[Cyclopath]

I listened to a podcast yesterday on the way home from the mountains with a friend. Some interesting takeaways: By 2050, infectious disease will kill more people than cancer and heart disease. It's far more profitable to make drugs like statins than antibiotics. It's risky, slow, and expensive to bring a drug to market, you want a lot of people buying it on a long term basis. Antibiotic use in farming is a big problem, as we all know. There is a conflict of interest between a doctor wanting to help their patient (example: following surgery, infection can often be a risk, it's been common to prescribe a course of antibiotics to play it safe) and the greater good. Hospitals are working on this. It isn't only bacteria, it's fungal diseases as well. Because it's prohibitively expensive to create new molecules designed from first principals to kill pathogens, we will probably have the most luck searching in the ground. Also, the ongoing loss of biodiversity is not helping, some living things have come up with answers to parts of this problem. This is a $$$ problem, and the market won't bring us a solution. We need to create strong incentives for "big pharma" or nationalize antibiotics going forward. These are a public good like electricity.

[Anne Elk]

Sounds like an interesting program. Many NWH'ers are in the age cohort from the era when the GP's answer to every sniffle and sore throat was to hand out antibiotics, without even checking if the infection was bacterial. I was miffed to find out (from my hospital bill) that during my achilles' tendon surgery, they'd infused me with an antibiotic as a "prophylactic". I remember reading a story about Jonas Salk - after he'd discovered the polio vaccine an interviewer asked if he had patented it. His response was something like, "Of course not - how can you patent the sun?" This is not where our thinking is these days with medicine.

[cdestroyer]

I have gathered this information from various sources about a new antibacterial resistant fungus that has been on the increase: candida auris While the threat is clear, much about C. auris infections has been murky—including how it spreads from one victim to another. Researchers have found it loitering on hospital mattresses, furniture, sinks, and medical equipment, but they haven't determined how it got there. Once it is present, however, it’s a tough bug to annihilate. The fungal cells can form tight, hardy clumps that can live on plastics for at least two weeks and can go into a metabolically dormant phase for a month. The microbe can be carried on the bottom of shoes, clings to surfaces in hospital rooms, flourishes on floors, and adheres to patients' skin, phones and food trays, health officials said. It also is odorless and invisible. chlorhexidine Hand hygiene Increased emphasis on hand hygiene is needed on the unit where a patient with C. auris resides. When caring for patients for C. auris, healthcare personnel should follow standard hand hygiene practices, which include alcohol-based hand sanitizer use or, if hands are visibly soiled, washing with soap and water. Wearing gloves is not a substitute for hand hygiene. As part of Contact Precautions, healthcare personnel should: * Always wear gloves to reduce hand contamination. * Avoid touching surfaces outside the immediate patient care environment while wearing gloves. * Perform hand hygiene before donning gloves and following glove removal. Candida auris is a globally emerging yeast, causing severe infections in patients with underlying diseases. This yeast is responsible for several outbreaks within healthcare facilities, where it can be found on hospital surfaces and patient care devices. Spread from these fomites may be prevented by improving the decontamination of hospital surfaces. UV-C decontamination may constitute an effective adjunct to routine room cleaning. OBJECTIVES: Our aim was to investigate the effect of different UV-C exposure times and distance in killing C auris, using strains from different countries. METHODS: Candida auris was seeded on glass slides and exposed to UV-C for 5, 10, 20 and 30 minutes at 2 and 4 m. RESULTS: A maximal effect of C auris killing was found after 30 minutes of UV-C exposure at 2 m. With half the time or twice the distance, the efficacy strongly diminished to ~10 and ~50 fold, respectively. At suboptimal exposure times and distances, the C auris strains from Japan/Korea were more sensitive to UV-C killing than C auris strains originating from Venezuela, Spain and India. CONCLUSIONS: Altogether, UV-C exposure times and distance are the most critical parameters to kill C auris, while strain variations of C auris also determine UV-C efficacy. Future studies should aim to determine the effect and place of UV-C on surface decontamination in hospital setting. Environmental disinfection C. auris can persist on surfaces in healthcare environments. C. auris has been cultured from multiple locations in patient rooms, including both high touch surfaces, such as bedside tables and bedrails, and locations further away from the patient, such as windowsills. C. auris has also been identified on mobile equipment, such as glucometers, temperature probes, blood pressure cuffs, ultrasound machines, nursing carts, and crash carts. Meticulous cleaning and disinfection of both patient rooms and mobile equipment is necessary to reduce the risk of transmission. Quaternary ammonium compounds (QACs) that are routinely used for disinfection may not be effective against C. auris. Data on hands-free disinfection methods, like germicidal UV irradiation, are limited, and these methods may require cycle times similar to those used to inactivate bacterial spores (e.g., Clostridioides difficile) when used for C. auris (Cadnum et al., 2018External). Until further information is available for C. auris, CDC recommends use of an Environmental Protection Agency (EPA)-registered hospital-grade disinfectant effective against Clostridioides difficile spores (List KExternal). It is important to follow all manufacturers’ directions for use of the surface disinfectant, including applying the product for the correct contact time. When use of products on List K is not feasible, published research found that the following products led to a substantial reduction (?4 log reduction) of C. auris in laboratory testing (Cadnum et al., 2018External; Rutala, et al., 2017External): * Oxivir Tb * Clorox Healthcare Hydrogen Peroxide Cleaner Disinfectant * Prime Sani-Cloth Wipe * Super Sani-Cloth Wipe Details on contact time and testing parameters are included in the references. This does not constitute an endorsement of a specific company or disinfectant. More research is needed to evaluate which disinfectants, including others not listed here, are effective against C. auris. Thorough daily and terminal cleaning and disinfection of patients’ rooms and cleaning and disinfection of areas outside of their rooms where they receive care (e.g., radiology, physical therapy) is necessary. Shared equipment (e.g., ventilators, physical therapy equipment) should also be cleaned and disinfected before being used by another patient.

[jinx'sboy]

Here’s an interesting Ted talk on antibiotics, resistance and a world without them. https://www.ted.com/talks/maryn_mckenna_what_do_we_do_when_antibiotics_don_t_work_any_more/transcript?language=en It increasingly looks like the world of antibiotics will be limited to the 80-90 years that many of us lived through. My wife, a lecturer at a Veterinary School, has been telling her students for years; “you are going have to figure out how to practice medicine without antibiotics”.