geoffrey modest medical blogs

Following on the last blog on  colistin - resistant  E coli, Paul Susman sent me the link  http://www.coha.org/ super - bacteria-in-rio-de-janeiros- olympic-arenas/   on the increasing spread of   Klebsiella pneumoniae  carbapenemase (KPC)-producing bacteria ​, which has been around for many years. A 2011 article (Arnold RS, South Med J 2011; 104: 45) noted at that time that  this difficult-to-treat  organism, associated with significant morbidity and mortality, had already spread from the northeastern US to most of the world.  The CDC commented that 50% of patients infected with this organism will die from it. The current link references the upcoming Olympics in Brazil, noting:​ --KPC is found off the beaches in Rio, where rowing, canoeing and swimming events will take place (ie, the swimmers, sailors and rowers will be exposed). The source is likely sewage contamination of the waterways --10 samples were taken from five differen...

Following on the last blog on colistin-resistant E coli, Paul Susman sent me the link  http://www.coha.org/super-bacteria-in-rio-de-janeiros-olympic-arenas/   on the increasing spread of   Klebsiella pneumoniae  carbapenemase (KPC)-producing bacteria ​, which has been around for many years. A 2011 article (Arnold RS, South Med J 2011; 104: 45) noted at that time that  this difficult-to-treat  organism, associated with significant morbidity and mortality, had already spread from the northeastern US to most of the world.  The CDC commented that 50% of patients infected with this organism will die from it. The current link references the upcoming Olympics in Brazil, noting:​ --KPC is found off the beaches in Rio, where rowing, canoeing and swimming events will take place (ie, the swimmers, sailors and rowers will be exposed). The source is likely sewage contamination of the waterways --10 samples were taken from five different beaches (Copacab...

an article was sent by burak alsan, from an interview with his wife marcie alsan (see  http://blogs.plos.org/publichealth/2016/05/31/to-fight-superbugs-fight-poverty/). ​ she stresses the connection between socioeconomic disparities and infectious diseases, specifically noting that "out of pocket payments were the most significant correlate of antimicrobial resistance across countries" and that "the entire correlation was driven by countries that had in place a policy by which copayments were imposed in the public sector". In particular, she found that of 47 countries, out-of-pocket health expenditures were the  only factor  significantly associated with antibiotic resistance, controlling for socioeconomic and environmental factors (eg sanitation, animal husbandry, and poverty) and structural health-care features (eg physician density, hospital bed density, total health expenditures). in particular, a "ten point increase in percentage...

not-so-shockingly, the US government reported the first case of a patient in the US with colistin-resistant e. coli, in a 49 yo Pennsylvania woman with a urinary tract infection. they found a plasmid-mediated piece of DNA which passed along the mcr-1 gene, conferring colistin resistance (see  http://www.reuters.com/article/us-health-superbug-idUSKCN0YH2KT  . for the case study, see  antibiotic resistance colistin PA antimicagents2016  in dropbox, or doi:10.1128/AAC.01103-16). this is precisely the issue reported last year in China [see  http://gmodestmedblogs.blogspot.com/2015/11/troubling-microbiome-changes.html  . this blog looked at the initial report from China, noting that China is the world's largest producer of poultry and pig products and one of the largest veterinary users or colistin (aka polymixin E),  find ing this resistant bug in 16 samples from various sites: sputum, urine, ascitic fluid, bile... ]. since the Chinese...

Ciproflox acin ​-resistant e. coli are increasingly found worldwide and are capable of causing extraintestinal infections, especially urinary tract infections. A report in 2006 found that 1.5% of healthy Seattle children excreted cipro-resistant e coli in their stool, without prior fluoroquinolone exposure. A new study looked at 80 healthy children  and their mothers ​ who were part of the St Louis twin cohort, assessing stool samples from 2010-2013 semiannually from mothers, and monthly from their twins til age 2 yo and then bimonthly, analyzing for e coli resistance  (see  microbiome gut colonization resistant  ecoli   jinfectdis2015  in  dropbox , or  J Infect Dis. (2015)  212  (12):  1862-1868). results: --15 kids (19%) and 8 mothers (20%) excreted ciprofloxacin-resistant e coli at least once, and 11 of 23 colonized subjects had multiple and usually consecutive positive samples --overall 33% of 4...

A couple of recent studies have found very troubling microbial changes, one dealing with the effect of PPIs on the gut microbiome, the other with the evolution of a very serious development in antibiotic resistance. 1. I sent out a blog in December 2014 on use of PPIs (proton-pump inhibitors) and changes in the microbiome (see  http://gmodestmedblogs.blogspot.com/2014/11/gastric-acid-suppression-and-microbiome_23.html   ), which noted that gastric acid suppression (mostly with PPIs) in kids led to pretty profound changes in both the lung and gut microbiomes. Another study just came out looking at the PPI-associated gut microbiome changes in adults, which could predispose people to C. difficile infections (see   ppi microbiome gastro2015  in dropbox, or Gastroenterology 2015;149:883). details: --background: C diff infections happen more often in those on PPIs. There are data showing that increases in gut Enterococcaceae...

the US White House just released a report (see  https://www.cdc.gov/drugresistance/pdf/report-to-the-president-on-combating-antibiotic-resistance.pdf ) outlining a 5-point 5-year plan to  r educe and combat antimicrobial resistance, including plans to:         --improve surveillance efforts         --slow the emergence and spread of resistant bacteria         --develop rapid tests to identify and characterized resistant bacteria         --accelerate development of antibiotics and vaccines         --improve international collaboration specific targets include:         --c. difficile: reducing incidence of infection by 50% over 2011 estimates         --carbapenem-resistance Enterobacteri...