Posts Tagged ‘infectious diseases’
RTP panels address rogues gallery of multidrug-resistant bacteria
Tuesday, March 1, 2011, 2:29 pm No Comments | Post a CommentHow to prevent bacterial infections associated with poor hygiene in hospitals, nursing homes and day care centers has become a necessary though rarely pleasant topic for healthcare providers.
Source: Centers for Disease Control and Prevention
Every year, an estimated 5 percent of all hospitalized Americans, or about 1.7 million, are treated for a healthcare-associated infection. About 90,000 of them die, according to numbers reported by the Centers for Disease Control and Prevention. The infections are caused by multiple bacteria that can be traced back to healthcare settings and 14 percent involve a superbug, methicillin-resistant staphylococcus aureus or MRSA.
After rising rapidly in the 1990s, the number of MRSA cases began to decrease in the past decade, but following in MRSA’s footsteps are superbug wannabes such as floroquinolone-resistant pseudomonas aeruginosa (FQRP), vancomycin-resistant enterococci (VRE) and clostridium difficile, a bacterium that wreaks havoc after antibiotics wipe out healthy gut flora.
Staphylococcus aureus
Efforts to reduce healthcare-associated infections received boosts in the past few years.
In 2008, the Centers for Medicare and Medicaid Services stopped paying hospitals for infections they considered “serious complications that should never occur in a hospital” and private health insurers began to follow suit. The following year, the federal stimulus bill provided states with about $50 million to establish surveillance and prevention programs.
North Carolina’s state plan to monitor and prevent healthcare-associated infections, which took effect in January and relies on voluntary reporting, is such a program.
“It’s not inevitable that you go into the [intensive care unit] and you get a [central line-associated] bloodstream infection,” said Dr. Megan Davies, chief of the N.C. Division of Public Health’s epidemiology section.
Davies was one of five infectious disease experts in the Research Triangle who addressed healthcare-associated infections and the rogues gallery of multi-drug resistant bacteria. The Feb. 22 panel discussion was put together by Duke University and Becton Dickinson, a New Jersey-based medical instruments company whose corporate innovation center is in Research Triangle Park.
Enterococci faecium
Healthcare-associated infections add an estimated $28 billion to $33 billion in national healthcare costs every year, according to a report the CDC published in 2009.
Avoidable infections can enter the body at a surgical site or through a catheter, a ventilator or a central line used to supply medication, blood and fluids directly into the bloodstream.
In North Carolina, large programs to collect infection data and improve infection control have existed since 1997: the Statewide Program for Infection Control and Epidemiology, or SPICE, at the University of North Carolina School of Medicine and the Duke Infection Control Outreach Network, or DICON, that linked the Duke University School of Medicine and 39 community hospitals.
Central line-associated bloodstream infections and cases involving MRSA have decreased in the past decade due to efforts by SPICE and DICON.
But direct costs from dealing with healthcare-associated infections statewide are estimated to still exceed $280 million per year, according to the N.C. Department of Health and Human Services.
Innovations to prevent these infections such as special cleaning and medical supplies exist, said William Rutala, director of SPICE and one of the five infectious disease experts on the panel. But better compliance with more basic prevention tools such a hand hygiene would be an important first step.
Only an average 40 percent of healthcare workers washed their hands in accordance with CDC guidelines, studies conducted in the 1990s showed. And other studies show that only about one-third of the surfaces at high risk of harboring infectious bacteria in hospital rooms were thoroughly cleaned before new patients came in, Rutala said.
Fewer and fewer new antibiotics to battle the multi-drug resistant bacteria is yet another problem, said Dr. David Weber, associate chief of staff at UNC Health Care who was another infectious disease expert on the panel.
Years of antibiotic overuse and patients cutting short antibiotic treatments are driving forces behind the rogues gallery - not only in healthcare settings but maybe also in livestock farming.
About two-thirds of the MRSA central-line bloodstream infections in hospitals involve bacteria that came from outside the hospital but whose origin isn’t clear, according to Dr. Vance Fowler, an infectious disease specialist at Duke University.
Antibiotics are used extensively to promote growth in livestock farming, said Jorge Ferreira, a graduate student at the N.C. state University College of Veterinary Medicine. Daily use of antibiotics is also normal in dairy cows.
Fowler and Ferreira are collaborating on research to find out more about MRSA and whether the superbug is transmitted from animals to humans. They presented some of their findings as part of a panel discussion at the N.C. Biotechnology Center in RTP, a few hours after the infectious disease panel met in Durham.
So far, Ferreira reported, MRSA strains have been found in pigs, cows, dogs, cats and even hamsters.
Global health: What’s in it for the Research Triangle?
Wednesday, February 16, 2011, 5:25 pm No Comments | Post a CommentTravel can spread diseases as seafaring Europeans proved about 500 years ago, delivering smallpox, influenza and the bubonic plague to the Americas and in return bringing syphilis back with them to Europe.
So it shouldn’t come as a surprise that a biotech hot spot like North Carolina’s Research Triangle, where scientists are taking aim at diseases like HIV/AIDS, diabetes and cancer, is also a hub for global health research - an emerging academic discipline that has gained significance as international travel, trade and finance have picked up.
North Carolina’s global health sector supports at least 7,000 jobs, according to a Duke University study that was based on 2007 data and published last year. The sector generates more than $500 million in annual salaries and wages and more than $18 million in annual tax revenue. Most of the jobs are in the Triangle, home to three large universities, multiple research institutes and nonprofits dedicated to boost health and health care and hundreds of businesses involved in research and development.
Cover of the North Carolina Medical Journal's latest issue.
The accumulation of brainpower makes the Research Triangle one of the few places in the U.S. where emerging diseases will be researched, medicines to treat them will be developed and programs to improve people’s wellbeing at home and abroad will be established.
“Global health involves highly interdisciplinary and interconnected areas that include human and animal health, medicine, law, engineering, economics, environmental science, agriculture and the social and biological sciences,” as four Duke researchers write in the North Carolina Medical Journal’s latest issue.
Their point of view is part of the NCMJ’s global health forum, which takes up much of the issue.
More than two dozen contributors, including nurses, doctors, community advocates, economists, a veterinarian, a lawyer and a pharmacist, explore what role North Carolina health care professionals and institutions play in global health and the benefits the state is reaping in return.
The forum’s premise follows much the same lessons we learned from the seafaring Europeans: Global health oftentimes is local health.
Today, HIV/AIDS has replaced the bubonic plague. Air travel spreads new influenza strains like H1N1. An obesity epidemic is threatening a rise in diabetes worldwide. Rising temperatures, an effect of global warming, are changing not only growing conditions for plants but also living conditions for animals that carry diseases.
North Carolina is feeling the effects of all these global developments:
- The number of people living with HIV/AIDS in North Carolina and in the Raleigh-Cary area is higher than the national average, according to the U.S. Centers for Disease Control and Prevention.
- Children ages 10 to 17 in North Carolina are among the most obese in the U.S., according to a 2009 report of the N.C. Department of Health and Human Services.
- Chronic disease and infant mortality rates in some eastern North Carolina are comparable to those in developing countries such as Malaysia, Thailand and Nicaragua, according to figures of the N.C. State Center for Health Statistics. The eastern part of the state also faces a particular shortage of health workers.
- North Carolina is getting warmer from the beaches through the Piedmont and across the mountains, according to the Arbor Day Foundation. Since 1990, much of North Carolina has switched from a zone where plants must survive temperatures as low as 0 degrees Fahrenheit to a zone where temperatures don’t dip below 10 degrees Fahrenheit. North Carolina has a long history of tick-borne diseases and research has shown milder winters increase tick-borne encephalitis among humans.
But North Carolina also stands to benefit from the work done in the Research Triangle to address global health issues:
- Researchers at the University of North Carolina at Chapel Hill and Family Health International, a Durham nonprofit, helped test a vaginal gel that contained 1 percent of the Gilead HIV/AIDS drug tenofovir. The test involved South African women and demonstrated that the gel reduced the risk of an HIV infection by up to 59 percent, according to results first published last year.
- RTI International, a research institute in Research Triangle Park, has developed a behavioral program to reduce the likelihood that at-risk women will get infected with HIV. The program is recognized by the CDC and implemented globally and locally.
- The UNC-CH chapter of Engineers without Borders has been involved in improving water quality in communities in Eastern Europe, Latin America and just outside Chapel Hill. Tests in a historically black neighborhood that borders the Orange County landfill showed that nine of 11 wells did not meet federal water quality standards.
- In 2009, UNC and CDC started a program in eastern North Carolina that used global models of mircofinance. It helps women start in business and provides health education.
- Nurses, physicians and dentists educated in India, the Philippines, Nigeria and Columbia are easing the health worker shortage in North Carolina. In the Research Triangle, about 15 percent percent of the physicians, 5.8 percent of nurses and less than 1 percent of dentists were educated outside of the U.S., according to an analysis by a postdoctoral fellow in the UNC School of Nursing that was based on unpublished data from the 2008 North Carolina Professions Data System.
Read all of the contributions to the NCMJ’s global health forum here.
Read here why in 2009 the Research Triangle was the first stop in the U.S. global health revamp.
Disease and prejudice
Wednesday, November 3, 2010, 10:26 pm No Comments | Post a CommentThe risk of catching an infectious disease is high in India compared to the U.S. That’s a fact. So it’s no wonder when an American visiting India gets sick, right? Not so fast, says Mark Schaller.
Mark Schaller
The psychology professor at the University of British Columbia in Vancouver suggested Wednesday after his presentation at N.C. State University that coming down with diarrhea or a fever in India may have just as much to do with a visitor’s expectations and fears as with the country’s abundance of bacteria and viruses.
Schaller comes by his suggestion through researching the relationship of behavior and disease.
Neither a medical doctor nor an expert in the human immune system, he focuses on what he calls the behavioral immune system: Behaviors that evolved over time as defenses against pathogens, including hygiene rituals, cooking practices and cultural attitudes toward anything foreign. Read more…
RTP researchers help track diseases linked to climate change
Tuesday, April 27, 2010, 8:53 pm No Comments | Post a CommentDuke University researchers suspect climate change is a reason why a deadly new version of a tropical fungus is spreading in the temperate climate of the Pacific Northwest.
Cryptococcus gattii
In Africa, South America, Southeast Asia and Australia, crytococcus gattii infects eucalyptus trees and bothers people with compromised immune systems, such as HIV/AIDS patients and organ transplant recipients, who inhale its spores. But the strain that was first documented on Vancouver Island, Canada, a decade ago and has now spread to Seattle and Portland causes chest pain, fever, shortness of breath and weight loss in otherwise healthy people and has killed at least six of them.
In February 2007, the first North Carolina case, an otherwise healthy man, was treated at Duke University Medical Center, the Duke researchers reported in PLoS One. In a paper they published a week ago in PLoS Pathogen, the researchers wrote that the cryptococcus gattii strain in the Pacific Northwest was new, much more virulent and favored mammals.
