Antibiotic Locks

I'm finding my self using antiniotic locks more and more. Michael Allon, one of the key investigators who drove the adoption of albuterol for hyperkalemia is a player in this space. Here is one of his convincing studies:

Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen

Must read article on funding for antibiotic resistance

Maryn McKenna writes about NIH funding for highly resistant bacterial infections. The data comes from a poster by Eli Perecevich (Blog) and ML Scweizer.

The investigators looked at funding into Enterobacter species, MRSA and other resistant staph, C. difficile, Acinetobacter baumanii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus faecium as the definition of resistant organism research. In 2009, the NIH spent $398 million. For comparison, in 2007 the NIH spent $1.24 billion dollars on HIV research.

Perecevich and Scweizer then compared the mortality from the different diseases and the relative amount of money spent on them (see graph at right).

Though 95% confidence intervals or P values were not provided, the difference appears significant.

The easy explanation is to blame the politics of AIDS. HIV infection, like breast cancer, is a disease with a well organized and loud constituency and they have labored hard to get funding. Unfortunately that funding comes at the expense of other diseases that may be less visible despite having equivalent impact.

The other cynical answer is to blame capitalism. The fact that HIV treatment is lifelong makes it very profitable for drug companies to focus their research on anti-viral treatment, especially compared to acute bacterial infections that may require only 10 days of treatment. I have secondhand knowledge that in the world venture financed early drug research this is very important, however, these are NIH dollars, which should not be influenced by potential profit.

I think the answer is that the market for drug resistant infection is driven by the availability of good grant requests and interested researchers. For 30 years the best and brightest ID researchers have been going into HIV research, it will take a while to turn that battleship to other areas of interest. Supporting this theory is the fact that research on resistant organisms increased from $180 million to $398 million from 2007 to 2009. So interest and money are being directed to this field but it will take time.

This post from Dr RW is great

Must read post about a recent Lancet paper comparing outcomes for patient treated for health care associated pneumonia (HCAP) and looked at outcomes based on adhering or non-adhering to the ATS and IDSA guidelines.

Spoiler alert: patients treated off guidelines did better.

New Virus. Killing people. Scarrier than Lehman Brothers.

These emerging viral illnesses always scare the crap out of me. From the WHO:

13 October 2008 -- The results of tests conducted at the Special Pathogens Unit, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service in Johannesburg, and at the Special Pathogens and Infectious Disease Pathology branches of the Centers for Disease Control in Atlanta, USA, provide preliminary evidence that the causative agent of the disease which has resulted in the recent deaths of 3 people from Zambia and South Africa, is a virus from the Arenaviridae family.

Analysis continues at the NICD and CDC in order to characterize this virus more fully. CDC and NICD are technical partners in the Global Outbreak Alert and Response Network (GOARN).

Meanwhile, a new case has been confirmed by PCR in South Africa. A nurse who had close contact with an earlier case has become ill, and has been admitted to hospital. Contacts have been identified and are being followed-up

Love the name GOARN. Reminds me of the alien Kirk had to battle mano-a-mano.