaily 4th September 2oo8)

Copper handles, electrical switches eliminate harmful bacteria

We had earlier given information that Indian scientists had proved that silver and copper nano-particles have antibiotic properties. Now comes this news
Copper handles, light switches Eliminate Resistant Hospital Germs In A Worldwide Field Test
Medical News today: 23 Aug 2008
In earlier times, copper was considered to be very antimicrobial. In India we have been using copper vessles all the time, but now have opted for stainless steel as a fashion. But now the antimicrobial property of copper may play an important role in the struggle against dangerous hospital germs. In a worldwide noted field test, a whole hospital ward at a Clinic in Hamburg, Germany, was equipped with door handles, door plates and light switches made of copper. Because the germs are not only transmitted from one hand to another but, in many cases, also by touching door handles and switches. According to the clinic and the involved scientists at the University Halle-Wittenberg, the first study results have shown "significantly less chances of survival" of microbes on copper surfaces. "The struggle against high-resistant agents cannot be won with the previous means, such as the use of new antibiotics and intensive disinfection measures. We must break new grounds in order to reduce the potential danger for our patients," Professor Prof. Dr. med. Jorg Braun, chief physician of the I. Medical Department at the Asklepios Clinic Wandsbek said that "Scientific tests performed by several independent working groups have shown beyond doubt that copper surfaces can efficiently kill bacteria and other germs," Prof. Dr. Dietrich H. Nies, Director of the Institute for Biology at the Martin Luther University Halle-Wittenberg, Germany, also confirms.Comparable studies under clinical conditions are planned or are being performed at the same time in Great Britain, South Africa, the US and Japan. The tests at the Asklepios Clinic in Hamburg, Germany, were initiated by laboratory tests in which 99.9 percent of the bacteria, including the high hazard MRSA agents, were eliminated within a period of a few minutes up to two hours on copper surfaces. In contrast, the same microbes were able to survive up to three days on stainless steel surfaces. This is why the US Environmental Protection Agency (EPA) has confirmed the antimicrobial effect of copper only recently, in March this year.

Kamikaze bacteria illustrate evolution of co-operation

Suicidal Salmonella sacrifice themselves to allow their clones to get a foothold in the gut.
Bacteria can commit suicide to help their brethren establish more damaging infections — and scientists think that they can explain how this behaviour evolved.
The phenomenon, called self-destructive cooperation, can help bacteria such as Salmonella typhimurium and Clostridium difficile to establish a stronghold in the gut.
Published online 20 August 2008 Nature doi:10.1038/news.2008.1055

Silver and copper nanoparticles kill bacteria

An Indian research team has found a novel way to kill bacteria that grow resistant to conventional antibiotics. Researchers from Mumbai and Kolkata have found that silver and copper nanoparticles could kill several deadly bacteria.
See doi:10.1038/nindia.2008.196; Published online 2 May2008 Nature INDIA

Bacteria Subsisting on Antibiotics

The researchers, led by George M. Church, a geneticist at Harvard Medical School, found hundreds of bacteria that can subsist on antibiotics as their sole source of carbon. They isolated strains from soils in 11 locations, including alfalfa fields in Minnesota and urban plots in Boston, and fed them 18 natural and synthetic antibiotics, including common ones like penicillin and ciprofloxacin. Bacterial growth was seen with almost all of them.
The researchers, who reported their findings in Science, say these microbes could be considered super-resistant, since they can tolerate antibiotic concentrations that are 50 times the levels used to define bacteria as resistant.
None of the microbes studied by the team cause illness in people, though some are closely related to pathogenic bugs. And no human pathogens are known to have the ability to eat antibiotics. They wouldn’t necessarily be expected to — there are plenty of better food sources in the body.
But the findings represent an indirect threat to human health by showing that there’s a large reservoir of resistance in common bacteria in nature. And since bacterial resistance can be acquired through gene transfer, the possibility exists that human pathogens could pick up resistance from one of these relatives in the soil.
(Science 4 April 2008: Vol. 320. no. 5872, pp. 100 – 103 DOI: 10.1126/science.1155157)

Dr. Tamhankar comments---
Can this be a new threat for us???

Can Chloroquine induce resistance to antibiotics??

Malaria is taking several lives every year. Chloroquine is the cheapest and most widely used drug to cure malaria. The latest research done by the Lakeridge Health Centre in Oshawa, canada, reveals that chloroquine use is associated with the risk of resistance to antibiotics. People living in remote villages in Guyana, were studied under the research. These people were specially chosen to study the antibiotics resistance because these people were never exposed to antibiotics. Hence the researchers expected zero resistance level in these people. But the study showed that 4.8 percent people under the study had high antibiotic resistance level. These people had strains of E. coli that were resistant to the antibiotic ciprofloxacin.
Dr. Michael Silverman of Lakeridge Health Centre in Oshawa, Ontario said that the loss of effect of these commonly used antibiotics could give a death blow to public health.
The researchers are still doubtful whether high resistance level is related to cholroquine alone. The researchers added that the only possible solution to fight this complicated problem is to increase the efforts to prevent malaria.

Dr. A.J. Tamhankar comments-----

1. The % of people with resistance in the study is very small.
2. But if it is true that this population was really not subjected to antibiotic use earlier, then it gives FEW conjectures. A. there could always be a segment of population everywhere that could be resistant to any external agent used against them. B. The researchers might have carried resistant E.coli on them which got transmitted to these people in study. C. It could be an example to show that RESISTANCE DOESNOT RECOGNISE ANY BOUNDRIES.
3. Let us hope this is not true for India!!

FDA (USA) warning on CIPRO

The FDA as issued a renewed warning that Antibiotics like CIPRO and Fluoroquinolones pose the risk of tendinitis and ruptured tendons. The risk is greater in patients of 60 years and more, those who have certain organ transplants and those using steroid therapy. Patients with tendon pain should immediately stop taking the drug. Most cases involve the Achilles tendon, which attaches the calf muscle to the heel. Less frequent ruptures affected tendons in the shoulders, biceps, hands and elsewhere.

Gut superbug leading to more illnesses and deaths

The number of people hospitalized with a dangerous intestinal superbug Clostridium difficile has been growing by more than 10,000 cases a year in US according to a new study. Resistant to some antibiotics, it has become a regular menace in hospitals and nursing homes.
A recent study found it played a role in nearly 300,000 hospitalizations in 2005, more than double the number in 2000.
The infection, Clostridium difficile, is found in the colon and can cause diarrhea and a more serious intestinal condition known as colitis. It is spread by spores in feces. But the spores are difficult to kill with most conventional household cleaners or antibacterial soap.
C-diff, as it's known, has grown resistant to certain antibiotics that work against other colon bacteria. The result: When patients take those antibiotics, competing bacteria die off and C-diff explodes.
It is opined that one of the causes of the resistance development could be overuse and inappropriate use of antibiotics.
See http://www.cdc.gov/eid/content/14/6/929.htm

Globle Warming May Make 'Perfect Storm' of Diseases

(By Charles Q. Choi, in LiveScience-posted: 24 June 2008)
A "perfect storm" of diseases can get unleashed by the kind of extreme swings in weather expected with global warming, triggering mass die-offs of wildlife or livestock, research now reveals.
Now the first clear example of such a perfect storm of diseases has been discovered by an international team of scientists.
Global warming is predicted to lead to extreme swings in weather events such as droughts and floods. These could theoretically lead normally tolerable diseases to converge and trigger multiple outbreaks of epidemics with catastrophic mortality.
The clear example of a disease cascade came when researchers investigated outbreaks of canine distemper virus that killed an unusually high number of lions in East Africa, at Tanzania at Serengeti National Park in 1994 and Ngorongoro Crater in 2001.
These infections can have awful effects, such as "a grand mal seizure — the animal is unable to control its movements, starts thrashing about helplessly with every muscle in its body flexed to the maximum, grinding its teeth and foaming at the mouth," said researcher Craig Packer, an ecologist at the University of Minnesota. "Then the seizure stops for a few minutes before starting all over again."
Numerous epidemics of this virus have occurred within these ecosystems over the past 30 years that had proved essentially harmless to the lions, however the lions that survived the 1994 and 2001 distemper epidemics were in unusually poor condition.
"The lions were lethargic, thin, anemic, and had enlarged lymph nodes, physical changes that do not usually occur after recovery from canine distemper virus," said researcher Linda Munson, a veterinary pathologist at the University of California, Davis.
The reason could be that the virus outbreaks in 1994 and 2001 were both preceded by severe droughts, one of the types of weather events predicted to occur more frequently as Earth's climate continues to warm. This debilitated populations of Cape buffalo, a major prey of lions.
After the rains returned, the weakened, starving buffalo suffered heavy tick infestations, resulting in high levels of a tick-borne blood parasite in the lions. These parasites are normally present in the felines at harmless levels.
The canine distemper virus had suppressed the immune systems of the lions, which was already challenged by the high level of blood parasites — a sort of one-two punch. The tick-borne disease thus reached fatally high levels, leading to mass die-offs of lions. The poor condition of survivors of the 1994 and 2001 epidemics also turned out to be due to very high levels of blood parasites.
It was known that global warming and climate change can alter or expand the range of germs, but now we also know that it could "dramatically alter the normal balance between hosts, their parasites and the pathogens those ticks transmit in the same ecosystem where these relationships have been in balance for years," Munson said.
The number of lions analyzed in the Serengeti in 1994 dropped by more than a third after the double infection. Similar losses occurred in Ngorongoro Crater in 2001.
"This is a good example of how extreme variations in climate can lead to disease outbreaks," said Princeton University ecologist Andrew Dobson, who did not participate in this study. "We'll have to look for more and more examples of this as climate gets more variable."
Co-infections may lie at the heart of many of the most serious die-offs in nature, Packer said. Dobson added, "It's likely going on all the time — there just aren't enough people doing this kind of long-term study to see it."
Another place to look for the potential impact of co-infections would be colony collapse disorder in honeybees, he added. This mysterious ailment is claiming the lives of an alarming amount of the bees that help pollinate dozens of key flowering crops, such as apples and citrus fruit.
"There is a strong suspicion that colony collapse disorder is caused by co-infection of multiple disease agents, but more research is needed to nail it down," Packer told LiveScience.
The lion populations recovered quickly, within years of each of the two big die-offs. However, most climate change models predict an increase in droughts in East Africa, so the lions' ability to rebound might increasingly get challenged.
"The next step would be to try to minimize ticks on the lions during the next drought to see if tick removal protected the lions from mortality in case of a co-incident outbreak of distemper," Packer said. Munson, Packer and colleagues detailed their findings in the June 25 issue of the journal PLoS

A patient’s explanation as to why patients in ICU get infections

This patient – a programme officer in Aakashawani- was in ICU for a month and after three weeks when the patient was about to be released… got Pneumonia.

• Doctors and Nurses don’t wash hands every time they touch one patient after another. The same was true about tools like stethoscope, spatula etc.
• The pots for stool and urine are not cleaned completely and properly every time.
• For doing suction every time a new tube should be used. Relatives of the patients spend money and purchase new tubes but still the new tubes are swindled by staff and the old tube is used repeatedly. Not only this, the old tube is kept in the tray near by just like that.
• Doctors and nurses used the same hand gloves repeatedly in spite of patients relative providing new gloves time and again.
• The ICU has air-conditioning, which re-circulates the same air without purification.
  After fortunately coming out all this, the patient felt "God is great" and so most of the patients are coming out of ICU without complications and fatality.
  (Sakal weekly: Diwali issue, 2007)

How Do Tomatoes Get Salmonella? From poop to produce.
By Ryan Hagen in Slate
Federal health officials are still trying to pinpoint the source of the salmonella-tainted tomatoes that sickened at least 167 people in 17 states since April and claimed the life of a Texas cancer patient. How can salmonella, a bacterium that normally lives inside animal intestines, get on your tomatoes?
Manure, runoff, and wild animals. Livestock animals, especially when kept in large numbers in confined spaces, can contract salmonella and carry the bug without showing any symptoms at all. Infected cows, pigs, and chickens shed the bacteria in their waste, which is sometimes used to fertilize nearby fields. The heat generated when manure is composted kills off most, but not all, disease-causing bacteria.
Contaminated water supplies can also put salmonella on your tomatoes. Runoff from livestock pastures, or from leaky or overtopped waste lagoons at industrial farming sites, can dirty streams, groundwater, and other bodies of water farmers draw on for irrigation. According to an FDA investigation, that was the likely cause of a 2002 salmonella outbreak in imported Mexican cantaloupes.
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Since salmonella can infect anything with an intestinal tract, wild animals can spread the bacteria onto crops through their own droppings or from fecal matter they track in from elsewhere. The 2006 outbreak of E. coli in spinach, for example, was traced to a pack of wandering wild boars. The swine had picked up tainted cow manure on their hooves before breaking through the fence of a nearby spinach field to graze.
Producers do rinse their harvest with chlorinated water to remove most of the harmful bacteria, but enough can be left to make you sick. If the skin of a tomato is punctured when the fruit is picked from the vine or when presliced for sale in a supermarket or restaurant, then bacteria get inside, and no amount of washing will make it safe to eat. This is partly why on-the-vine tomatoes have been exempt from this most recent salmonella scare.
Salmonella and E. coli poisoning used to be primarily associated with the consumption of undercooked meat. But that's changing, as produce-related outbreaks become more common and more widely publicized. In 1999, produce was responsible for 40 separate food poisoning incidents in the United States. In 2004, that number climbed to 86. There have been 13 major outbreaks involving tomatoes alone since 1990.
Why the shift? One factor is a lack of inspections of farms and packing plants by the Food and Drug Administration, which means that more contaminated produce slips into the market undetected. The U.S. Department of Agriculture inspects every meatpacking plant in the country each day, keeping close tabs on safety conditions. By contrast, the Food and Drug Administration, which is charged with regulating produce, might inspect a vegetable packing facility once a year, and the number of inspections is shrinking. In 1972, the FDA inspected 50,000 farms and plants. By 2006, that number had dwindled to 10,000. Meanwhile, having increasingly centralized packing plants means that crops from a single contaminated field can mingle with clean produce and be shipped across a wider swath of the country than ever before.

Scientists 'on brink of cure' for superbug

Simple procedure of placing a gel inside the nose could provide 'major breakthrough' within three years in hospitals' battle against MRSA http://www.independent.co.uk/news/science/scientists-on-brink-of-cure-for-superbug-830345.html

National/regional guidelines for antibiotic resistance

Ameet Bhuvan from Vellore has informed about this article
Need for national/regional guidelines and policies in India to combat antibiotic resistance
Lakshmi V Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad - 500 082, Andhra Pradesh India
http://www.ijmm.org/article.asp?issn=0255-0857;year=2008;volume=26;issue=2;spage=105;epage=107;aulast=Lakshmi

MRSA: The cure

New drug undergoing human trials offers hope of breakthrough. Gel placed in the nose could beat superbug that kills 1,600 every year
http://www.independent.co.uk/news/science/mrsa-the-cure-830341.html

Antibiotic usage-CME

Information from Dr. Radha Madhavan
A CME programme is being organized with lectures and plans of actions against emergence of drug resistance at SRM Medical College Hospital and research center at Kattankulathur, Kanchipuram District Tamilnadu 603203, on behalf of association of Microbiologists of Tamilnadu and pondicherry chapter by the middle of September 2008.
(Dr. Radha Madhavan, Proffesor of HCD, Dept of Microbiology, SRM MCH ARC,
Kattankuathar, Chennai. radhamadhavan77@gmail.com)

Gut superbug causing more illnesses and deaths

The number of people hospitalized with a dangerous intestinal superbug Clostridium difficile has been growing by more than 10,000 cases a year in US according to a new study. Resistant to some antibiotics, it has become a regular menace in hospitals and nursing homes. A recent study found it played a role in nearly 300,000 hospitalizations in 2005, more than double the number in 2000.
The infection, Clostridium difficile, is found in the colon and can cause diarrhea and a more serious intestinal condition known as colitis. It is spread by spores in feces. But the spores are difficult to kill with most conventional household cleaners or antibacterial soap.
C-diff, as it's known, has grown resistant to certain antibiotics that work against other colon bacteria. The result: When patients take those antibiotics, competing bacteria die off and C-diff explodes.
It is opined that one of the causes of the resistance development could be overuse and inappropriate use of antibiotics.
See http://www.cdc.gov/eid/content/14/6/929.htm

Dear Dr Tamhankar,
It is really wonderful that you have put the web page.
I will send the report of the meeting with civil society on Rational Use of Drugs which included Rational Use of Antibiotics. As part of Women's Health activities, specially addressing Maternal Mortality, Rational Use of Antibiotics in dealing with sepsis & also Malaria etc was dealt with. National Commission of Women organized a consultation on Draft National Policy for women in Agriculture. I made the public health inputs which amongst other things included communicable diseases eg Malaria in Assam, Chattisgarh, where incidentally there has been shortage of chloroquin & other health problems, injury, infections, fungal diseases etc. & the need for Rational use of Antibiotics & the problem of emergence of antibiotic Resistance. Since Chairpersons of State Commission of Women were there the concern has been introduced, & will be followed up.
Dr. Mira Shiva, IHES/AIDAN/IPHC (South Asia)