Vaccine and antibiotics stabilized (with silk proteins) so refrigeration is not needed — NIH study

English: Woman receiving rubella vaccination, School of Public Health of the State of Minas Gerais (ESP-MG), Brazil (Photo credit: Wikipedia)

From the 10 July 2012 EurekAlert

Could pave way for development of enhanced delivery and storage in third world, save billions in cost

Researchers funded by the National Institutes of Health have developed a new silk-based stabilizer that, in the laboratory, kept some vaccines and antibiotics stable up to temperatures of 140 degrees Fahrenheit. This provides a new avenue toward eliminating the need to keep some vaccines and antibiotics refrigerated, which could save billions of dollars every year and increase accessibility to third world populations.

Vaccines and antibiotics often need to be refrigerated to prevent alteration of their chemical structures; such alteration can result in less potent or ineffective medications. By immobilizing their bioactive molecules using silk protein matrices, researchers were able to protect and stabilize both live vaccines and antibiotics when stored at higher than recommended temperatures for periods far longer than recommended….

Related articles

• Vaccine and antibiotics stabilized so refrigeration is not needed – NIH study (nih.gov)
• New silk technology stabilizes vaccine and antibiotics so refrigeration is not needed (medicalxpress.com)
• Vaccine and antibiotics stabilized so refrigeration is not needed — NIH study (eurekalert.org)
• Stabilizer cuts need to refrigerate drugs (upi.com)
• Stabilization of vaccines and antibiotics in silk (nextbigfuture.com)
• Why Silk May Be Added To Vaccines Someday (wnyc.org)
• Silky scheme for vaccine storage without refrigeration (newscientist.com)
• Silky scheme for vaccine storage without refrigeration (newscientist.com)
• New silk technology preserves heat-sensitive drugs for months without refrigeration (biologynews.net)
• Silk Preserves Heat-Sensitive Drugs for Months without Refrigeration (blogs.voanews.com)

How algorithm driven medicine can affect patient care

How algorithm driven medicine can affect patient care

From the KevinMD article of  Mon Jan 30, 2012

 

Whenever someone is scheduled for an operation, the assigned nurse is required to fill out a “pre-op checklist” to ensure that all safety and quality metrics are being adhered to. Before the patient is allowed to be wheeled into the OR we make sure the surgical site is marked, the consents are signed, all necessary equipment is available, etc. One of the most important metrics involves the peri-operative administration of IV antibiotics. SCIP guidelines mandate that the prophylactic antibiotic is given within an hour of incision time to optimize outcomes. This has been drilled into the heads of physicians, health care providers, and ancillary staff to such an extent that it occasionally causes total brain shutdown.

Let me explain. For most elective surgeries I give a single dose of antibiotics just before I cut. For elective colon surgery, the antibiotics are continued for 24 hours post-op. This is accepted standard of care. You don’t want to give antibiotics inappropriately or continue them indefinitely.

But what about a patient with gangrenous cholecystitis or acute appendicitis? What if, in my clinical judgment, I want to start the patient on antibiotics right away (i.e. several hours before anticipated incision time) and then continue them for greater than 24 hours post-op, depending on what the clinical status warrants? I should be able to do that right?

Well, you’d be surprised. You see, at two different, unaffiliated hospitals I cover, the surgeons have seen that decision-making capability removed from their power….

Stinky frogs are a treasure trove of antibiotic substances

Some of the nastiest smelling creatures on Earth have skin that produces the greatest known variety of anti-bacterial substances that hold promise for becoming new weapons in the battle against antibiotic-resistant infections. (Credit: Image courtesy of American Chemical Society)

From the 30 November Science Daily news item

Some of the nastiest smelling creatures on Earth have skin that produces the greatest known variety of antibacterial substances that hold promise for becoming new weapons in the battle against antibiotic-resistant infections, scientists are reporting. Their research is on amphibians so smelly (like rotten fish, for instance) that scientists term them “odorous frogs.”..

Simple guidelines decreased unnecessary antibiotic use in Quebec, Canada

 

 

 

 

 

From the 26 July 2011 Eureka Alert

Antibiotic overuse and resistance have emerged as major threats during the past two decades. Following an outbreak of Clostridium difficile infections, which often result from antibiotic use, health care professionals in Quebec, Canada targeted physicians and pharmacists with an education campaign that reduced outpatient antibiotic use, according to a study published in Clinical Infectious Diseases and now available online.

The Quebec Minister of Health and the Quebec Medication Council collaborated with designated physicians and pharmacists to develop guidelines to improve prescribing practices. First issued in January 2005, the guidelines emphasized proper antibiotic use, including not prescribing antibiotics when viral infections were suspected and selecting the shortest possible duration of treatment. Approximately 30,000 printed copies of the original recommendations were distributed to all physicians and pharmacists in Quebec. An additional 193,500 copies were downloaded from the Medication Council’s website.

(The current versions of the guidelines are available online:
http://www.cdm.gouv.qc.ca/site/aid=166.phtml
.)

During the year after the guidelines were initially distributed, the number of outpatient antibiotic prescriptions in Quebec decreased 4.2 percent. In other Canadian provinces, the number of these prescriptions increased 6.5 percent during the same period.

According to study author Karl Weiss, MD, of the University of Montreal, “It is possible to decrease antibiotic consumption when physicians, pharmacists, state governments, etc., are working together for a common goal. This is the key to success: having everybody involved and speaking with a common voice.”

Dr. Weiss added, “Simple, short, easy-to-use guidelines have an impact on physicians when they are readily available. The web is an increasingly important tool to reach our audience and should now be used as such in the future. With handheld electronic devices available for all health care professionals, these downloadable guidelines can be accessed and used at any time and any circumstance.”

Related articles

• Superbug gonorrhoea found in Japan (newscientist.com)
• Drug-resistant STD prompts global warning (independent.co.uk)
• (Reuters) – Scientists have found a “superbug” strain of gonorrhea in Japan that is resistant to all recommended antibiotics and say it could transform a once easily treatable infection into a global public health threat. (theboldcorsicanflame.wordpress.com)

A drugstore within – Mesenchymal stem cells protect and heal

Mesenchymal stem cell

A drugstore within -Mesenchymal stem cells protect and heal

From the 7 July 2011 Eureka news alert

 

A stem cell that can morph into a number of different tissues is proving a natural protector, healer and antibiotic maker, researchers at Case Western Reserve University and their peers have found.

Mesenchymal stem cells reaped from bone marrow had been hailed as the key to growing new organs to replace those damaged or destroyed by violence or disease, but have failed to live up to the billing.

Instead, scientists who’d been trying to manipulate the cells to build replacement parts have been finding the cells are innately potent antidotes to a growing list of maladies.

The findings are summarized in the July 8 issue of Cell Stem Cell.

The cell, referred to as an MSC, “is a drugstore that functions at the local site of injury to provide all the medicine that site requires for its successful regeneration,” said Arnold Caplan, professor of biology at Case Western Reserve, and lead author of the paper.

Here’s how: (click here for rest of article)

Economics and evolution help scientists identify new strategy to control antibiotic resistance

Image via Wikipedia

Economics and evolution help scientists identify new strategy to control antibiotic resistance

From the March 18 2011 Science Daily news article

ScienceDaily (Mar. 20, 2011) — A team of scientists from the University of Oxford, U.K. have taken lessons from Adam Smith and Charles Darwin to devise a new strategy that could one day slow, possibly even prevent, the spread of drug-resistant bacteria. In a new research report published in the March 2011 issue of Genetics, [Abstract***]the scientists show that bacterial gene mutations that lead to drug resistance come at a biological cost not borne by nonresistant strains. They speculate that by altering the bacterial environment in such a way to make these costs too great to bear, drug-resistant strains would eventually be unable to compete with their nonresistant neighbors and die off.

“Bacteria have evolved resistance to every major class of antibiotics, and new antibiotics are being developed very slowly; prolonging the effectiveness of existing drugs is therefore crucial for our ability to treat infections,” said Alex Hall, Ph.D., a researcher involved in the work from the Department of Zoology at the University of Oxford. “Our study shows that concepts and tools from evolutionary biology and genetics can give us a boost in this area by identifying novel ways to control the spread of resistance.”

The research team measured the growth rates of resistant and susceptible Pseudomonas aeruginosa bacteria in a wide range of laboratory conditions. They found that the cost of antibiotic resistance has a cost to bacteria, and can be eliminated by adding chemical inhibitors of the enzyme responsible for resistance to the drug. Leveling the playing field increased the ability of resistant bacteria to compete effectively against sensitive strains in the absence of antibiotics. Given that the cost of drug resistance plays an important role in preventing the spread of resistant bacteria, manipulating the cost of resistance may make it possible to prevent resistant bacteria from persisting after the conclusion of antibiotic treatment. For instance, new additives or treatments could render antibiotic resistance more costly for bacteria, making it less likely that the resistant strains will persist at the end of treatment.

“If we’ve learned one thing about microscopic organisms over the past century, it’s that they evolve quickly, and that we can’t stop the process,” said Mark Johnston, Editor-in-Chief of the journal GENETICS. “This research turns this fact against the bacteria. This is an entirely new strategy for extending the useful life of antibiotics, and possibly for improving the potency of old ones.”

***For suggestions on how to get this article for free or at low cost click here

Related Articles

• Antibiotic resistance is not just genetic (sciencedaily.com)
• Pollution with antibiotics leads to resistant bacteria (physorg.com)
• Hospital infections: Unique antibody from llamas provide weapon against Clostridium difficile (ScienceDaily [news article])

Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice

Careful cleaning of children’s skin wounds key to healing, regardless of antibiotic choice
Hopkins Children’s study suggests antibiotics may not always be best therapy

From the February 21 Eureka news alert

When it comes to curing skin infected with the antibiotic-resistant bacterium MRSA (methicillin-resistant Staphylococcus aureus), timely and proper wound cleaning and draining may be more important than the choice of antibiotic, according to a new Johns Hopkins Children’s Center study. The work is published in the March issue of Pediatrics.

Researchers originally set out to compare the efficacy of two antibiotics commonly used to treat staph skin infections, randomly giving 191 children either cephalexin, a classic anti-staph antibiotic known to work against the most common strains of the bacterium but not MRSA, or clindamycin, known to work better against the resistant strains. Much to the researchers’ surprise, they said, drug choice didn’t matter: 95 percent of the children in the study recovered completely within a week, regardless of which antibiotic they got.

The finding led the research team to conclude that proper wound care, not antibiotics, may have been the key to healing.

“The good news is that no matter which antibiotic we gave, nearly all skin infections cleared up fully within a week,” says study lead investigator Aaron Chen, M.D., an emergency physician at Hopkins Children’s. “The better news might be that good low-tech wound care, cleaning, draining and keeping the infected area clean, is what truly makes the difference between rapid healing and persistent infection.”

Chen says that proper wound care has always been the cornerstone of skin infection treatment but, the researchers say, in recent years more physicians have started prescribing antibiotics preemptively.

Although the Johns Hopkins investigators stop short of advocating against prescribing antibiotics for uncomplicated MRSA skin infections, they call for studies that directly measure the benefit — if any — of drug therapy versus proper wound care. The best study, they say, would compare patients receiving placebo with those on antibiotics, along with proper wound cleaning, draining and dressing.

Antibiotics can have serious side effects, fuel drug resistance and raise the cost of care significantly, the researchers say.

“Many physicians understandably assume that antibiotics are always necessary for bacterial infections, but there is evidence to suggest this may not be the case,” says senior investigator George Siberry, M.D., M.P.H., a Hopkins Children’s pediatrician and medical officer at the Eunice Kennedy Shriver Institute of Child Health & Human Development. “We need studies that precisely measure the benefit of antibiotics to help us determine which cases warrant them and which ones would fare well without them.”

The 191 children in the study, ages 6 months to 18 years, were treated for skin infections at Hopkins Children’s from 2006 to 2009. Of these, 133 were infected with community-acquired MRSA, and the remainder had simple staph infections with non-resistant strains of the bacterium. Community-acquired (CA-MRSA) is a virulent subset of the bacterium that’s not susceptible to most commonly used antibiotics. Most CA-MRSA causes skin and soft-tissue infections, but in those who are sick or have weakened immune systems, it can lead to invasive, sometimes fatal, infections.

At 48-hour to 72-hour follow-ups, children treated with both antibiotics showed similar rates of improvement — 94 percent in the cephalexin group improved and 97 percent in the clindamycin group improved. By one week, the infections were gone in 97 percent of patients receiving cephalexin and in 94 percent of those on clindamycin. Those younger than 1 year of age and those whose infections were accompanied by fever were more prone to complications and more likely to be hospitalized.

###

Co-authors on the study included Karen Carroll, M.D., Marie Diener-West, Ph.D., Tracy Ross, M.S., Joyce Ordun, M.S., C.R.N.P., Mitchell Goldstein, M.D., Gaurav Kulkarni, M.D., and J.B. Cantey, M.D., all of Hopkins.

The research was funded by a grant from the Thrasher Research Foundation and the General Clinical Research Center at Johns Hopkins.

Related:

Knowledge Gaps, Fears Common Among Parents of Children with Drug-Resistant Bacteria 
http://www.hopkinschildrens.org/Fears-Common-Among-Parents-of-Children-with-Drug-Resistant-Bacteria.aspx

Community-Acquired MRSA Becoming More Common in Pediatric ICU Patients 
http://www.hopkinschildrens.org/Community-Acquired-MRSA-Becoming-More-Common-in-Pediatric-ICU-Patients.aspx

 

 

 

 

Texas A&M research shows bacteria provide example of one of nature’s first immune systems

From the December 23, 2010 Eureka news release

COLLEGE STATION, Texas, Dec. 23, 2010—Studying how bacteria incorporate foreign DNA from invading viruses into their own regulatory processes, Thomas Wood, professor in the Artie McFerrin Department of Chemical Engineering at Texas A&M University, is uncovering the secrets of one of nature’s most primitive immune systems.

His findings, which appear in “Nature Communications,” a multidisciplinary publication dedicated to research in all areas of the biological, physical and chemical sciences, shed light on how bacteria have throughout the course of millions of years developed resistance to antibiotics by co-opting the DNA of their natural enemies—viruses.

The battle between bacteria and bacteria-eating viruses, Wood explains, has been going on for millions of years, with viruses attempting to replicate themselves by – in one approach – invading bacteria cells and integrating themselves into the chromosomes of the bacteria. When this happens a bacterium makes a copy of its chromosome, which includes the virus particle. The virus then can choose at a later time to replicate itself, killing the bacterium—similar to a ticking time bomb, Wood says.

However, things can go radically wrong for the virus because of random but abundant mutations that occur within the chromosome of the bacterium. Having already integrated itself into the bacterium’s chromosome, the virus is subject to mutation as well, and some of these mutations, Wood explains, render the virus unable to replicate and kill the bacterium.

With this new diverse blend of genetic material, Wood says, a bacterium not only overcomes the virus’ lethal intentions but also flourishes at a greater rate than similar bacteria that have not incorporated viral DNA.

“Over millions of years, this virus becomes a normal part of the bacterium,” Wood says. “It brings in new tricks, new genes, new proteins, new enzymes, new things that it can do. The bacterium learns how to do things from this.

“What we have found is that with this new viral DNA that has been trapped over millions of years in the chromosome, the cell has created a new immune system,” Wood notes. “It has developed new proteins that have enabled it to resists antibiotics and other harmful things that attempt to oxidize cells, such as hydrogen peroxide. These cells that have the new viral set of tricks don’t die or don’t die as rapidly.”

Understanding the significance of viral DNA to bacteria required Wood’s research team to delete all of the viral DNA on the chromosome of a bacterium, in this case bacteria from a strain of E. coli. Wood’s team, led by postdoctoral researcher Xiaoxue Wang, used what in a sense could be described as “enzymatic scissors” to “cut out” the nine viral patches, which amounted to precisely removing 166,000 nucleotides. Once the viral patches were successfully removed, the team examined how the bacterium cell changed. What they found was a dramatically increased sensitivity to antibiotics by the bacterium.

While Wood studied this effect in E. coli bacteria, he says similar processes have taken place on a massive, widespread scale, noting that viral DNA can be found in nearly all bacteria, with some strains possessing as much as 20 percent viral DNA within their chromosome.

“To put this into perspective, for some bacteria, one-fifth of their chromosome came from their enemy, and until our study, people had largely neglected to study that 20 percent of the chromosome,” Wood says. “This viral DNA had been believed to be silent and unimportant, not having much impact on the cell.

“Our study is the first to show that we need to look at all bacteria and look at their old viral particles to see how they are affecting the bacteria’s current ability to withstand things like antibiotics. If we can figure out how the cells are more resistant to antibiotics because of this additional DNA, we can perhaps make new, effective antibiotics.”

 

New superbug genes sure to spread, U.S. expert says

New superbug genes sure to spread, U.S. expert says

From a December 15 Reuters Health News item by Maggie Fox

WASHINGTON (Reuters) – A little loop of genes that give bacteria the power to resist virtually all known antibiotics is spreading quickly and likely to cause doctors headaches for years to come, an expert predicted on Wednesday.

They come on the equivalent of a genetic memory stick — a string of genes called a transmissible genetic element. Bacteria, unlike higher forms of life, can swap these gene strings with other species and often do so with wild abandon.

This one is called New Delhi metallobeta-lactamase 1 or NDM-1 for short and Dr. Robert Moellering of Harvard Medical School and Beth Israel Deaconess Medical Center in Boston predicts it will cause more trouble in the coming years.

“What makes this enzyme so frightening is not only its intrinsic ability to destroy most known beta-lactam antibiotics but also the company it keeps,’ Moellering wrote in a commentary in the New England Journal of Medicine.….

….

Antibiotic-resistant bacteria are nothing new — virtually all strains of the common Staphylococcus bacteria are now resistant to penicillin. Almost as soon as penicillin was introduced in the 1940s, bacteria began to develop resistance to its effects, prompting researchers to develop many new generations of antibiotics.

But their overuse and misuse have helped fuel the rise of drug-resistant “superbugs.” The U.S. Centers for Disease Control and Prevention says most infections that people get while in the hospital resist at least one antibiotic.

[Click here for the CDC Web page on Antibiotic Resistance
It contains detailed information under topics as About Antimicrobial Resistance and Diseases/Pathogens Associated with Antimicrobial Resistance.
References and Resources includes information on campaigns and surveillance systems as well as links to related podcasts, e-cards, and videos.  There are also links to government and organizational Web sites.

KILLER MRSA

For example, half of all Staphylococcus aureus infections in the United States are resistant to penicillin, methicillin, tetracycline and erythromycin. Methicillin-resistant staph aureus or MRSA killed an estimated 19,000 people in the United States alone in 2005.

NDM-1 resists many different types of antibiotic. In at least one case, the only drug that affected it was colistin, a toxic older antibiotic.

“Thus far, the majority of isolates in countries throughout the world can be traced to subjects who have traveled to India to visit family or have received medical care there,” Moellering wrote.

“However, the ability of this genetic element to spread rapidly among Enterobacteriaceae means that there will almost certainly be numerous secondary cases throughout the world that are unrelated to travel to the Indian subcontinent.”

Experts have been warning for years that poor hospital practices and the overuse of antibiotics spread dangerous bacteria, but practices are changing only slowly.

“The fact that there is widespread nonprescription use of antibiotics in India, a country in which some areas have less than ideal sanitation and a high prevalence of diarrheal disease and crowding, sets the ideal stage for the development of such resistance,” Moellering wrote….

 

 

Get Smart : Know When Antibiotics Work

The US Centers for Disease Control publishes a wealth of information about antibiotics for consumers, health practitioners, and the media.

Topics include appropriate antibiotic use, dangers of antibiotic resistance, and an antibiotic quiz.

Information for Everyone includes both print and online materials, fact sheets, and Q and A’s.

Information for Healthcare Providers includes Treatment Guidelines, Patient Education Materials, and Continuing Education materials.