Author Interviews, Hospital Acquired, Infections / 08.06.2015

Stephanie Bonne, MD, FACS Assistant Professor Trauma, Acute, and Critical Care Surgery Washington University in St. LouisMedicalResearch.com Interview with: Stephanie Bonne, MD, FACS Assistant Professor Trauma, Acute, and Critical Care Surgery Washington University in St. Louis Medical Research: What is the background for this study? What are the main findings? Response: We had previously implemented education programs in our ICU in an attempt to decrease our Central Line-Associated Bloodstream Infection (CLABSI) rate.  We were, however, unable to come to zero.  We were looking for innovative ways to lower our CLABSI rate, and the use of Clorhexidine/Silver Sulfadiazine catheters was unable to move our CLABSI rate.  We decided to try Minocycline/Rifampin catheters, and monitor our Central Line-Associated Bloodstream Infection rate. Medical Research: What should clinicians and patients take away from your report? Response: The use of Minocycline/Rifampin impregnated catheters can lower Central Line-Associated Bloodstream Infection rate, particularly in ICUs who have been unable to reach a Central Line-Associated Bloodstream Infection rate of zero with other measures. (more…)
Author Interviews, Diabetes, mBio, Microbiome / 04.06.2015

Patrick M. Schlievert Ph.D Professor and Chair Department of Microbiology Carver College of Medicine Iowa City Iowa 52242MedicalResearch.com Interview with: Patrick M. Schlievert Ph.D Professor and Chair Department of Microbiology Carver College of Medicine Iowa City Iowa 52242 Medical Research: What is the background for this study? Dr. Schlievert:
  1. As people become obese and enter pre-diabetes type II, there is a gut microbiome shift in bacteria from Bacteroidetes to Firmicutes. A dominant pathogenic Firmicute in humans is Staphylococcus aureus.
  2. As people become obese, their skin becomes wetter due to enhanced sweating upon exertion and the presence of more skin folds. These, plus mucous membranes have enhanced Staphylococcus aureus numbers, such that 100% of people become colonized and numbers of the bacterium rise to 1013 per person. This number of bacteria is like a cubic inch of margarine spread across the skin and mucous membranes.
  3. All pathogenic Staphylococcus aureus bacteria make and secrete a family of toxins called superantigens, including toxic shock syndrome toxin and staphylococcal enterotoxins. In high amounts (0.1 μg/human), these toxins can be lethal, causing toxic shock syndrome. At lower concentrations, the same superantigen toxins cause total body inflammation without lethality.
  4. In order to show that a microbes causes human disease, it is necessary to fulfill Koch’s postulates:
    1. Must associate human symptoms with a particular disease,
    2. Must isolate a potentially causative bacterium that is always present when the disease is present.
    3. Must produce the disease in an experimental animal.
    4. Must re-isolate the microbe from the experimental animal and re-cause the disease in another animal.
Medical Research: What are the main findings? Dr. Schlievert: We have fulfilled Koch’s postulates, showing that Staphylococcus aureus and its superantigen toxins cause type II diabetes. (more…)
Author Interviews, Cognitive Issues, Infections, PLoS / 24.05.2015

Dr. Michael Eriksen Benrós Mental Health Centre Copenhagen University of Copenhagen Faculty of Health Sciences Copenhagen NV, Denmark, National Centre for Register-based Research Aarhus University DenmarkMedicalResearch.com Interview with: Dr. Michael Eriksen Benrós Mental Health Centre Copenhagen University of Copenhagen Faculty of Health Sciences Copenhagen NV, Denmark, National Centre for Register-based Research Aarhus University Denmark Medical Research: What is the background for this study? Response: It is increasingly recognized that infections and immune responses can affect the brain and activate immunocompetent cells within the brain, influencing on neuronal signal transduction and possibly cognition. Impaired cognition has been observed in association with several infections and with elevated levels of CRP in smaller studies. Furthermore, experimental activation of inflammatory reactions in healthy volunteers has been shown to induce short-term reduced cognitive performance. Moreover, particularly patients with infection in the brain or sepsis have been shown to have affected cognition in long time periods after the infection has been cleared, thus infections might also have a longer lasting effect on cognition. However, large-scale longitudinal studies had been lacking on the association between infections and cognitive ability in the general population. Medical Research: What are the main findings? Response: Our study is the first large-scale study utilizing the extensive Danish registers to follow 190,000 males that had their IQ assessed at conscription, out of which 35% had a previous hospital contact with infection before the IQ testing was conducted. Our research shows a correlation between severe infections with a hospital contact and subsequent impaired cognition corresponding to an IQ score of 1.76 lower than the average. People with five or more hospital contacts with infections had an IQ score of 9.44 lower than the average. The study thus shows a clear dose-response relationship between the number of infections. Furthermore the effect on cognitive ability increased with the temporal proximity of the last infection and with the severity of the infection. Infections in the brain affected the cognitive ability the most, but many other types of infections severe enough to require a hospital contact where also associated with impairment of the cognitive ability. (more…)
Author Interviews, Genetic Research, Infections, Inflammation, NYU / 07.05.2015

Dr. Ludovic Desvignes. PhD. Assistant Professor, Departments of Medicine and Pathology NYU Langone Medical CenterMedicalResearch.com Interview Dr. Ludovic Desvignes PhD. Assistant Professor, Departments of Medicine and Pathology NYU Langone Medical Center MedicalResearch: What is the background for this study? Dr. Desvignes: This study is the result of a collaboration at NYU Langone Medical Center, between the laboratories of Dr. Stefan Feske and Dr. Joel Ernst, my mentor. Dr. Feske and colleagues had developed a mouse model of rare, inherited mutations he had identified in infants. These mutations occur in the genes for STIM1 and ORAI1, which are crucial for calcium flux in cells of the immune system. The young patients affected by these mutations suffer from severe, recurrent and chronic infections that often cause death before their first birthday. In particular, some of these patients cannot control infection with BCG, which is a normally innocuous strain of mycobacteria administered to protect against tuberculosis (TB). TB is a chronic infection and one of the leading causes of infection-related death worldwide. Going into this study, Dr. Feske and colleagues knew that without functional calcium channels, immune cells do not function properly. However, they did not fully understand how these channels contribute to immune responses to infectious pathogens in a living organism and in particular, for pathogens that cause chronic infections such as TB. This is why Dr. Ernst and I collaborated with Dr. Feske and provided him with our clinical and research expertise in TB. MedicalResearch: What are the main findings? Dr. Desvignes: Dr. Feske’s mice are genetically engineered to lack STIM1 in a certain type of immune cells, known as T cells or T lymphocytes. We infected these mice with Mycobacterium tuberculosis, the bacterium causing TB. Mycobacterium tuberculosis causes chronic infection by manipulating the immune system even in healthy people. The first very surprising result of our study was that mice lacking calcium flux in T cells handled acute TB fairly well. Only during the chronic phase of infection did they become unable to control mycobacterial growth and developed a strong inflammation in their lungs, which was due to an infiltration by different types of immune cells, including T cells. We discovered that the accumulation of STIM1-deficient T cells in the lungs resulted from the cells’ inability to die, which is a normal mechanism to limit an immune response and prevent excessive inflammation. Another immune control mechanism that failed in the absence of STIM1 is mediated by a subset of T cells called induced regulatory T cells, or iTreg cells. These cells are essential to prevent normal immune responses from going “overboard” by suppressing the functions of other immune cells, including T cells. We found that calcium signals are required for the development of iTreg cells and that their numbers were strongly reduced in the lungs of infected STIM1-deficient mice. We therefore think that the lack of iTreg cells in the absence of STIM1 contributes to the severe lung inflammation in chronic TB. The third finding that really surprised us was that T cells accumulating in the lungs of STIM1-deficient mice produced large amounts of a protein called interferon gamma. While interferon gamma is required to control Mycobacterium tuberculosis, it is also a very potent promoter of inflammation and too much of it can lead to tissue damage. Dr. Feske and colleagues had previously observed that calcium fluxes promote the production of interferon gamma in T cells cultured in vitro and we expected the STIM1-deficient T cells to be defective in the production of that protein. During chronic TB, however, calcium signaling turned out to be not only dispensable for the production of interferon gamma by T cells but it was actually required to limit its production and thus, to control inflammation. (more…)
Author Interviews, Infections / 05.05.2015

MedicalResearch.com Interview with: Gerardo U. Lopez, M.A.T, M.Ed., Ph.D. Research Associate Soil, Water and Environmental Science The University of Arizona Tucson, AZ 85721 Medical Research: What is the background for this study? What are the main findings? Dr. Lopez: The background for this study was based on the missing data gaps on fomite-to-finger transfer in the literature that could be used as input parameters for Quantitative Microbial Risk Assessments (QMRA). This research was supported by the Center for Advancing Microbial Risk Assessment, funded by the U.S. Environmental Agency’s Science To Achieve Results (STAR) program and the U.S. Department of Homeland Security. Two different studies were conducted: 1st “Transfer Efficiency of Bacteria and Viruses from Porous and Nonporous Fomites to Fingers under Different Relative Humidity Conditions”   Appl. Environ. Microbial. 2013, 79(18):5728 and 2nd “Evaluation of a Disinfectant Wipe Intervention on Fomite-to-Finger Microbial Transfer”. This research was supported by The Clorox Company. Based on the findings of these two studies along with other input parameters drawn from previous studies, we were able to develop a risk assessment that focused on forecasting the exposure to Campylobacter jejuni contaminated surfaces during preparation of chicken fillets and how using a disinfectant wipe intervention to clean a contaminated work area decreases the risk of infection following the preparation of raw chicken fillet in a domestic kitchen. The title of our new publication is “Impact of Disinfectant Wipes on  the Risk of Campylobacter jejuni Infection During Raw Chicken Preparation in Domestic Kitchens” Accepted for publication in Journal of Applied Microbiology. Editor's note: For EPA Registered Disinfectant Wipes The main findings were that the annual risk of C. jejuni infections showed a 99% reduction per person per event from 2 out of 10 to 2 out of 1000. (more…)
Author Interviews, MRSA, NEJM / 20.03.2015

Loren G. Miller, M.D., M.P.H. Los Angeles Biomedical Research Institute (LA BioMed) Infectious Disease SpecialistMedicalResearch.com Interview with: Loren G. Miller, M.D., M.P.H. Los Angeles Biomedical Research Institute (LA BioMed) Infectious Disease Specialist   Medical Research: What is the background for this study? Dr. Miller: Skin and skin structure infections are extremely common reasons for persons to seek medical care in the U.S., accounting for approximately 14.2 million outpatient visits in 2005, the latest year for which statistics are available, and 850,000 hospital admissions. Until this study was completed, the most effective approach to outpatient antibiotic treatment of uncomplicated skin infections in the era of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) was unclear. Prior to this research, there were no data on which antibiotics were best for treatment of these common skin infections. Medical Research: What are the main findings? Dr. Miller: Two antibiotics frequently prescribed to treat serious skin infections - clindamycin and trimethoprim sulfamethoxazole (TMP-SMX) - had similar rates of success in curing uncomplicated infections in outpatients. They also had similar rates of side effects. To conduct the study, we recruited outpatients from emergency departments, clinics and other healthcare facilities associated with Los Angeles County's Harbor-UCLA Medical Center, University of Chicago Medical Center, San Francisco General Hospital and Vanderbilt University Medical Center from May 2009 to August 2011. We studied 524 adults and children with uncomplicated skin infections who had cellulitis, abscesses of 5 centimeters or more or both. In the multicenter, double blind, randomized clinical trial, 264 received clindamycin and 260 received TMP-SMX. We followed the outpatients for a month after their treatment. We found similar outcomes for both groups - 80.3% of the outpatients who received clindamycin and 77.7% of the outpatients in the group that received TMP-SMX were cured within seven to 10 days after the end of their treatment. These are not considered significant differences, so our evaluation is that these two commonly prescribed antibiotics for serious skin infections are similarly effective in treating uncomplicated skin infections in children and adults who have few or no major co-existing conditions. (more…)
Author Interviews, Infections, JAMA, University of Michigan / 17.03.2015

Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MIMedicalResearch.com Interview with: Lona Mody, MBBS, MSc Associate Division Chief, Clinical and Translational Research Associate Director, Clinical Programs, VA GRECC Associate Professor, Internal Medicine Research Associate Professor, Institute of Gerontology University of Michigan Geriatrics Ann Arbor, MI Medical Research: What is the background for this study? What are the main findings? Response: Over 1.5 million residents live in 15,600 Nursing Homes in the US. The acuity of illness in this population has increased substantially in the last decade, as has the risk of acquiring new infections. Multi-drug resistant organisms, also known as MDROs, are endemic in this setting with prevalence estimates upwards of 35% and surpassing those in the hospitals. Nursing homes historically have had few infection prevention resources, which contributes to these high rates. Patients with indwelling devices such as urinary catheters and feeding tubes present an attractive habitat for these ‘superbugs’ and thus carry the added burden of device-related infections. The authors examined the effect of a targeted infection program, or TIP, to reduce the prevalence of Multi-drug resistant organisms and new catheter or feeding tube infections among patients with indwelling devices. The TIP intervention was three-fold:
  1. Surveillance for infections and Multi-drug resistant organism colonization with regular feedback to facilities;
  2. Extensive and interactive staff education using adult learning theory about key infection prevention practices and hand hygiene; and
  3. Use of gowns and gown when providing assistance to patients for high-risk activities such as bathing and grooming.
Staff education emphasized precautionary measures against the spread of infection and included mock game shows, songs and dances. Hands were cultured for bacteria before and after hand washing. Outcomes were measured by results of the cultures taken for each patient and monitoring infection rates. A team of researchers from the University of Michigan and the Veterans Affairs Ann Arbor Health System has demonstrated that simple measures might be all it takes to push back at the spread of Multi-drug resistant organisms or ‘superbugs’ in nursing homes as well as reduce infections. In their study of patients with indwelling devices, MDROs were reduced by 23 percent among 418 residents in six southeast Michigan nursing homes who participated over the course of the three-year study. The numbers of catheter-associated urinary tract infections and MRSA acquisitions also decreased, 46 percent and 22 percent respectively. The trial examined the relationship between acquisition of antimicrobial resistance among nursing home and assisted living facility residents with the use of devices by adapting new methodological approaches and study designs to study infection prevention interventions including the use of cluster-randomized study design for infection prevention interventions, adopting adult learning practices to engage frontline healthcare personnel and using multi-anatomic site sampling to demonstrate effectiveness of the program. (more…)
Annals Internal Medicine, Author Interviews, Infections / 17.02.2015

Robert M Centor, MD, MACP Chair ACP Board of Regents Regional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801 Professor, General Internal Medicine UAB Birmingham, AL 35294-3407MedicalResearch.com Interview with: Robert M Centor, MD, MACP Chair ACP Board of Regents Regional Dean, UAB Huntsville Regional Medical Campus Huntsville, AL 35801 Professor, General Internal Medicine UAB Birmingham, AL 35294-3407 Medical Research: What is the background for this study? What are the main findings? Dr. Centor: European researchers have shown that Fusobacterium necrophorum, an obligate gram-negative anaerobe, likely causes approximately 10% of young adult pharyngitis.  This same organism is the major cause of peritonsillar abscess in the age group (and this age group has the highest rate of peritonsillar abscess).  The organism also causes around 80% of the Lemierre Syndrome.  We knew of no US data evaluating the role of this bacteria as a cause of pharyngitis.  The European studies also did not report the signs and symptoms of Fusobacterium pharyngitis. (more…)
Author Interviews, Heart Disease, Outcomes & Safety, Surgical Research / 23.01.2015

MedicalResearch.com Interview with: Keita Morikane, Director Division of Clinical Laboratory and Infection Control Yamagata University Hospital Medical Research: What is the background for this study? What are the main findings? Response: The risk factors for surgical site infection following cardiac surgery is extensively investigated, but those specifically of open heart surgery or coronary artery bypass remains unknown. The main findings were that the risk factors between the two types of cardiac surgery were considerably different. (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Hospital Acquired, Vanderbilt / 21.01.2015

Michael Noto, MD, PhD Pulmonary and Critical Care Medicine Vanderbilt University Medical CenterMedicalResearch.com Interview with: Michael Noto, MD, PhD Pulmonary and Critical Care Medicine Vanderbilt University Medical Center Medical Research: What is the background for this study? What are the main findings? Dr. Noto: Health care-associated infections are the most common complication for hospitalized patients and several studies have suggested that bathing critically ill patients with the antimicrobial chlorhexidine reduces health care-associated infections.  In the largest study of chlorhexidine bathing to date, however, we were unable to demonstrate a reduction in infections. (more…)
Author Interviews, Toxin Research / 06.01.2015

Rick Vetter (retired) Department of Entomology Univ. Calif. Riverside Riverside, CA 92521MedicalResearch.com Interview with: Rick Vetter   (retired) Department of Entomology Univ. Calif. Riverside Riverside, CA  92521 Medical Research: What is the background for this study? What are the main findings? Response: Regarding the spider toxinology field, many misconceptions have been voiced over the years with statements being made in the medical literature which are tenable sounding explanations offered by well-meaning physicians, however, when given further scrutiny, are not supported by the data.  An example of this is the platitude from years ago (and sometimes still today) that brown recluse spider bites are feasible diagnoses anywhere in North America because the spiders CAN get transported around.  However, these authors never actually show that brown recluse spiders ARE frequently transported around in sufficient numbers such that they are tenable culprits in necrotic skin lesions. The evidence developed in the last decade regarding this situation shows that brown recluses DO NOT get transported often, DO NOT establish extra-indigenous populations often and they are not likely etiologies for necrotic skin lesions outside of their indigenous range.  Similarly, a commonly heard statement over the decades is that spiders are likely vectors of bacterial skin lesions.  Several studies have swabbed the fangs and mouthparts of spiders, found bacteria and proudly proclaim the association between spider bites and bacterial infections.  However, these same authors never actually prove that verified spider bites result in bacterial transfer to humans. This current study was instigated in part due to statements made in the 1990s by the late Dr. Philip Anderson, Missouri dermatologist and brown recluse spider bite expert, that recluse spider bites are never infected even in non-medicated patients.  So if spiders actually can vector bacteria, then a data-mining of the vast literature on spider bites worldwide should show significant bacteria association in the form of infected skin lesions as signs of envenomation.  In contrast, there is almost a complete absence of reports of infection when one examines the thousands of spider bites that include a vast array of medically important spiders including the widows, recluses, armed or wandering spiders of South America, Sydney funnel web spiders, wolf spiders, yellow sac spiders, as well as studies involving a random conglomeration of species.  A mechanism to explain this lack of bacterial vectoring may lie in the fact that the venom of spiders (as well as other venomous animals) has antibacterial and antimicrobial capabilities which may function evolutionarily to prevent bacterial transfer from prey to spider in bites. (more…)
Antibiotic Resistance, Author Interviews, Infections, Science / 04.01.2015

Melanie Blokesch PhD Assistant Professor (tenure-track) Laboratory of Molecular Microbiology Global Health Institute, School of Life Sciences Swiss Federal Institute of Technology Lausanne (EPFL) Lausanne SwitzerlandMedicalResearch.com Interview with: Melanie Blokesch PhD Assistant Professor (tenure-track) Laboratory of Molecular Microbiology Global Health Institute, School of Life Sciences Swiss Federal Institute of Technology Lausanne (EPFL) Lausanne Switzerland Medical Research: What is the background for this study? What are the main findings? Dr. Blokesch: We have been studying the cholera-causing bacterium Vibrio cholerae for many years in my laboratory. Our main focus has always been on elucidating how this pathogen acquires new genetic material that allows it to evolve. This is often accomplished through a mechanism known as horizontal gene transfer (HGT). There are three main modes of horizontal gene transfer in bacteria and the one we are primarily interested in is called natural competence for transformation. When the bacterium enters the state of natural competence it can take up free genetic material from its surrounding and in case it recombines this new material into its own genome the bacterium is considered to be naturally transformed. Notably, natural competence/transformation was first described in 1928 by Fred Griffith, who showed that transformation can render harmless bacteria pathogenic. These early experiments can be considered a milestone in molecular biology as it later led to the discovery of DNA as the carrier of genetic information. Medical Research: What are the main findings? Dr. Blokesch: The main finding of our study is that the pathogen V. cholerae does not solely rely on free DNA floating around but that it actively kills neighbouring bacteria followed by the uptake of their DNA. Indeed, we were able to show that the two processes - killing of other bacteria and DNA uptake - are co-regulated by the same proteins within the bacterial cell. We also used imaging techniques to visualize the killing of other bacteria by V. cholerae, followed by the release of their genetic material, which the predator then pulled into its own cell. We further quantified these HGT events by following the transfer of an antibiotic resistance gene from the killed bacterium to the predatory V. cholerae cell. Notably, the spread of antibiotic resistances is a major health concern and HGT is a major driver of it. (more…)
Author Interviews, Infections, PLoS / 22.12.2014

Leonard A. Mermel DO FACP, FIDSA, FSHEA Professor of Medicine, Warren Alpert Medical School of Brown University and Division of Infectious Diseases, Rhode Island Hospital Providence, Rhode IslandMedicalResearch.com Interview with: Leonard A. Mermel DO FACP, FIDSA, FSHEA Professor of Medicine, Warren Alpert Medical School of Brown University and Division of Infectious Diseases, Rhode Island Hospital Providence, Rhode Island Medical Research: What is the background for this study? What are the main findings? Dr. Mermel: While talking to infectious diseases physicians some years ago in Israel, Greece, and Thailand, I learned that unlike my experiene here in the US, most of the bloodstream infections they see are far and away due to Gram-negative bacteria.  So, a hypothesis was generated, namely that the likelihood of Gram-negative bacteremia compared to Gram-positive bacteremia was greater the closer to the equator.  A writing group was formed, colleagues around the world graciously shared their data.  The main finding is that in fact, we unequivocally found that the likelihood of Gram-negative, compared to Gram-positive bacteremia is more common closer to the equator.  This difference was greatest during the warmer months of the year.  We also found that the % GDP spent on healthcare in a given country is also associated with more Gram-negative than Gram-positive bacteremia.  These findings may reflect differences in the human microbiome as one gets closer or farther from the equator as has been recently demonstrated, differences in survival of Gram-negative compared to Gram-positive bacteria under certain environmental conditions, and likely reflects differences in public health and other factors. (more…)
Author Interviews, Heart Disease, Infections, Lancet / 24.11.2014

MedicalResearch.com Interview with: Dr. Martin Thornhill PhD Department of Cardiology, Taunton and Somerset NHS Trust Taunton, Somerset, UK Medical Research: What is the background for this study? What are the main findings? Dr. Thornhill: In 2008 NICE introduced controversial new guidance recommending that antibiotic prophylaxis to prevent infective endocarditis should no longer be used. It was a rational decision, given the evidence for the effectiveness of antibiotic prophylaxis and potential concerns about costs, the development of antibiotic resistance and possible side effects from antibiotics, but it went against other guidelines from around the world that existed at the time. The main findings are that in England:
  1. There has been a large and significant decline in the use of antibiotic prophylaxis.
  2. There has been a significant increase in the number of cases of infective endocarditis, above the baseline trend, using hospital coding data, corrected for changes in the size of the English population.
(more…)
Author Interviews, Biomarkers, Infections, Nature, UCLA / 19.11.2014

Weian Zhao PhD Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine. Founder of Velox BiosystemsMedicalResearch.com Interview with: Weian Zhao PhD Assistant Professor at the Sue and Bill Gross Stem Cell Research Center, Chao Family Comprehensive Cancer Center, Department of Biomedical Engineering, Edwards Lifesciences Center for Advanced Cardiovascular Technology and Department of Pharmaceutical Sciences at University of California, Irvine. Medical Research: What is the background for this study? Dr. Zhao: Bloodstream infections are a major cause of illness and death. In particular, infections associated with antimicrobial-resistant pathogens are a growing health problem in the U.S. and worldwide. According to the Centers for Disease Control & Prevention, more than 2 million people a year globally get antibiotic-resistant blood infections, with about 23,000 deaths. The extremely high mortality rate for blood infections is due, in part, to the inability to rapidly diagnose and treat patients in the early stages. The present gold standard to detect a blood infections, is a blood culture and it takes 2-5 days for the detection and the identification of the bacteria. Recent molecular diagnosis methods, including polymerase chain reaction, can reduce the assay time to hours but are often not sensitive enough to detect bacteria that occur at low concentrations in blood, as is common in patients with blood infections.  Therefore, less expensive and less technically demanding methods are urgently needed for the rapid and sensitive identification of blood infections. (more…)
Author Interviews, Infections, JAMA / 15.10.2014

Andre Kalil, M.D., M.P.H. Professor of Medicine Director, Transplant ID Program University of Nebraska Nebraska Medical Center Omaha, NE 68198-5400MedicalResearch.com Interview with: Andre Kalil, M.D., M.P.H. Professor of Medicine Director, Transplant ID Program University of Nebraska Nebraska Medical Center Omaha, NE 68198-5400 Medical Research: What are the main findings of the study? Dr. Kalil: In recent years, physicians treating staph infections with vancomycin have seen an increase in the minimum inhibitory concentration (MIC), the lowest concentration of an antimicrobial agent that inhibits the growth of a microorganism. This condition is referred to as vancomycin “MIC creep.” It is an indicator that the bacteria might be developing a reduced susceptibility to vancomycin. There also have been reports suggesting that elevations in vancomycin MIC values may be associated with increased treatment failure and death. To determine the effectiveness of vancomycin and other newer antibiotics used to treat Staphylococcus aureus, the UNMC team analyzed nearly 8,300 episodes of Staphylococcus aureus bloodstream infections from patients around the U.S. and in several other countries. The adjusted absolute risk of mortality among patients with Staphylococcus aureus bloodstream infections with high-vancomycin MIC was not statistically different from patients with Staphylococcus aureus bloodstream infections with low-vancomycin MIC. (more…)
Author Interviews, C. difficile, Gastrointestinal Disease, JAMA / 13.10.2014

Dr. Ilan Youngster, MD, MMSc Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Division of Infectious Diseases, Boston Children’s Hospital Boston, MassachusettMedicalResearch.com Interview with: Dr.  Ilan Youngster, MD, MMSc Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Division of Infectious Diseases, Boston Children’s Hospital Boston, Massachusetts Medical Research: What are the main findings of the study? Dr. Youngster: The main finding is that oral administration seems to be as safe and effective as more traditional routes of delivery like colonoscopy or nasogastric tube. This is important as it allows Fecal microbiota transplantation (FMT) to be performed without the need of invasive procedures, making it safer, cheaper and more accessible to patients. (more…)
Brigham & Women's - Harvard, Infections, Surgical Research / 11.10.2014

Michael S. Calderwood, MD MPH Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston, MAMedicalResearch.com Interview with: Michael S. Calderwood, MD MPH Division of Infectious Diseases Brigham and Women's Hospital Boston, MA Medical Research: What are the main findings of the study? Dr. Calderwood: "In our study, we found that the risk of surgical site infection (SSI) following total hip arthroplasty and coronary artery bypass graft (CABG) surgery is higher for Medicare patients undergoing surgery in U.S. hospitals with lower surgical volume. This suggests that volume leads to experience, and experience leads to improved outcomes." "We found a significantly higher risk of surgical site infection in U.S. hospitals performing <100 total hip arthroplasty procedures and <50 CABG procedures per year on Medicare patients. In the lowest volume hospitals, 1 out of 3 infections following total hip arthroplasty and 1 out of 4 infections following CABG were in excess of expected outcomes based on experience in the highest volume hospitals." (more…)
Antibiotic Resistance, Author Interviews, PNAS / 05.09.2014

MedicalResearch.com Interview with: David T. Fox, Ph.D. Scientist 3 Los Alamos National Laboratory andDavid T. Fox, Ph.D. Scientist 3 Los Alamos National Laboratory and Prof. Samir Mitragotri Center for Bioengineering and Department of Chemical Engineering University of California, Santa Barbara, CA 93106Prof. Samir Mitragotri Center for Bioengineering and Department of Chemical Engineering University of California, Santa Barbara, CA 93106 Medical Research: What are the main findings of this study? Answer: Our research team identified a molten salt, choline-geranate, that possessed multiple beneficial biological traits. Specifically, when mixed in a 1:2 ratio (choline:geranate) this solvent is able to effectively disrupt and neutralize 72-hour biofilms formed by both Pseudomonas aeruginosa and Salmonella enterica. Further, our studies demonstrated the same solvent exhibited minimal cytotoxicity effects to normal human bronchial epithelial (NHBE) cells and was able to deliver an antibiotic, cefadroxil, through the stratum corneum into the epidermis and dermis. Most importantly, the research culminated in demonstrating the molten salt was able to neutralize ~95% of the bacteria found within a 24-hour P. aeruginosa biofilm when grown on a skin wound model (MatTek)  and ~98% of the bacteria when formulated with the antibiotic, ceftazidime. When the biofilm was treated with only antibiotic in a saline solution, less than 20% of the bacteria were neutralized. (more…)
Author Interviews, Hospital Acquired, JAMA, Surgical Research / 28.08.2014

Christopher Mantyh, M.D. Associate Professor of Surgery Chief of Colorectal Surgery NSQIP Surgical Champion Duke University Medical CenterMedicalResearch.com Interview with: Christopher Mantyh, M.D. Associate Professor of Surgery Chief of Colorectal Surgery NSQIP Surgical Champion Duke University Medical Center Medical Research: What are the main findings of the study?  Dr. Mantyh: Specific perioperative bundles can drastically reduce surgical site infections in colorectal surgery patients. (more…)
Author Interviews, Infections, NEJM / 27.08.2014

MedicalResearch.com Interview with: Ziad A. Memish, M.D. Alfaisal University Riyadh Saudi Arabia Medical Research: What are the main findings of the study? Dr. Memish:  This is an important study as we looked at the secondary transmission of MERS-CoV among household/family contacts.  Of the total study population of 280 contacts from 26 clusters collected over 6 months period last year, only 12 family contacts were positive for MERS-CoV. Knowing that 7 (2.5%) were positive by PCR, only additional 5 probable secondary transmission were identified by serology which is a very small fraction missed by PCR. (more…)
Author Interviews, NEJM, Respiratory / 22.08.2014

John DeVincenzo, M.D. Professor of Pediatrics Division of Infectious Diseases Professor of Microbiology, Immunology and Biochemistry University of Tennessee School of Medicine. University of Tennessee. Medical Director, Molecular Diagnostics and Virology Laboratories Le Bonheur Children's Hospital Memphis, TennesseeMedicalResearch.com Interview with: John DeVincenzo, M.D. Professor of Pediatrics Division of Infectious Diseases Professor of Microbiology, Immunology and Biochemistry University of Tennessee School of Medicine. Le Bonheur Children's Hospital Memphis, Tennessee Medical Research: What are the main findings of the study? Dr. DeVincenzo: The main findings are
  • a) This is the first time that anyone has shown that the infection caused by the RSV virus can be effectively reduced in a human after the infection has already started.
  •  b) We also show for the first time that once we reduce the amount of virus in the patient, that very quickly, they start to feel better. This clinical improvement was not expected to occur so rapidly.
  • c) The antiviral appeared safe and it was easy to give.
(more…)
Author Interviews, MRSA / 15.08.2014

dr_kyle_popovichMedicalResearch.com Interview with: Kyle J. Popovich, MD, MS Rush University Medical Center Stroger Hospital of Cook County, Chicago, Illinois   Medical Research: What are the main findings of the study? Dr. Popovich: Colonization with methicillin-resistant Staphylococcus aureus (MRSA) at body sites outside the nares was common, with more than half of all colonized individuals having MRSA colonization in the rectal or groin areas.  Resistance to mupirocin was uncommon and molecular testing showed no signs of resistance to chlorhexidine gluconate. (more…)
Author Interviews, HIV, Infections, Lancet / 27.05.2014

Dr. Duncan ChandaMedicalResearch.com Interview with: Dr. Duncan M. Chanda MD Institute for Medical Research & Training and UNZA-UCLMS Research and Training Project University Teaching Hospital Lusaka, Zambia MedicalResearch: What are the main findings of the study? Dr. Chanda:  The main findings are that in this cohort of relatively healthy patients, with a median CD4 of 367, ART can be delayed till the end of TB short course chemotherapy without deleterious effects. This differs from studies that looked at cohorts with very low median CD4  ( around 25-150 in most cases) in which early cART was found to reduce mortality and other AIDS defining events.   (more…)
Author Interviews, Infections, Stroke / 01.05.2014

Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PTMedicalResearch.com Interview with: Professor Stuart Allan Faculty of Life Sciences, AV Hill Building The University of Manchester Manchester, M13 9PT MedicalResearch.com: What are the main findings of the study? Dr. Allan: Using an experimental model of stroke it was found that animals with preceding Streptococcus pneumoniae infection had a worse outcome than uninfected animals. This confirms and extends previous data, both clinical and preclinical, that systemic inflammation is a key contributor to stroke outcome. Importantly, effects of infection were also demonstrated in animals with co-morbidities associated with stroke (atherosclerosis and age), with outcomes worse than observed in healthy young subjects. Exacerbating effects of infection on stroke are mediated via the pro-inflammatory cytokine, interleukin-1 (IL-1), shown by reversal of the increased ischaemic brain damage and functional impairments by treatment with the IL-1 receptor antagonist (IL-1Ra). Infection also leads to increased platelet activation and microvascular coagulation after stroke, which contributes to the increased injury. Collectively, these data are the first to show, how systemic inflammatory mechanisms induced by one of the most common non-invasive, human S.pneumoniae isolates, lead to critical illness after stroke in different rodent species and strains, and how common stroke comorbidities interact with infection to worsen outcome after stroke. (more…)
Author Interviews, Infections, NIH, Rheumatology / 31.03.2014

MedicalResearch.com Interview with: Eleftherios Mylonakis, M.D., Ph.D., FIDSA Dean's Professor of Medical Science Chief, Infectious Diseases Division Alpert Medical School and Brown University and Dr. Irene Kourbeti MD Research Associate Infectious Disease Division Rhode Island Hospital, Providence, RI MedicalResearch.com: What are the main findings of the study? Answer : There was high quality of evidence that biologic agents are associated with increased risk of all opportunistic infections, but there was no difference in mortality attributed to the opportunistic infections. Patients receiving biologics were twice more likely to develop opportunistic infections (OIs) compared to controls (OR 1.79; 95% CI, 1.17-2.74) with a number needed to harm (NNH) of 582 patients. That means that 1 opportunistic infection  would occur in every 582 patients receiving biologics. The opportunistic infections usually occurred at the commencement of the use of the biological agent and they were not statistically more in patients with a previous exposure to anti-TNF agents as compared to the patients that had never received an anti-TNF agent.. (more…)
Author Interviews, Hand Washing / 28.02.2014

Professor Didier Pittet, MD, MS Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine SwitzerlandMedicalResearch.com Interview with : Professor Didier Pittet, MD, MS Director, Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Switzerland MedicalResearch.com: What are the main findings of the study? Prof. Pittet:  The density of bacterial contamination of the stethoscope’s membrane is closely correlated with the density of bacterial counts on the doctor’s fingertips. This is true for both common skin comensals and multi-resistant nosocomial pathogens such as MRSA. (more…)
Author Interviews, Infections, JAMA, Vaccine Studies / 25.02.2014

Signe Sørup, PhD Research Center for Vitamins and Vaccines (CVIVA) Bandim Health Project, Statens Serum Institut Artillerivej 5, DK-2300 Copenhagen S, DenmarkMedicalResearch.com Interview with: Signe Sørup, PhD Research Center for Vitamins and Vaccines (CVIVA) Bandim Health Project, Statens Serum Institut Artillerivej 5, DK-2300 Copenhagen S, Denmark MedicalResearch.com: What are the main findings of the study? Dr. Sørup: We found that admissions with any type of infection was reduced with 14 % for Danish children having the live, attenuated vaccine against measles, mumps, and rubella (MMR) as the most recent vaccine compared with children having the inactivated vaccine against Diphtheria, Tetanus, Pertussis, Polio, and Haemophilus Influenzae type b (DTaP-IPV-Hib) as the most recent vaccine. In Denmark herd immunity against measles, mumps, and rubella is high and only 26 of the more 42,000 admissions was related to measles, mumps, and rubella; so this finding cannot be explained by the specific protection against the targeted diseases. In Denmark MMR vaccination is recommended at 15 months of age, but only 50% of the children in the study had received MMR before 16 months of age. We estimated that one hospital admission between 16 and 24 months of age could be avoided for 201 children vaccinated with MMR before 16 months of age rather than later. These results are based on a retrospective cohort study including approximately half a million Danish children. The analyses are adjusted for age and a long range of background factors, including socio-economic factors. (more…)
Author Interviews, Infections / 07.10.2013

George Alangaden MD Senior Staff Physician, Transplant Infectious Diseases Medical Director of Infection Prevention Henry Ford Hospital Professor of Medicine, Wayne State University Infectious Diseases, CFP-316 Detroit, MI 48202MedicalResearch.com Interview with: George Alangaden MD Senior Staff Physician, Transplant Infectious Diseases Medical Director of Infection Prevention Henry Ford Hospital Professor of Medicine, Wayne State University Infectious Diseases, CFP-316 Detroit, MI  48202 MedicalResearch.com: What are the main findings of the study? Dr. Alangaden:
  • Infections caused by Mycobacterium marinum infections are rare. A total of 5 patients were identified in our hospital over a 10 year period.
  • In all instances the infection affected the skin and soft tissues of the hand and arm and presented as sores or bumps on the skin that did not improve after usual antibiotic therapy.
  • All patients had an history of some trauma to the hand and subsequent exposure to water  from home aquariums
  • The time to onset of infection after exposure ranged from 11 days to 56 days.
  • The median time from infection to diagnosis and appropriate therapy was 161 days (range 33-379 days).
  • In all cases the diagnosis was made by doing a skin biopsy.
  • All patients were cured after several weeks of treatment with appropriate antibiotics. (more…)
Author Interviews, Infections, PLoS / 11.03.2013

MedicalResearch.com Author Interview: Dr. Donald K. Milton, MD, Dr.P.H dr_donalk_k_miltonDr. Donald K. Milton, MD, Dr.P.H Professor and Director Maryland Institute for Applied Environmental Health University of Maryland MedicalResearch.com: What are the main findings of the study? Dr. Milton: We found that total viral copies detected by molecular methods were 8.8 times more numerous in fine (≤5 µm) than in coarse (>5 µm) aerosol particles and that the fine particles from cases with the highest total number of viral RNA copies contained infectious virus. Surgical masks reduced the overall number of RNA copies by 3.4 fold. (more…)