Highly drug-resistant infections rising among American children

A new review of surveillance data reveals that rates of highly drug-resistant infections are on the increase among children in the United States. The findings reinforce the need for better ways to track, prevent, and treat these serious infections in children and for bolstering stewardship programs.

The researchers came to this conclusion after analyzing a large reference-laboratory database of samples collected from pediatric patients all over the U.S. between 1999-2012. The samples were of an important infection-causing bacteria called Pseudomonas aeruginosa.

P. aeruginosa is a common cause of healthcare-associated infections that can result in prolonged illness, require longer hospital stays, and, ultimately, raise the risk of death.

The researchers report their findings in the Journal of the Pediatric Infectious Diseases Society.

First and corresponding author Latania K. Logan, assistant professor at Rush University Medical Center in Chicago, IL, says:

“Infections with P. aeruginosa can be serious and are associated with significant morbidity and mortality.”

Antibiotics have transformed medicine – they have made it possible to treat once deadly infections and paved the way for advances like transplant surgery and chemotherapy for cancer. They have reduced disease and saved lives.

However, misuse of the drugs has also contributed to the increasing problem of antibiotic resistance, now a serious and growing threat to public health.

Multi-drug resistant P. aeruginosa a ‘serious threat’

The Centers for Disease Control and Prevention (CDC) include antibiotic-resistant P. aeruginosa among the top 18 drug-resistant threats to Americans.

The CDC class multi-drug resistant P. aeruginosa as a serious threat – that is, “not considered urgent” but the threat “will worsen and may become urgent without ongoing public health monitoring and prevention activities.”

Their estimates show 51,000 healthcare-associated P. aeruginosa infections in adults and children occur in the U.S. each year. This includes 6,700 cases where the bacterium is resistant to multiple types of antibiotic, resulting in 440 deaths a year.

The CDC suggest hospital antibiotic stewardship programs should contain the following core elements:

  • Commitment from leaders: dedicate the human, financial, and information technology resources necessary to implement the program

  • Accountability: appoint a single leader responsible for getting results – evidence from successful programs shows this works

  • Drug expertise: appoint a single pharmacist leader who works to improve antibiotic use

  • Action: implement at least one recommended action – such as evaluate the need for continuing treatment after a set period (for example, “antibiotic time-out” after 48 hours)

  • Monitoring: track patterns of drug prescribing and resistance

  • Informing: keep doctors, nurses, and relevant staff up-to-date about antibiotic use and resistance

  • Education: educate clinicians about resistance and optimal prescribing.

Highly resistant P. aeruginosa infections rising in children

However, the researchers behind the new study note that – despite many papers warning about rising national rates of antibiotic resistance – few investigate the trends of drug-resistant P. aeruginosa in children specifically.

They looked at data from a surveillance network of laboratories serving around 300 hospitals across the U.S. The laboratories analyze patient samples of P. aeruginosa for resistance to several types of drugs.

For their analysis, the researchers included data on children aged 1-17 who were in outpatient, inpatient, intensive care unit, and long-term care settings from January 1999 – July 2012. They excluded children under 1 year old and patients with cystic fibrosis.

The researchers found the proportion of P. aeruginosa samples that were resistant to at least three classes of antibiotics – that is, multi-drug resistant – increased from 15.5 percent in 1999 to 26 percent in 2012.

The proportion that were resistant to carbapenems rose from 9.4 percent to 20 percent over the same period. Carbapenems are a class of antibiotic that is considered a treatment of last resort for highly resistant infections.

The researchers found both multi-drug resistant and carbapenem-resistant P. aeruginosa were more common in patients in intensive care units, in children aged 13-17, in respiratory samples, and among patients in the Midwest states (Iowa, Kansas, Minnesota, Missouri, Nebraska, and the Dakotas).

Source : http://www.medicalnewstoday.com/articles/314207.php

Research links father’s gene to baby’s birth weight

Research suggests that expression of the father’s genes enhances a baby’s growth.

A father’s genetic code influences the weight of a baby at birth, according to a new study. The study led by the UCL Institute of Child Health (ICH) suggests that genes inherited from the mother and father regulate a baby’s growth at different times during the pregnancy, to ensure a successful birth as well as the mother’s survival.

Low birth weight is a well-known risk factor for Type 2 diabetes and cardiovascular problems in later life. One group of growth genes of particular interest are the imprinted genes inherited from one’s parents. If the paternal one is expressed, the maternal one is imprinted (silenced) and vice versa.

The ‘parental conflict hypothesis’ suggests that expression of the father’s genes enhances a baby’s growth, improving the success of the paternal genome to be passed on. In contrast, the mother’s genome limits foetal growth, distributing equal resources to each of her offspring, whilst ensuring her own survival post-birth allowing her to reproduce again.

The study, published in the journal PLOS ONE, looked at the relationship between birth weight and the paternally expressed Insulin-like growth factor 2 (IGF2) early in gestation, where IGF2 is a key hormone regulating growth in the womb. Professor Gudrun Moore, lead author at the UCL Institute of Child Health, says most of us think of both the mother’s and father’s genes as having an equal influence on birth weight, but this does not appear to be the case.

“Our study suggests that the two parental genomes may be acting at different times during the pregnancy in order to control the baby’s size. Whilst greater foetal growth appears to be promoted by the father’s genes early on, it must still require careful regulation by the mother to ensure a successful birth,” he said. He added that understanding the genetic basis of foetal growth is of critical importance in the prevention and monitoring of small and low weight babies.

Source: The Indian Express