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Antimicrobial Stewardship Programs: A Call to Action

Over the past 30 years, many multidrug-resistant organisms have emerged across healthcare settings in the United States. At the same time, there has been a dramatic drop in the development and approval of new antibiotics. “The antimicrobial armamentarium has been depleted,” explains Neil Fishman, MD. “As a result, our ability to treat infectious diseases has been severely compromised. Resistant infections are increasing morbidity and mortality while simultaneously increasing healthcare costs.” Research has shown that a multifaceted approach is required to prevent, detect, and control the emergence of antimicrobial-resistant organisms. This includes ensuring that effective and appropriate therapeutic agents are available and that healthcare settings have the diagnostic capacity to rapidly and reliably detect specific pathogens and their antimicrobial susceptibilities. Promoting better infection prevention and control practices and antimicrobial stewardship programs is important in reducing the burden of infectious diseases, Dr. Fishman says. More healthcare facilities nationwide are launching antimicrobial stewardships because they have the potential to reduce the emergence and transmission of resistant pathogens and decrease antimicrobial resistance. A Joint Position Statement on Antimicrobial Stewardship In the April 2012 issue of Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) published a joint position paper focusing on the need for public policy around the issue of antimicrobial stewardship. SHEA, IDSA, and PIDS have been at the forefront of addressing the need for antimicrobial resistance programs for many years, says Dr. Fishman, co-author of the position paper. “Great efforts are needed to improve prevention and control practices throughout the country.” Key Recommendations...

The Role of DPP-4 Inhibitors in Diabetes

Over the past several years, new drugs have emerged to expand our treatment armamentarium for type 2 diabetes, and these products have enhanced our understanding of the pathophysiology of type 2 diabetes. Newer therapies include the incretin class. The development of two products in the this class, glucagon-like peptide-1 (GLP-1) receptor agonists and dipeptidyl peptidase-4 (DPP-4) inhibitors, has demonstrated safe, effective, and beneficial effects that include lower fasting glucose and postprandial glucose, reduction of A1C, and lower risk for hypoglycemia. How DPP-4 Inhibitors Work DPP-4 is an enzyme that degrades endogenous GLP-1. While GLP-1 receptor agonists increase GLP-1 amounts and activity, DPP-4 inhibitors raise endogenous GLP-1 by inhibiting GLP-1 degradation. Levels of DPP-4 are increased by approximately six-fold. This results in increased insulin secretion, as well as a reduction of glucagon stimulation, which then results in improved fasting and postprandial glucose and improvements in A1C. There are currently just a couple of DPP-4 inhibitors available in the United States, but other agents are currently under FDA review. In clinical research, DPP-4 inhibitors have been well tolerated. An important consideration for patients who use these medications is that they are weight neutral and have been associated with a low risk of hypoglycemia. DPP-4 inhibitors are available for once-daily oral administration. This may improve adherence to drug regimens. They are also available in fixed-dosed combination with metformin, which may also be cost-effective and further improve patient adherence. The long-term safety of DPP-4 inhibitors is continuing to accumulate in medical research. Ongoing trials are addressing efficacy of this drug class as well as its role in cardiovascular disease safety. Clinicians should review...

Light Technology Zaps Hospital Superbugs

A lighting system appears to be able to kill hospital superbugs—including MRSA and C. Difficile—by decontaminating the air and exposed surfaces in a narrow spectrum of visible-light wavelengths, known as HINS-light. Clinical trials from the University of Strathclyde in Glasgow, Scotland, have shown that HINS-light significantly reduces bacterial pathogens in the hospital environment than can be achieved by cleaning and disinfection alone. This technology may provide hospitals with an additional effective means to prevent the spread of hospital-acquired infections—a crisis plaguing hospitals around the world. A narrow spectrum of visible-light wavelengths is used to excite molecules contained within bacteria. This in turn produces highly reactive chemical species that are lethal to bacteria, such as meticillin-resistant Staphylococcus aureus and Clostridium difficile. Traditional disinfection and sterilization methods have significant limitations. Unlike other decontamination methods such as those involving gas sterilants or UV-light, HINS-light is harmless to patients and staff. Furthermore, the pervasive nature of light permits the  treatment of air and all visible surfaces, regardless of accessibility, either through direct or reflected exposure to HINS-light within the treated environment. This enables hospitals to continuously disinfect wards and isolation...
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