Deadly Fungus Spreads Through U.S. Healthcare Facilities

The number of cases of Candida auris (C. auris), a dangerous multidrug-resistant fungus, in the U.S. has grown from 7 to 122 over the past 9 months, the CDC says in its Morbidity and Mortality Weekly Report[1]

C. auris can cause severe illness and high mortality (60%), especially among patients who are in intensive-care units, those with a central venous catheter, and people who have received antibiotics or antifungal medications. [1] [2]

Sharon Tsay, lead author and an Epidemic Intelligence Service officer at the CDC, says:

“It seems to affect the sickest of the sick patients, particularly those in hospitals and nursing homes with other medical problems.” [1]

There have been 77 confirmed cases of C. auris in U.S. hospitals. Upon examining the patients’ close contacts, another 45 cases were identified, for a total of 122 U.S. patients with the fungal infection as of May 12. Among the original 77 patients, the patients’ average age was 70, and 55% were men.

Read: First Cases of Drug-Resistant Candida Auris Spreading in U.S. Hospitals

Of the 122 total cases, the majority were reported in healthcare facilities in New York, New Jersey, and Illinois. Most of the patients were chronically ill and spent long stretches at high-acuity skilled nursing facilities. [2]

According to the CDC:

“In Illinois, 3 cases were associated with the same long-term care facility. In New York and New Jersey, cases were identified in multiple acute care hospitals, but further investigation found most had overlapping stays at interconnected long-term care facilities and acute care hospitals within a limited geographic area. The case in Massachusetts was linked to the Illinois cases.”

The good news: none of the infections reported in the U.S. were resistant to all available antifungal drugs. However, according to Paige Armstrong, an Epidemic Intelligence Service officer for the CDC, the fungus is “acting a lot like some super bacteria that we’ve seen previously.” [1]

CDC analysis of the first 35 clinical isolates showed that 86% were resistant to fluconazole, 43% were resistant to amphotericin B, and 3% were resistant to echinocandins. [2]

Invasive candidiasis – when the yeast gets into the bloodstream – is the most dangerous type of fungal infection. But C. auris can also make its way into respiratory tract, urine, bile fluid and even bone, leaving doctors scratching their heads as to why the fungus seems to linger, and what other infections it might cause. [3]

Read: Deadly Fungal Infection a Growing Concern in U.S. Hospitals

Says Tsay:

“The fact that it has been found in other sites may also reflect its ability to persist on a patient’s body and be spread in the environment around them – one of (the) reasons that C. auris is causing outbreaks.”

The CDC is monitoring the situation. New York State Health Commissioner Howard Zucker said during a recent press conference:

“It is important for New Yorkers to understand C. auris poses no risk to the general public. We’re taking aggressive actions to contain its spread in hospitals and nursing homes.”

Sources:

[1] CNN

[2] Medscape

[3] Science Alert

CNN


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Superbugs may be More Widespread than Previously Thought

The potentially deadly, drug-resistant “superbug,” carbapenem-resistant Enterobacteriaceae (CRE), is more widespread in U.S. hospitals than previously thought, an earlier-released study has found. [1]

Researchers looked for cases of infections caused by CRE in a sample of 4 U.S. hospitals – 3 in the Boston area and 1 in California – and identified numerous varieties of the bacterium. [2]

Each year, CRE bacteria sicken about 9,300 people and claim the lives of 600 people in the United States, according to the CDC. Those numbers are climbing. CRE bacteria, in particular, have been called “nightmare bacteria” by CDC Director Tom Frieden because they often continue to thrive even in the face of “last-resort” antibiotics – drugs reserved for the toughest infections. [1]

Read: It’s Here – Bacteria Resistant to ALL Antibiotics Shows up in the U.S.

In the study, the researchers also found that CRE has a plethora of genetic traits that make it resistant to antibiotics, and these traits can be easily transferred between the many CRE species.

The study documented the identical gene in different species. William Hanage, associate professor of epidemiology at Harvard Chan School and senior author of the study, says that “the extent to which this has happened is really quite surprising,” He added that the team “found 2 cases of high-level resistance we could not explain.”

He compared it to dark matter: 

“We know it’s there because we can see its effects, but what’s actually making it happen at the moment is unknown. If I were to criticize my own work, I would say it is a shame that we weren’t able to get more hospitals and more samples from elsewhere within the health care systems.”

Based on the findings, the researchers believe that CRE is more common than previously thought, and that it may be transmitted from person to person without causing symptoms.

Source: CBC News

In fact, Dr. Alex Kallen, a medical officer in the CDC’s Division of Healthcare Quality Promotion, said “the most common source of transmission with CRE is asymptomatic.” For that reason, the team writes in Proceedings of the National Academy of Sciencesthere needs to be increased surveillance of CRE. [2]

A healthy person might be able to carry CRE (it resides in the gastrointestinal tract) without developing an infection. However, if the bacterium is transferred to someone with a compromised immune system, it can be deadly. [1] [2]

Hanage said:

“We often talk about the rising tide of antibiotic resistance in apocalyptic terms. But we should always remember that the people who are most at risk of these things would be at risk for any infection, because they are often among the frailer people in the health care system. [2]

While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease. We need to look harder for this unobserved transmission within our communities and health care facilities if we want to stamp it out. [1]

The best way to stop CRE making people sick is to prevent transmission in the first place. If it is right that we are missing a lot of transmission, then only focusing on cases of disease is like playing whack-a-mole; we can be sure the bacteria will pop up again somewhere else.”

On a related front, it has come to light that a Nevada woman in her 70’s died months ago from a CRE infection that none of the 26 antibiotics available in the United States would touch. Dr. James Johnson, a professor of infectious diseases at the University of Minnesota, said of the case:

“I think this is the harbinger of future badness to come.” [3]

Read: Antimicrobial Resistance Could be a “Bigger Threat Than Cancer by 2050”

Johnson added that it’s hard to believe nobody else in the country is carrying the same strain. He said that when people ask him “How close are we to the edge of the cliff?,” he tells them: “We’re already falling off the cliff.”

Last fall, a Reuters investigation revealed that thousands of U.S. deaths due to superbugs go unreported each year, because in many cases it is not indicated on death certificates.

Source:

[1] HealthDay

[2] CNN

[3] USA Today

CBC News


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Study Finds Pharma Reps Influence Doctor Prescription Decisions

Doctors at teaching hospitals are more likely to prescribe generic drugs over name-brand ones when pharmaceutical sales representatives are kept at bay, a study published in JAMA shows. [1]

By comparison, doctors working in hospitals that don’t keep pharma sales reps on a short leash – freely accepting meals and gifts, and letting reps have free reign of the hospital – prescribed far more name-brand medications.

In other words, pharma reps know how to sweet-talk docs into choosing significantly more expensive drugs over cheaper generics.

Findings of the Study

For the teaching hospital study, researchers looked at 19 centers in 5 states that restricted visits by drug reps by:

  • limiting access
  • limiting gifts
  • or punishing reps who broke the rules

The team compared prescriptions by 2,126 doctors at teaching hospitals with 24,593 of their peers with similar characteristics who did not limit reps’ access. The study also examined more than 16 million prescriptions in total, using data from CVS Caremark, a large pharmacy benefit manager.

In an editorial accompanying the study, Charles Ornstein, from ProPublica, writes:

“Understanding the financial relationships between physicians and the drug industry is only 1 window into prescribing habits. It is just as important, if not more so, to understand how prescribing practices of physicians compare with their peers. Most physicians generally are not aware if their drug choices are similar to other physicians in their fields; there has been no definition of what constitutes ‘normal’ prescribing.” [2]

Read: Pharma Companies Spend 19x More on Marketing Than Research

Significant changes were found in 6 of the 8 drug classes studied at 9 of the 19 hospitals reviewed. The policies were enacted at various times from 2006-2011. Changes in prescribing started immediately and lasted from 12 to 36 months afterward, however. This led to an increase of up to 10% in physicians favoring cheaper generics over more expensive, name-brand drugs – a small, but significant number. [1] [3]

One thing the study didn’t examine was whether generic drugs were the more medically-sound approach. Privacy laws made it impossible to study that aspect. [3]

Furthermore, the fact that changes were found in 6 of the 8 drug classes does not prove that physicians made better choices without pharma reps influencing them, though it does appear that was the case.

Study leaders Ian Larkin and George Loewenstein, both economists, suggest that healthcare providers go the route taken by hospitals such as the Mayo Clinic, the Cleveland Clinic, and California’s Kaiser group, which pay their doctors straight salaries. This would create a conflict-free environment where patients don’t have to worry that their doctors making decisions about their health based on money or gifts. [4]

After all, the “do no harm” snippet from the Hippocratic Oath should include patients’ ability to afford their medicine.

Sources:

[1] ProPublica

[2] The JAMA Network

[3] Newsweek

[4] Slate


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