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May 26, 2015   Download print version

Improper antibiotic use often due to misdiagnosis

New platforms genetically 'barcode' tens of thousands of cells at once, potentially unlocking secrets of disease

Heath Affairs reports on antibiotic resistance

HLAC's new standards document available on website

Stress levels linked to risk of liver disease death, study shows

Men should be screened for osteoporosis, too

Army researchers look for permanent end to Ebola virus

Major donations bolster hospital, medical research



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Self Study Series:
June 2015

Control of CRE transmissions and the use of Ethylene Oxide Sterilization

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Improper antibiotic use often due to misdiagnosis

Misdiagnosis often leads to improper antibiotic use in hospitals, new research finds. Incorrect antibiotic use can cause patient harm, reduce the effectiveness of antibiotics and increase healthcare costs, the researchers noted.

"Antibiotic therapies are used for approximately 56 percent of inpatients in U.S. hospitals, but are found to be inappropriate in nearly half of these cases, and many of these failures are connected with inaccurate diagnoses," study author Dr. Greg Filice said in a news release from the Society for Healthcare Epidemiology of America.

Filice, an internist with the Minneapolis Veterans Affairs Health Care System, and his colleagues analyzed 500 inpatient cases at the Minneapolis VA Medical Center. They found that inappropriate use of antibiotics occurred with 95 percent of patients who received an incorrect or indeterminate diagnosis, or those with an identified symptom but no diagnosis.

By comparison, incorrect use of antibiotics occurred in 38 percent of patients who received a correct diagnosis. Overall, only 58 percent of patients received a correct diagnosis, researchers found. The most common misdiagnoses were pneumonia, cystitis, urinary tract infections, kidney infections and urosepsis (when an infection starts in the urinary tract and spreads to the bloodstream).

The findings suggest that programs overseeing antibiotic use in hospitals would be more effective if designed to help providers make accurate initial diagnoses and to know when antibiotics can be safely withheld, Filice said.

The researchers said relying on intuition rather than proper analysis contributed to incorrect diagnoses and inappropriate use of antibiotics at hospitals. Other contributing factors on the part of staff: fatigue, sleep deprivation, mental overload, dealing with patients with a previous diagnosis from another healthcare provider, lack of clinical experience, and lack of experience with drug side effects.

The study was published online May 18 in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. (HealthDay) Visit NIH for the study.



New platforms genetically 'barcode' tens of thousands of cells at once, potentially unlocking secrets of disease

If someone handed you a smoothie and asked you to determine every ingredient that went into it the feat would be difficult because all of the ingredients would be combined to create on flavor, Harvard Medical School reported. To continue the example (in a bit of a gross way), imagine the smoothie was made up of 20,000 ground up brain cells. Tests could be run to determine what cells were present in the smoothie, but their origins would be more difficult to determine, leaving you with only a general cell profile of the sample. A similar scenario is true for human tissue because he cell averages of these samples don't paint the whole picture.

"If you take a hunk of tissue and grind it up and analyze the RNA, you have no idea if it represents what every cell in that population is doing or what no cell in the population is doing," said Marc Kirschner, the John Franklin Enders University Professor of Systems Biology and chair of the Department of Systems Biology at Harvard Medical School. "Imagine if you had a population of men and women. If you assume everyone is an average of men and women, you [probably] wouldn't represent a single person in that population."

These tissues now must be characterized cell-by-cell, or at least by cell type, which is time consuming and often costly. To remedy this, scientists have developed high-throughput techniques that give each cell an individualized "genetic barcode," this allows them to analyze complex tissue by profiling each cell instead of averaging the entire population.

The researchers hope these new innovations will allow researchers to discover new cell types, and even create maps of cell diversity in tissues like the brain, leading to a better understanding of genetic disease.

The findings were published in a recent edition of the journal Cell

Visit Harvard for the study.



Heath Affairs reports on antibiotic resistance

Many of the world's diseases are caused by microorganisms such as bacteria, fungi, viruses, and parasites. While there are a number of drugs designed to treat these infections, resistant strains are emerging at a rate that is currently outpacing the development of effective new drugs. Methicillin-resistant Staphylococcus aureus (MRSA) alone kills more than 19,000 Americans every year--more than emphysema, HIV/AIDS, Parkinson's disease, and homicide combined. Despite this public health need, pharmaceutical companies do not have strong economic incentives to develop new antibiotic drugs.

Unless new drugs are developed--together with measures taken to slow the emergence of new drug-resistant microbes--previously treatable infections will become major public health concerns, posing grave threats to infected individuals and increasing the risk of spreading to others. In recent years, several global and national public health organizations have highlighted the growing number of multidrug-resistant microbes as a major public health priority.

The commonly used term "antimicrobial resistance" applies to any microbe--bacteria, fungus, or virus--against which drugs have declining, limited, or zero effectiveness. This policy brief primarily focuses on the diminishing effectiveness of many drugs specifically in fighting bacteria, referred to here as "antibiotic resistance."

With so many agencies involved in the regulation and use of antibiotics, comprehensive solutions must focus on creating a coordinated plan that touches on aspects of research and development as well as enhanced infection prevention and control, and stewardship to ensure the proper use of these drugs across different settings.

This brief provides an overview of antibiotic resistance, including a summary of its current impact, the factors that contribute to its spread, and the policy recommendations put in place by federal and global public health agencies. It also reviews the debate around the regulation of antibiotic use in agriculture and examines new developments in policy and research associated with multidrug-resistant bacterial diseases and their underlying causes.

There are several potential directions for new antimicrobial drug research and development. Better diagnostic tools could affect the way antibiotic resistance is detected, diagnosed, and reported. More rapid tests could help to prevent overprescription of antibiotics and assist with global surveillance measures already emerging as a result of policy goals.

There are also potential developments for new drugs. Researchers at Northeastern University recently published a paper in Nature about a potential new antibiotic called teixobactin that targets polymers that build the bacterial cell wall. The drug's pathway--examined in mice but not yet in humans--is similar to vancomycin, another antibiotic often used as a last-resort treatment for resistant strains of bacteria such as MRSA. In their paper, the researchers highlighted how the technology used for this discovery might help lead to additional drug discoveries.

While it is tempting to assume that a potential new human antibiotic means that the pharmaceutical industry's interest in developing new antibacterial drugs will spring back into gear, it's important to consider that the failure rate for antibiotics from early discovery stage to actual drug approval is 97 percent. In general, new antibiotics are less profitable compared to other types of drugs, as their use is tightly controlled by hospitals trying to prevent the emergence of new resistant strains, and yet drug companies are not able to compensate for slow adoption by charging more because they'd have to compete with inexpensive generic antibiotics. In 2011, for example, Pfizer, one of the few drug companies to work on developing new antibiotics, closed its research lab in Connecticut.

For healthcare facilities, life science researchers, federal agencies, and local health officials to meet many of the specific goals outlined in the Obama administration's recent National Action Plan, they will require additional resources. To that end, President Obama's fiscal year 2016 budget proposes to nearly double the amount of federal funding for combating and preventing antibiotic resistance to more than $1.2 billion. Congress, however, is unlikely to support and enact the president's full budget request. Visit Health Affairs for the full report.



HLAC's new standards document available on website

Healthcare Laundry Accreditation Council (HLAC) document, "Accreditation Standards for Processing Reusable Textiles for Use in Healthcare Facilities - 2016 Edition," is now available for viewing and downloading at The new Standards go into effect January 1, 2016.

The 60+ page document comes after a lengthy and thorough review by HLAC's board of directors and public comment from professionals who serve the healthcare industry or use or process healthcare textiles, according to HLAC board president Gregory Gicewicz.

"With the 2016 revision, HLAC continues to promote a heightened awareness and increased understanding of the infection prevention and safety culture among healthcare laundry personnel," Gicewicz said.

The newly revised Standards document recently received the Association of periOperative Registered Nurses (AORN) AORN Seal of Recognition. The AORN Seal of Recognition confirms that the content of the document has undergone thorough review by AORN and meets the guidelines of the "AORN Perioperative Standards and Recommended Practices."

The HLAC Accreditation Standards are established as the minimum acceptable practice for the preparation of hygienically clean, reusable healthcare textiles for patient care, implemented and executed by accredited laundry facilities processing reusable healthcare textiles. The document covers the complete textile processing cycle: from handling and transporting to laundering and finishing to customer service. Special attention has been directed to laundry processes directly related to patient safety and OSHA required practices, including Bloodborne Pathogen Exposure Control Standards. Visit HLAC for the new standards.



Stress levels linked to risk of liver disease death, study shows

Suffering from anxiety or depression could carry an increased risk of death from liver disease, a study suggests. The study is the first to identify a possible link between high levels of psychological distress and deaths resulting from a variety of liver diseases.

Reasons for this are unclear as the biological links between psychological distress and liver disease are not well understood, researchers say.

Previous research suggests mental distress can put people at increased risk of cardiovascular disease. At the same time, risk factors for cardiovascular disease - such as obesity and raised blood pressure - have been linked to a common form of liver disease, known as non-alcoholic fatty liver disease.

In a similar way, suffering from anxiety and depression may be indirectly linked to an increased risk of death from liver disease, the team says.

Dr Tom Russ, of the University of Edinburgh's Centre for Clinical Brain Sciences, who led the research, said: "This study provides further evidence for the important links between mind and body, and of the damaging effects psychological distress can have on physical wellbeing. While we are not able to confirm direct cause and effect, this study does provide evidence that requires further consideration in future studies."

Adapted by MNT from original media release.



Men should be screened for osteoporosis, too

Men are far less likely than women to be screened for osteoporosis, even though they are more likely to suffer worse consequences from the bone-thinning condition, a new study finds.

Up to 2 million American men have osteoporosis, and another 8 million to 13 million men have low bone density, a precursor to osteoporosis, the researchers said.

While most women in the study said they would accept osteoporosis screening if it was offered, only 25 percent of men said they would get screened. Women were also over four times more likely than men to take measures to prevent osteoporosis, such as taking calcium and vitamin D supplements to strengthen their bones.

"We were surprised at how big a difference we found between men and women regarding osteoporosis," study author Dr. Irina Dashkova, a geriatric fellow at North Shore-LIJ Health System in New Hyde Park, NY, said in a health system news release.

"The fact that longevity is increasing in our population is wonderful. But we know from research that when men suffer fractures, their mortality is higher than in women and that severe medical consequences and loss of independence are much more prevalent in men," she said.

"In our environment, you just get this perception that osteoporosis is a women's problem. This has to be changed, and the sooner the better," Dashkova said in the news release.

The findings were to be presented Friday at the American Geriatrics Society annual meeting in Washington, D.C. Research presented at medical meetings should be viewed as preliminary until published in a peer-reviewed journal.

More than 10 million Americans have osteoporosis, and another 43 million have low bone density, according to the National Osteoporosis Foundation. Research suggests that 13 percent of white American men older than 50 will have at least one osteoporosis-related fracture in their lifetime.

Certain health problems and drugs that boost osteoporosis risk are specific to men, including some prostate cancer drugs, the researchers pointed out.

Dr. Gisele Wolf-Klein, program director for the geriatric fellowship at North Shore-LIJ, was a mentoring author and collaborated with Dashkova on the research. "Our survey clearly establishes that physicians are just not thinking of screening men. It's only when older men fall and break their hip that someone thinks maybe we should do something to prevent them breaking the other hip," Wolf-Klein said in the news release. Visit Web MD for the report.



Army researchers look for permanent end to Ebola virus

The U.S. Army Edgewood Chemical Biological Center, or ECBC, and the U.S. Army Medical Research Institute of Infectious Diseases, or USAMRIID, are partnering to help expedite progress in the global fight against Ebola. 

ECBC is working with USAMRIID on two critical studies - a vaccine study and a biomarker study - that will advance the global fight against Ebola. This disease has a high death rate - to date, there have been 22,000 cases and 9,000 deaths attributed to the most recent outbreak - with no known cure or effective vaccine. ECBC and USAMRIID are trying to change that. 

USAMRIID, the Department of Defense's lead laboratory for medical biological defense research, called upon the ECBC-US Army Medical Research Institute of Chemical Defense Mass Spectrometry Core Facility to assist with two of its ongoing Ebola research programs - characterizing a potential vaccine and identifying biomarkers of infection. 

For the vaccine work, ECBC is analyzing several different vaccine preparations provided by USAMRIID to quantify VP40 and glycoprotein concentrations expressed in virus-like particles generated from Ebola (strains Zaire and Sudan). The aim is to monitor quality control of the vaccine production process and to determine if a correlation can be made between protective immunity and the amount of Ebola-specific structural proteins, GP and VP40, that are present. This type of research is foundational in creating a long-term solution to a devastating disease. 

"Our role was to blindly and independently quantitate the amount of protein present in each vaccine combination. With this information, we hope to better understand the varying degrees of protection observed during the vaccine study," said Trevor Glaros, an ECBC mass spectrometry core facility manager leading the ECBC/USAMRIID Ebola collaboration. 

In addition to vaccine research, ECBC is also supporting USAMRIID to discover Ebola-specific biomarkers in serum. The scientists will analyze Ebola-infected serum to discover a protein-based panel of biomarkers. 

"The hope is that this panel of biomarkers will constitute a unique fingerprint for Ebola infection, which can be used to diagnose patients before symptoms develop," stated Lisa Cazares, the USAMRIID researcher leading the project. A tool like this would give first responders the ability to administer the appropriate care and the unprecedented ability to track the disease outbreak in real time. Biological analysis of this scope required additional instrumentation, which ECBC was able to secure from its partner, Thermo Fisher Scientific. 

Thermo Fisher Scientific generously loaned ECBC a complete Q Exactive Plus mass spectrometry system with a Dynex nanoflow liquid chromatography pump and autosampler. This new equipment relieves the burden on existing instrumentation and, given its technological advancements, allows for a more rapid and thorough analysis. Visit the U.S. Army for the report.



Major donations bolster hospital, medical research

A stretch of the Upper East Side of Manhattan will be transformed into even more of an international hub for hospitals and medical research with a total of $250 million in separate donations from the industrialist David H. Koch and the financier Henry R. Kravis and his wife, Marie-Josée Kravis.

Memorial Sloan Kettering Cancer Center will announce a $150 million gift from Koch, the billionaire executive vice president of Wichita, KS, based Koch Industries. His donation will fund the construction of a $1.3 billion, 750,000-square-foot, 23-story outpatient cancer center to be built on East 74th Street and FDR Drive. The center, which will be named for Koch, is expected to serve some 1,300 patients daily.

Also, Rockefeller University plans to announce a $100 million gift from the Kravis foundation to build a laboratory research building that will be the centerpiece of a 2-acre campus extension over FDR Drive from East 64th to East 68th. That building, which is to be named for the couple, will be two stories high and span three city blocks.

Though Koch, 75 years old, has given away some $1.3 billion to charity, the gift to Memorial Sloan Kettering is his largest single donation. When asked in an interview if he was worried about having to outdo himself in the future, he laughed.

The new facility will provide radiology, chemotherapy and outpatient bone-marrow transplants, and concentrate on lung, skin, head and neck, and hematological cancers. Each one of those cancers types will have its own mini-center within the Koch building, but those individual areas have yet to be named with gifts.

The new laboratory facilities, which will be used for a variety of biological sciences, will replace current labs that date back to the 1950s, said Marc Tessier-Lavigne, the president of Rockefeller University. Visit the Wall Street Journal for the story.