Things that make you go "hmmm"...

I’ve been in an undisclosed location for the past week or so. Hint—if I were to hop on the above watercraft and drive directly across the above body of water, I’d be in the city that in the Potawatomi language translates (roughly) as “fine land”.

In among my beach reading I ran across this article, about a recent biowarfare exercise:

“AVI BioPharma, Inc., and the Naval Research Center recently announced the successful completion of a rapid-response exercise conducted by the Joint Project Manager Transformational Medical Technologies…..In a total of 18 days, AVI conceived, designed and manufactured two novel RNA-based drug candidates, one against a Gram negative bacterial target and one against a viral target.”

Eighteen days to conceive, design and manufacture a drug active against a Gram negative pathogen! Meanwhile, the only option for treatment of many multiple-drug resistant Gram negative infections is a drug that’s over 50 years old.

Changing the equation?

Remember Eli’s post from last month, about a tipping point at which the risk for a multiply-drug resistant infection begins to outweigh the benefit of a “discretionary” surgical procedure? I thought about that when I read this report about MDR-GNR sepsis after prostate biopsy, which may lead to a re-evaluation of PSA screening guidance. Hat tip to Jason Barker for sending me the link. The two money quotes:

“We’re all beginning to see more and more sepsis as a result of resistant bacteria after prostate biopsies,” said Peter T. Scardino, chief of surgery at the Memorial Sloan- Kettering Cancer Center in New York, which does about 2,000 of the tests annually. “This is an extremely worrisome problem”

........

“There has been this huge enthusiasm for everyone getting their PSA checked, which has led to a lot of prostate biopsies that have not benefited anyone,” said James R. Johnson, an infectious diseases physician at the Veterans Affairs Medical Center in Minneapolis. “The more dangerous the biopsy becomes because of infection risk, the more likely it is that the balance is shifting toward harm, rather than benefit.”

David Livermore fights NDM-1, the 'super' superbug

David Livermore and NDM-1

There is a new story at MSNBC.com highlighting David Livermore, NDM-1, and the myriad of reasons for the expansion of MDR-bacteria and hospital infections: little investment in antibiotic discovery and infection prevention.  I like this quote from the article in regards to infection prevention: "If it is done properly, it can ease the demand for drugs in the first place."  Dr. Livermore is the Director of the Antibiotic Resistance Monitoring & Reference Laboratory (ARMRL) at the HPA Centre for Infections in London. The story is surprisingly well-written, includes the usual human-interest angle and quite long but worth a read.

h/t Mark Vander Weg

Sensitivity of perianal swabs for MDR-GNR

Quick last abstract from ICAAC.  Graham Snyder et al. from Beth Israel Deaconess Medical Center in Boston enrolled 35 patients with known multidrug-resistant Gram-negative bacteria in clinical cultures (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, Proteus mirabilis, and Morganella morganii). Each patient received a perianal swab. The sensitivity was 79%. It was a small study with the usual caveats.

Conflict of Interest: Graham was a medical resident that I worked and published with at Maryland.

link to medpage article