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1rem

“Usually for antibiotic awareness you have a week,” said Dr. Teena Chopra, “But for 

a whole month has been dedicated, for a reason.”

Awareness Month and Antimicrobial Awareness Week. As Chopra explains, too often the people most affected by a lack of vigilance in these areas already experience marginalization and discrimination.

“We are all global citizens, and having that uniform, consistent health care for all is where we need to move toward,” said Chopra.

Teena Chopra, MD, MPH is the Corporate Medical Director of Hospital Epidemiology at Detroit Medical Center, as well as a professor at the Wayne State University School of Medicine.

Chopra credits several mentors as inspiring her to specialize in infectious disease. Living and working in Detroit, MI, she has seen firsthand how infectious diseases can ravage underserved populations, moving her to practice where she’s most needed.

causes an estimated half a million infections a year and over a billion dollars in expenses in the US alone.

The Centers for Disease Control and Prevention (CDC) classifies 

However, until the disease touches their lives, the general public is largely unaware of its prevalence or even what 

 is. “We, as the health care community, need to raise more awareness for 

Listen in as Chopra discusses treatment regimens for 

 infection (CDI), as well as the populations disproportionately affected by this debilitating disease.

Missed Episode 6 of Contagion Community? 

Listen in on the conversation and feel free to offer your feedback on this episode, interest in participating in the podcast, or suggest ideas for future episodes. Please email your correspondence to Nina Cosdon: 

Dr. Teena Chopra discusses the global need to do more to prevent healthcare-associated infections like C difficile in vulnerable patient populations.

C difficile, Antimicrobials, and the Patients Most Affected

Investigators revisit an 80-year-old antimicrobial to reduce its toxicity while preserving its activity against drug resistant gram-negative bacteria.

Back to the Future to Combat Today's "Super Bugs"

Anticoagulant treatment for 3 to 6 months was sufficient for the majority of COVID-19 patients with venous thromboembolism, the study authors found.  


Comparing Venous Thromboembolism in COVID-19 and Non-COVID-19 Hospitalized Patients

Sulbactam-durlobactam is efficacious against carbapenem-resistant infections, and Innoviva is preparing for the antibiotic's PDUFA at the end of this month. 

Antibiotic Shows Noninferiority Vs Colistin for Acinetobacter infections

The latest issue of the Morbidity and Mortality Report discusses the cases.



Two Cases of Drug-Resistant Ringworm In New York City

On the same day WHO Director-General Tedros Adhanom Ghebreyesus declared the end of the COVID-19 public health emergency, CDC Director Rochelle Walensky announced she will be stepping down at the end of June. 

WHO Declares End of COVID-19 Global Health Emergency, Walensky to Step Down as CDC Director

Complicated intra-abdominal infections (cIAI) are challenging to treat because of the potential for high morbidity and mortality in these patients.

In addition, there can often be more variability in the number of clinicians involved in care as well as the types of patients who are experiencing these infections. “[cIAI] They are probably a little more heterogenous because the clinical decision-making comes from multiple areas; there are surgeons and there are emergency room physicians [involved],” Tony Hodges, MD, FACP, FCCP, Chief Medical Officer, La Jolla Pharmaceutical Company. “The ages of the patients may range from pediatric to the aged. The comorbidities that align with those age groups are also there and the risk factors for antimicrobial resistance also vary within those cohorts.”

Fortunately, there are treatment options for these infections. One particular antibiotic, eravacylcine (Xerava), which is produced by La Jolla, was FDA approved in August of 2018 for the treatment of cIAI in adults 18 years and older. 

 is a tetracycline-class antibacterial injection that has demonstrated potent activity against multidrug-resistant pathogens. In clinical trials, eravacycline was well tolerated and produced favorable results in curing patients with cIAI and demonstrated non-inferiority to ertapenem and meropenem.

The drug was assessed for cIAI in 2 Phase 3 studies called IGNITE (Investigating Gram-Negative Infections Treated with Eravacycline.) In the first trial, IGNITE1, 541 patients with cIAI were randomized to receive intravenous (IV) treatment with either eravacycline 1.0 mg/kg every 12 hours (n = 270) or ertapenem, 1.0 g every 24 hours (n = 271) for at least 4, 24-hour cycles. The primary endpoint was cure rates after about 1 month. The clinical cure was 86.8% and 87.6% in the eravacycline and ertapenem groups, respectively.

In the second trial, IGNITE4, a total of 499 patients with cIAIs were randomized to IV treatment with eravacycline 1.0 mg/kg twice-daily (n = 250) or meropenem 1 g every 8 hours (n = 249). The clinical cure rates evaluated about 1 month after the start of the treatments were comparable for eravacycline and meropenem whether evaluated according to the criteria set out by the FDA (90.8% vs 91.2%) and EMA (92.4% vs 91.6%).

One of the novel aspects of this therapy is its ability to withstand resistance that other tetracycline-class medications have not, explained Hodges. “It has withstood resistance to primarily historically tetracycline-resistant mechanisms that have degraded or caused resistance with others within the class.”

This is also the biggest takeaway about the therapy in its latest studies.

La Jolla is presenting four posters on eravacycline at the ongoing 

European Congress of Clinical Microbiology and Infectious Diseases (ECCMID)

 Surveillance of Eravacycline Against Enterobacterales and Non-Fermentor Clinical Isolates, Including Resistant Isolates, Collected in Europe During 2021, and 

surveillance of eravacycline against Gram-positive pathogens, including resistant isolates, collected In Europe during 2021, Hodges explains these studies are primarily looking at minimal inhibitory concentration (MIC) with regards to 

 data.

“What you’ll see is retention or lack of MIC drift over the last 5 to 6 years historically…across intra-abdominal pathogens,” Hodges stated. 

Hodges talked with 

 about these studies, an in-depth discussion on the treatment guidelines and breakpoints related to these infections, and the goal of reaching “target attainment” for better treatment for patients to reduce complications and obtain stewardship.

Several years after its FDA approval, this antibiotic continues to prove its efficacy in vitro across various pathogens related to these infections.

Conferences

Eravacycline Remains Efficacious for Intra-Abdominal Infections

Vicky Enne, BSc, PhD, and Vanya Gant, MBBS, PhD, believe there’s a better way to diagnose pneumonia-causing pathogens in intensive care units (ICUs).

“When people get really sick in intensive care unit and develop a pneumonia, you’ve got to act fast,” said Gant. “You don’t know why, you don’t know what the bacteria are, and basically you guess.”

, these investigators detailed their multi-center, randomized, controlled trial, INHALE.

INHALE examined the utility of rapid diagnostics for hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) in critical care. The data were shared as a late breaking clinical trial at the 

“We took the [BioFire] FilmArray Pneumonia Panel…to find the etiological diagnosis of pneumonia, and we put that in a randomized control trial,” Enne explained. “It was a multi-center trial of 14 different ICUs.”

What made this trial unique was that the team specifically placed the device at the product of care in the ICU. “We did this for 2 reasons,” said Enne, “number 1 so that we would not lose transport time, and secondly so that ICU physicians would feel more ownership of the test.”

The goal of the study was to promote narrow-spectrum antimicrobial use, so the investigators sought to encourage the ICU physicians to engage with the FilmArray Pneumonia Pannel. “That way, they would be more likely to actually use it and prescribe accordingly,” said Enne.

The investigators emphasized that this trial was “completely real life” with no participants excluded; they wanted to mimic what actually happens in the ICU.

The study found that the proportion of patients on antibiotics improved by 20%, compared to the control group. However, the study failed to meet the inferiority margin for clinical cure. “We do not fully understand why,” said Enne, but this result has prompted further investigation. Gant clarified, “The diagnosis that the machine made we believe to be absolutely correct.”

Without a rapid and reliable diagnostic test, said Gant, “You give antibiotics that you think are a best bet, depending on where you are in the world and what the local bugs are resistant to, but it’s guesswork, and we should be able to do better.”

This study, “INHALE WP3: Results of a multi-center rrandomized controlled trial (INHALE) testing the utility of rapid multiplex PCR at point-of-care for the antibiotic management of hospital-acquired and ventilator-associated pneumonia in critical care,” was presented as a late-breaking vaccine study during the 

 conference, held October 19-23, 2022, in Washington, D.C.

Encouraging ICU physicians to utilize rapid diagnostics, like the FilmArray Pneumonia Panel, may improve patient outcomes. 

Taking the Guesswork out of ICU Pneumonia Diagnosis

 in the US, accounting for significant patient mortalities and draining hospital resources. Recurrent 

infection (rCDI) is associated with even higher patient deaths, and is recognized as an urgent public health threat.

 confirmatory results from a clinical study of SER-109, their investigational oral microbiome therapeutic for recurrent 

Eric Shaff, the president and CEO of Seres, was excited to share the implications of the positive trial results: “SER-109 is really the centerpiece of the company.”

“What if we could take this concept of fecal transplant and make it orally administered?” Shaff explained, “That was the catalyst behind the initiation of the company.”

“There really hasn’t been meaningful innovation in recurrent 

,” Shaff said, explaining that the antibiotics with which patients are typically treated can actually make things worse. When excess antibiotics wipe out the healthy bacteria in the gut microbiome, resilient 

 bacteria has the space and nutrients to flourish.

“SER-109 is intended to repopulate that natural ecosystem of bacteria that’s necessary to prevent the recurrence of 

In the phase 3 open-label clinical trial ECOSPOR IV, SER-109 demonstrated a sustained response rate of 91.3% in patients with a history of recurrent 

infection. In light of these positive results, Seres has begun the rolling submission for SER-109’s Biologics License Application (BLA).

Shaff anticipates the BLA submission will be completed by the middle of this year, when it will then be reviewed by the US Food and Drug Administration (FDA). Simultaneously, Seres is preparing for the global launch of SER-109.

“We’re making SER-109, we’re continuing to scale up our ability to produce the product, because we think this is going to be a global product, not just a US product,” Shaff said. “We think that patients worldwide can be served with SER-109.”

Eric Shaff, president and CEO of Seres Therapeutics, discusses the confirmatory trial findings for SER-109. Seres is filing a Biologics License Application for the recurrent C diff therapy.

New Therapeutic Repopulates the Gut Microbiome to Prevent Recurrent C Diff Infection

 remain a significant issue in medical facilities. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 31 hospital patients have an HAI on any given day.

The CDC estimated there were 687,000 HAIs in US acute care hospitals in 2015, and about 72,000 hospital patients with HAIs died during their hospitalizations.

Within these facilities remains numerous touchpoints that can harbor germs and bacteria that can be transmitted from patient to patient. One area within these facilities that is often overlooked is the patient mattress. HAI can be attributed to this high touchpoint and according to one new study, they remain neglected to the point of needed repair or replacement.

Edmond A. Hooker, MD, DrPH, professor, Department of Health Services Administration, MHSA associate director for Accreditation, Xavier University says with a majority of hospitals running at or over 100% capacity the ability to clean mattresses in a timely, efficient manner while disinfecting them is challenging.

“Hospitals want to get these beds turned over; a typical hospital is giving environmental services less than 30 minutes to clean a room, and it’s just not possible,” Hooker said.

Not only is it a time issue, but Hooker says the mattresses have changed. He explains that the material of the mattresses underwent a transformation  in the 1990s that helped prevent bed sores, but the material made them much more susceptible for germs and decreased their durability significantly. “The old vinyl mattresses lasted forever…and they were easy to clean because they weren’t porous,” Hooker said. “…We are not cleaning the thing which is probably the biggest source of infection—the mattress.” 

Hooker was the investigator on a study published in 

Infection Control & Hospital Epidemiology

which examined hospital mattresses. His study showed a very high failure rate for mattresses in 4 hospitals within 1 hospital system.

“In total, 727 beds and mattresses were evaluated, and 523 (72%) had damage: 340 (47%) required mattress cover replacement and 183 (25%) required replacement of the entire mattress,” Hooker wrote in the study.



spoke to Hooker who offered some insights into his study, the hidden dangers within mattresses including why he thinks it has been “the big miss” in avoiding HAI, and how we are doing overall at infection prevention measures.

A recent study showed that 25% of mattresses within 4 hospitals required complete replacement, underlying a serious health risk that could lead to unnecessary infections. 

The HealthCare-Associated Infection Risk Hiding in Plain Sight

Sepsis remains a difficult condition that needs timely therapeutic intervention in order to reduce mortality. In a large study, investigators reported a significant increase in the probability of death was associated with the delay in the number of hours antibiotics were first administered to inpatients. In fact, after adjusting for sepsis severity, ICU admission source and geographic region, inpatient mortality from the condition increased steadily after 1 hour of time to therapeutic intervention.

“We found that many people that come in with sepsis delayed care,” Chief Medical Officer Kathy Hudson, MD, at Phoebe Putney Memorial Hospital, said. “They may have an infection they are trying to doctor at home.” This delay can be problematic for clinicians as patients may already be close to sepsis.

Hudson’s Phoebe Putney Health System is using a monitoring tool, POC Advisor, to aid in detecting earlier the onset of sepsis which can then provide clinicians the opportunity to deliver interventions sooner in the process. The health system, which is a not-for-profit health system in southwest Georgia, is going to be using it at 3 hospital sites.

The monitoring tool analyzes data in real-time, accounting for more than 4000 comorbidities. It contains evidence-based algorithms that can reduce false positives for conditions that mimic sepsis resulting in higher quality alerts that clinicians trust.

By analyzing a broad cross-section of Phoebe’s electronic health record (EHR) data, including clinical notes using natural language processing, the platform can identify patients at risk of sepsis much earlier than the EHR SIRS-based sepsis alerts.

At Phoebe, clinicians will receive alerts with evidence-based protocols at the point of care. The solution’s dashboards track quality performance metrics to reduce practice variation by identifying gaps in bundle compliance. Additionally, the alert response dashboard will provide a comprehensive view of Phoebe’s clinician actions to promote timely interventions, support continuous improvement, educate staff and increase standardization of sepsis response.

 spoke to Hudson about the importance of identifying and treating sepsis earlier and how they plan to incorporate the POC Advisor into their health system.

1. Ferrer R, Martin-Loeches I, Phillips G, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. 

. 2014;42(8):1749-1755. doi:10.1097/CCM.0000000000000330

A predictive tool, POC Advisor, has been developed to support faster diagnosis and intervention of this dangerous condition. 

Detecting Sepsis Earlier

Until his mother was diagnosed with and subsequently died of the bacterial infection, Christian John Lillis had never heard of 

 shortly after their mother’s passing in 2010. “We were really determined that her death not be in vain,” Lillis said.

Lillis is the co-founder and executive director of the PLF, and describes its mission of PLF as threefold: educating the public, empowering advocates, and shaping policy.

Many legislators, like Lillis and the general public, are unfamiliar with 

 In 2018, the PLF held what Lillis believes to be the first-ever 

 Lobby Day on Capitol Hill, meeting with legislators to educate and advocate for policy addressing 

Prior to founding PLF, Lillis had 20 years of experience in fundraising, advocacy, and nonprofit management, including extensive work with the National LGBTQ Task Force and NYU Langone Medical Center.

in our bodies, but excessive or unnecessary antibiotics can kill off all other bacteria in the gut microbiome, enabling the 

to flourish with potentially deadly consequences.

Lillis cautioned the public against taking antibiotics without asking their doctor questions to gauge the type of bacteria they have, the necessity of the antibiotic, and whether they have been cultured for it.

We should also stop expecting medications like antibiotics to be the only path to recovery, Lillis pointed out. “It’s unsatisfying to us,” he said, but sometimes taking time to rest and let the body heal on its own really is the best course of action.

Lillis observed that before the outbreak of COVID-19, and with the exception of people at-risk for HIV, the public hard largely forgotten about infectious disease.

and other infectious diseases, Lillis said, “It’s not a personal choice, it’s not lifestyle, it’s not genetic predisposition…these are communicable diseases.” He continued, “We have to understand that we have to take care of each other.”

Christian Lillis, co-founder and executive director of the Peggy Lillis Foundation (PLF) for C diff Education & Advocacy, says that taking care of each other is often the best way to stop the spread of infectious diseases.

Taking Care of Each Other: The Peggy Lillis Foundation for C Diff Education and Advocacy

Welcome to our series, 1 Big Question, which asks 1 question to the medical community and we get their feedback on an important infectious disease topic.

In this episode, our 1 Big Question is: What are we doing right in antimicrobial stewardship and where do the challenges remain?

We interviewed Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, assistant professor of pharmacy practice at Loma Linda University School of Pharmacy, Jeffrey Rybak, PharmD, PhD, instructor, Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital, and Wendy Bullington, PharmD, internal medicine pharmacist at the Medical University of South Carolina.

Watch our video to learn more about their insights.

Providers offer their insights on this important topic. 

Clinical Perspectives on Antimicrobial Stewardship

With the different modes of transmission and the variability in their incidence rates, infectious disease outbreaks can be difficult to manage once they appear. 

The introduction of COVID-19 reaffirmed how quickly an infectious disease can take hold and how dangerous a viral pathogen can be to a larger, global population.

Ebola, on the other hand, has had very bad regional outbreaks in various countries within Africa. And while its mode of transmission is different (through body fluids), the fear it could spread to other areas in the world remains intense due to the disease’s harmful effects and potential mortality. Ebola’s 

 according to the World Health Organization, but there is also great variability with rates ranging from 25% to 90% from past individual outbreaks. 

is a mysterious fungal infection and not much is fully known for why outbreaks appear. It remains highly contagious in health care settings and is often multidrug resistant. Similar to Ebola, the mortality rates for 

 vary greatly according to Jeffrey Rybak, PharmD, PhD, instructor, Department of Pharmaceutical Sciences, St. Jude Children’s Research Hospital.

Outside of a smattering of cases in Europe and the US, Ebola outbreaks have remained on the African continent. Conversely, 

 has had outbreaks in several continents occurring simultaneously, according to Rybak.

In the second installment of an interview with 

Rybak discusses outbreaks across different geographic locations including one where there was a high incidence rate of COVID-19, 

 mortality rates, and whether it has enough durability that will provide it with a sense of permanency and therefore remain a concern in public health for years to come.

The emergence of this fungal infection remains mysterious as the world experiences more outbreaks. 

Considering Candida Auris Outbreak Behavior

) was first identified in a single case in Japan where a man had it appear in his ear. According to the Centers for Disease Control and Prevention (CDC), a retrospective review of 

strain collections found that the earliest known strain of the fungus dated back further to 1996 in South Korea.

In the ensuing years, the fungal pathogen has been mysterious in appearing very quickly in places and then disappearing almost as quickly. Earlier this year, two outbreaks were made public with one happening at a nursing home in Washington, DC, and the other at 2 hospitals in the Dallas area.

With the unpredictability of when it will appear, and its propensity to be multidrug-resistant, this particular pathogen is challenging to diagnose and treat.  

Healthcare Associated Infections (HAI)

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