Science Policy Around the Web November 26th, 2019

By: Andrew H. Beaven, PhD

Source: CDC

How Best To Use The Few New Drugs To Treat Antibiotic-Resistant Germs

Bacteria have existed for 3.5–4 billion years, and their survival demonstrates remarkable environmental plasticity. One consequence of their plasticity is that bacteria are able to rapidly become resistant to antibacterial drugs (drugs meant to help humans and animals stave off infection).

Combatting antibiotic drug resistant bacteria (so-called “superbugs”) has been pinpointed as a major, modern global health concern. A new Centers for Disease Control and Prevention (CDC) report published November 14, 2019 estimates that more than 2.8 million treatment-resistant infections and 35,000 annual deaths occur in the U.S. alone. Notably, the development of new antibiotics has lagged, therefore, scientists are recommending new methods to use old drugs. These include: limiting doses for healthy people and allow the body to do its work; flooding the body with multiple drug types at once; or sequentially changing drug types every 12 to 24 hours.

Given all we know about this global health concern, why is the market not being flooded with new antibiotics? Largely, because it is not lucrative for pharmaceutical companies to chase a moving target. Additionally, antibiotics are only used for short-term ailments (as opposed to those used for chronic illness) and many antibiotics remain unused in an effort to minimize new drug resistance. To help promote new antibiotic research, U.S. Senators Bob Casey (D-PA) and Johnny Isakson (R–GA) introduced the Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms Act of 2019 (DISARM Act of 2019; S.1712) to the Senate on June 4, 2019. The goal of the act is to strengthen American antimicrobial research and improve the development pipeline. While the act was called “essential and timely” by the President of the Infectious Diseases Society of America, it has not passed the Senate at time of publication.

(Richard Harris, NPR)

As SpaceX Launches 60 Starlink Satellites, Scientists See Threat to ‘Astronomy Itself’

On November 11, 2019, the private American aerospace company SpaceX, founded by Elon Musk in 2002, launched its second Starlink satellite payload rocket into outer space. Starlink is a prodigious project that aims to provide “high speed internet access across the globe,” specifically allowing internet access to “locations where access has been unreliable, expensive, or completely unavailable.” The Starlink webpage states that they will provide near-global internet coverage by 2021 through their satellite constellation (a network in which satellites work together to provide continuous coverage).

Even with the relatively few Starlink satellites currently in place, astronomers have already noted significant impact on their work. The primary point of concern is that the satellites are very bright, and astronomers say that even if the satellites are darkened, they will have a profound effect on Earth-based astronomy. Additionally, astronomers worry that Starlink will pollute radio wavelengths used to probe deep space and permanently pollute low-orbit space with “space junk.” SpaceX says they are attempting to minimize the effects Starlink has on the scientific community and that the project is moving ahead. Indeed, Mr. Musk has requested the Federal Communications Commission to allow 30,000 more satellites than 12,000 that were already approved. If successful, SpaceX would have eight times more satellites in low-Earth orbit than currently in orbit.

Other companies, such as, Amazon, Telesat, and OneWeb, are following close behind launching similar satellite constellations. Using outer space for private gain yields an important, unanswered question – who can profit from outer space? Megan Donahue, president of the American Astronomical Society acknowledges that “international space law is pretty wide open,” and that it for now the public must trust corporate good will. Currently, a set of United Nations treaties and principles as well as resolutions have laid out guidelines on the peaceful usage of space, but few exact rules are in place.

(Shannon Hall, The New York Times) 

Science Policy Around the Web – March 10, 2015

By: Ashley Parker, Ph.D

photo credit: Staphylococcus aureus Bacteria via photopin (license)

Antibiotic-Resistant Infections

Second Los Angeles hospital identifies “superbug” infections and Hartford Hospital says patients might have been exposed to E. coli

Recent “superbug” outbreaks in at least three hospitals have been associated with a sophisticated surgical instrument known as a duodenoscope. Duodenscopes are fiber-optic instruments used to examine the duodenum (small intestine), and are inserted into the mouth, through the stomach and into the top of the small intestine. Two Los Angeles hospitals, UCLA Ronald Reagan Medical Center and Cedars-Sinai Medical Center have reported seven and four carbapenem-resistant Enterobacteriaceae (CRE) infections, respectively, with two of the UCLA incidents resulting in death. 67 more patients at Cedars-Sinai Medical Center, who were treated with the same instrument are currently at risk. In Connecticut, Hartford Hospital reported at least five patients infected with a strain of drug resistant E. coli. These “superbug” infections were also linked to the use of two duodenoscopes in procedures that involved 281 patients. Dr. Rocco Orlando, the Chief Medical Officer at Hartford, stated that the patients found infected were treated successfully. The hospital remains confident that the 281 patients exposed to the instruments are not at greater risk for infection due to laboratory test revealing the strain’s sensitivity to other antibiotics. However, additional safety measures, including contacting these patients and bringing them in for screening, are currently taking place. In the earlier cases in Los Angeles, both hospitals offered free home monitoring kits to potentially exposed patients.

Hospital officials at all three hospitals stated that they followed the manufacturers’ disinfection procedures correctly to clean and disinfect the instruments. Since the reported outbreaks, both Los Angeles hospitals have enhanced their disinfection procedures beyond those recommended by the manufacturers. Proper sanitation of these instruments is currently under investigation. The U.S. Food and Drug Administration (FDA) released its first warning on February 19 regarding problems with the design of the instrument that may prevent effective cleaning. In this report, the FDA discussed reported issues of disinfecting these surgical instruments and the potential risk associated with the transmission of multi-drug resistant bacterial infections. The FDA Safety Communication also provided recommendations for healthcare providers regarding their responsibility to communicate the potential benefits and risks, and included information for patients who undergo such procedures with these duodenoscopes. The situation is still being monitored and the FDA will continue provide updates regarding the related use of these devices. (Steve Gorman, Reuters and Josh Kovner, Hartford Courant)

Healthcare and Infectious Disease

CDC puts C. difficile burden at 453,000 cases, 29,000 deaths

Hospital-acquired infections and the resulting costs of treating them continues to be an issue in the United States. The Center for Disease Control and Prevention (CDC) has recently reported that the bacterium Clostridium difficile is responsible for more than 450,000 cases per year and results in death in approximately 6.5% of cases. C. difficile is one of the major pathogens responsible for antibiotic-associated colitis, an infection resulting in inflammation of the large intestines. Further damage to the colon can cause the bacterial infection to leak into the bloodstream, resulting in septicemia. This is a major concern, primarily for patients who are treated with antibiotics in hospitals and long-term care facilities such as nursing homes.

Surveillance studies have been reported in the New England Journal of Medicine (NEJM) to monitor new cases of C. difficile. Although there were a considerable number of community-acquired cases in these studies, a significant number of infections were attributed to healthcare-associated environments. Strikingly, 10% of the patients with healthcare-associated infections died within a month.

As a result, serious efforts to reduce the incidence of C. difficile infections have been implemented. Hospitals are now required to report infection rates and healthcare workers are encouraged to use proper hand-washing techniques rather than rely on hand sanitizers to prevent the spread of C. difficile spores. In addition, measures to avoid the unnecessary use and prescribing of antibiotics have improved the incidence of antibiotic-associated hospital cases. Moving forward, additional evidence is needed to better understand the spread of infection and improve the disinfection of healthcare environments. (Robert Roos, Center for Infectious Disease Research and Policy)

Global Health and Infectious Disease

Malawi: Cholera Scare Hitting Malawi, Govt Alert

The United Nations Children’s Fund (UNICEF) is on high alert after a cholera outbreak in Malawi, Africa and its borders. Cholera is an infectious disease caused by the bacterium Vibrio cholerae which infects the small intestine. While some infected persons can be initially asymptomatic, progress of the infection can lead to excessive watery diarrhea, vomiting, severe dehydration, and death in 25-50% of untreated infections. The Ministry of Health in Malawi has reported 39 cases of cholera with two confirmed deaths. These reports are in the southern border areas of Malawi which is shared with the neighboring country of Mozambique. UNICEF has also reported more than 3400 cholera cases in Mozambique, including 37 deaths since December, many of which were children.

The continued spread of this disease is a pressing concern. In Malawi, the disease is associated with major flooding that occurred in January and the more than 230,000 people who are still displaced due to continued rainfall. Mahimbo Mdoe, the UNICEF representative in Malawi stated “[that] as humanitarian actors in Malawi, we need to move quickly.” UNICEF along with other organizations such as the European Union and UK’s Department for International Development are contributing to efforts to prevent the spread of cholera such as providing safe water, sanitation and hygiene services. In addition, UNICEF, in partnership with governmental and non-profit organizations, has dispatched essential medications and healthcare equipment to control the outbreak. (Paul Nthala, Malawi24)

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