Point-of-Care Optics Helps Halt the Spread of Infectious Diseases


Optical technologies offer an accurate, rapid, and low-cost approach to diagnosing infectious diseases non-invasively.


Early diagnosis is the critical starting point to a better outcome for a patient. It allows effective treatment to start earlier, giving the patient the best possible prognosis. Prompt diagnosis also reduces the potential spread of infection, significantly lowering health care costs.

Medical experts and health care companies around the world recognize the value of developing ways to diagnose infectious diseases noninvasively at the point of care (POC), particularly in developing countries and rural areas where medical screening can be nonexistent. Many believe that readily available optical componentry that can be scaled up for volume production provides the best route to success.“I’ve worked on optical spectroscopy-based noninvasive diagnostics for over 20 years, and application of my experience in this arena to infectious diseases was an opportunity that presented itself in 2014,” said John Maynard, vice president of product management at Avisa Pharma. “I was intrigued by the potential of a rapid, noninvasive, POC test to improve detection of lung infections and to better target antibiotics to treat these infections.”

"I was intrigued by the potential of a rapid, noninvasive, point-of-care test to improve detection of lung infections and to better target antibiotics to treat these infections."   --John Maynard, Avisa Pharma

Lung infections such as pneumonia are particularly deadly among the very young, very old, and patients with compromised immune systems. According to the World Health Organization (WHO), pneumonia kills 1.8 million children under the age of 5 every year. It kills more children than any other illness, in every region of the world. In spite of its huge toll, relatively few global resources are dedicated to tackling this killer.

Currently, the gold standard for detecting the cause of a pneumonia infection is to culture a sputum sample and see what grows. This process is highly dependent on getting a good sample that specifically comes from the part of the lung with the infection. But transporting and preparing the sputum for culture without contamination is challenging. And 24 to 72 hours are required to grow the cultures before a pathologist can determine the causative pathogens.

“The long time to an answer means doctors must treat patients empirically because they don’t know the cause of the infection,” Maynard said. “In contrast, the Avisa breath test for certain virulent urease respiratory pathogens measures the entire lung and does not require sputum, delivering a result in 10 minutes.”

The test works by detecting labeled CO2 emitted by bacteria that metabolize in urea in the breath of patients. First, a patient provides a baseline breath sample to establish their natural ratio of 13CO2 (the label) to 12CO2. Then, a nebulized mist of 13C urea is delivered to the lungs. In normal health, a person exhales around 20 times more 12CO2 than 13CO2, but if the patient’s lungs are infected with virulent bacteria that metabolize in urea, there will be relatively more 13CO2.

Measuring the difference in the ratio of 13CO2 to 12CO2 in the baseline and postnebulized samples can determine if a lung infection is caused by urease, avirulence factor found in several pathogenic bacteria. The Avisa instrument uses an NIR vertical-cavity surface-emitting laser (VCSEL) that is scanned over the 13CO2 and 12CO2 absorption peaks using wavelength modulation spectroscopy. From this, the difference in the ratios, known as the delta over baseline, can be determined. The entire procedure takes less than 10 minutes and provides the doctor with immediate information as to whether the pneumonia is caused by a virulent urease pathogen to allow better informed decisions on antibiotic use and choice.

 This laser-based breathalyzer comprises a single-use disposable cough sample collection tube and a bio-optical sensor with a patented biochemical coating formulated to react with the TB bacilli. Courtesy of Rapid Biosensor Systems.

This laser-based breathalyzer comprises a single-use disposable cough sample collection tube and a bio-optical sensor with a patented biochemical coating formulated to react with the TB bacilli. Courtesy of Rapid Biosensor Systems.

“Urease pathogens tend to be more virulent than the more common Streptococcus bacteria that cause pneumonia and require powerful, broad-spectrum antibiotics for effective treatment,” Maynard said. “Today, most doctors use empiric therapy to prescribe antibiotics for pneumonia, resulting in overuse that can lead to unnecessary hospitalizations, increasing antimicrobial resistance, and changes to the patient’s gut microbiome that can have longer-term health implications, including secondary C. difficile infection and metabolic changes.” Despite long regulatory review processes associated with any medical technology, Maynard said that several cost-effective optical-based devices that diagnose disease noninvasively could come to market in the next five years. Tuberculosis breathalyzer One such example is for detecting tuberculosis (TB). U.K.-based Rapid Biosensor Systems Ltd. has developed a laser-based breathalyzer that detects a specific antigen — as opposed to a byproduct of the disease. This specificity, the company says, is over 95 percent accurate and could help to contain the spread of the disease, which many thought was in decline.

 Tuberculosis is one of the world’s most serious public health problems, killing more adults than any other single infectious disease. U.K.-based Rapid Biosensor Systems has developed a laser-based breathalyzer that detects a specific antigen in a bid to contain the growing prevalence of this “old” disease. Courtesy of Rapid Biosensor Systems.

Tuberculosis is one of the world’s most serious public health problems, killing more adults than any other single infectious disease. U.K.-based Rapid Biosensor Systems has developed a laser-based breathalyzer that detects a specific antigen in a bid to contain the growing prevalence of this “old” disease. Courtesy of Rapid Biosensor Systems.

According to the WHO, previously common diseases such as TB have recently re-emerged, driven by various social factors, and pose a significant threat to world health. TB is spread through the air by an infected cough, sneeze, or spit. There are 8.8 million active cases diagnosed each year, and almost 2 million of those infected die. Despite effective drugs against TB, it remains one of the world’s most serious public health problems, killing more adults than any other single infectious disease.

The problem has been made worse because new strains of multidrug-resistant TB have added further pressure on health care systems. “There was, and still is, an unmet medical need for a very fast, low-cost, noninvasive test to detect active TB at the POC,” said Dennis Camilleri, CEO of Rapid Biosensor Systems. “The WHO had predicted this need because if TB can be screened quickly, while people wait two minutes for a result, then the positives can be treated sooner, thus minimizing the spread of this killer disease and ultimately reducing health costs.”

‘The emerging market economies need low-cost medical tests for infectious diseases if they are to reduce mortality, but there must be a willingness from governments to implement medical screening at the point of care.’—Dennis Camilleri, Rapid Biosensor Systems Ltd.

The Breath Analyser unit from Rapid Biosensor Systems comprises a single-use
disposable cough collection tube in which the sample is made up of the ?ne liquid
droplets produced by coughing. After being nebulized using a 0.9 percent saline
solution, the patient coughs into the collection tube. At the bottom of it is a bio-optical sensor with a biochemical coating formulated to react with the TB bacilli. A push-and-twist action seals the aerosol sample in the tube, causing the droplets to collect on the biosensor.

 Avisar laser spectrometer for measurement of 13CO2 to 12CO2 ratio in exhaled breath collected with the AvisarLink, which is currently in clinical trials. Courtesy of Avisa Pharma.

Avisar laser spectrometer for measurement of 13CO2 to 12CO2 ratio in exhaled breath collected with the AvisarLink, which is currently in clinical trials. Courtesy of Avisa Pharma.

“With breath-based antigen tests, the actual infection antigen/bacilli in a cough sample is being detected and not a byproduct of TB,” Camilleri said. “In our case, we use [an] evanescent wave optical sensor with a proprietary biocoating that detects the change in optical fluorescence signal caused by the presence of the TB bacilli.” With its portable, easy-to-use, disposable, and speedy TB Breathalyser, Rapid Biosensor Systems hopes that uptake in developing countries, in particular, will help to contain further spread of the disease. As ever, cost is the biggest challenge. But it’s one that Camilleri hopes will be surmountable should sufficient investment be made available to scale up production.

 Pneumonia patient breathing through AvisarLink nebulizer and breath collection kit. The AV-U13 drug is delivered to the lungs as a nebulized mist using the Aerogen Solo mesh nebulizer mated to the Aerogen Ultra adapter. Exhaled breath is sampled from the chamber attached to the Ultra adapter at the baseline and postnebulization. Courtesy of Avisa Pharma.

Pneumonia patient breathing through AvisarLink nebulizer and breath collection kit. The AV-U13 drug is delivered to the lungs as a nebulized mist using the Aerogen Solo mesh nebulizer mated to the Aerogen Ultra adapter. Exhaled breath is sampled from the chamber attached to the Ultra adapter at the baseline and postnebulization. Courtesy of Avisa Pharma.

“The emerging market economies need low-cost medical tests for infectious diseases if they are to reduce mortality, but there must be a willingness from governments to implement medical screening at the POC,” he said. “Optical/photonics is a volume business: The higher the volume, the lower the cost of materials, which will meet the cost targets proposed by the WHO for tests of this kind.” Gastrointestinal diseases Infectious diseases within the gastrointestinal tract are notoriously tricky to diagnose, as they are often associated with nonspecific symptoms, such as obscure gastrointestinal bleeding, diarrhea, and bloating. Because of its length and position in the digestive system, the small intestine can be very challenging to reach and visualize, often requiring an invasive procedure during which the patient needs to be sedated. But a new device with four minicameras that can be swallowed by the patient could offer a much less invasive alternative. The CapsoCam Plus capsule endoscope from California-based medical device innovator CapsoVision provides a comprehensive 360° view of the patient’s digestive tract without the need for the patient to be sedated. The procedure itself is pain-free.

 CapsoCam Plus capsule endoscope contains four cameras that capture high-resolution images at a maximum 20 fps. Courtesy of CapsoVision.

CapsoCam Plus capsule endoscope contains four cameras that capture high-resolution images at a maximum 20 fps. Courtesy of CapsoVision.

“Patients don’t have to wear bulky external equipment during the examination, and they don’t have to return to the physician’s office once the examination is complete,” said Elina Jaime, product manager at CapsoVision. “The procedure is completely wire-free, which also saves time for the staff and eliminates scheduling bottlenecks while reducing valuable exam room time.” The capsule is approximately the size of a vitamin pill and can be swallowed with a few sips of water. With four lateral, onboard cameras that capture high-resolution, 360° images, CapsoCam Plus provides a detailed examination of the mucosal surface, including a look at areas behind mucosal folds. “Through advances in optics, we are able to place four high-resolution cameras around the circumference of the capsule to capture a full 360-degree view of the gastrointestinal tract,” Jaime said. “These cameras capture high-resolution images at a maximum frame rate of 20 fps — 5 fps per camera.”

 Through advanced optical technology, CapsoCam Plus captures a full 360° view of the gastrointestinal tract, providing physicians with more detailed imaging and a larger vertical field of view. Courtesy of CapsoVision.

Through advanced optical technology, CapsoCam Plus captures a full 360° view of the gastrointestinal tract, providing physicians with more detailed imaging and a larger vertical field of view. Courtesy of CapsoVision.

Two of the most important features embedded in the capsule are the Smart Motion Sense technology and the onboard storage system. Smart Motion Sense takes pictures only when the capsule is in motion, which reduces image redundancy and physician review time. The onboard storage capabilities allow the capsule to operate without transmitting radio frequency waves, making it safe for use in patients with implantable devices such as pacemakers and insulin pumps. The capsule can be used for diagnostic purposes and to visualize post-treatment changes in the patient’s digestive tract to assess the effectiveness and success of treatment. Outside the United States, the CapsoCam Plus video capsule system is intended for visualization of the small bowel mucosa in patients ages 2 and above. It may be used as a tool in the detection of abnormalities of the small bowel. In the United States, the CapsoCam Plus video capsule system is intended for visualization of the small bowel mucosa in adults. It may be used as a tool in the detection of abnormalities of the small bowel.

'Nightmare bacteria' are trying to spread in the U.S., CDC says

Aggressive testing at hospitals and clinics can stop superbugs

by Maggie Fox / Apr.03.2018 / 10:03 AM ET / Updated Apr.04.2018 / 5:21 PM ET /NBC News

“Nightmare bacteria” with the power to resist most antibiotics are popping up across the U.S., but new, aggressive policies can help stop them from spreading, federal health officials said Tuesday.

A new program for testing suspect bacteria turned up unusual antibiotic-resistance genes 221 times in 2017, the Centers for Disease Control and Prevention reported. And 11 percent of people screened for these superbugs carried them, even though they had no symptoms, the CDC said.

“CDC’s study found several dangerous pathogens, hiding in plain sight, that can cause infections that are difficult or impossible to treat,” said the CDC’s Dr. Anne Schuchat. “While they are appearing all over the place, an aggressive approach can snuff them out.”

Antibiotic-resistant germs kill more than 23,000 Americans a year. They evolve quickly, developing mutations that let them evade the effects of antibiotics. If they are not stopped fast, they spread. Worse, the antibiotic-resistant DNA can be carried in little cassettes of genetic material called plasmids that bacteria can slip in their entirety to one another and to other species of bacteria.

It’s already happened several times in the U.S. — and when one superbug gives new powers to a different superbug, the result can be an infection that is impossible to treat.

“Once antibiotic resistance spreads, it is harder to control—like a wildfire,” the CDC said in a statement.

The World Health Organization has labeled antibiotic resistance a “fundamental threat” to humanity.

The CDC tried out a new system aimed at quickly identifying these superbugs. They’ve helped staff up state health departments and labs to speedily test samples so that hospitals, clinics and other facilities can rapidly isolate patients infected with them.\

“We were able to put 500 additional staff across the country to help with this,” Schuchat told NBC News.

The results were sobering. One in four of the samples sent in carried superbug genes, the CDC team reported. When the facilities involved looked further, they found 11 percent of seemingly unaffected people screened carried such germs without having any symptoms.

“This means the germ could have spread undetected in that health care facility,” the CDC said.

That is what has been happening for decades with all sorts of infections, from methicillin-resistant Staphylococcus aureus (MRSA) to killer Clostridium difficile infections.

Inappropriate overuse of antibiotics is and has been a major factor, said Dr. Lance Price, who directs the Antibiotic Resistance Action Center at George Washington University.

“Healthy people will carry these bugs without symptoms,” said Price, who was not involved in the CDC study. “We can spread them to susceptible people. We can become almost like a human mosquito, spreading these germs.”

Healthy people can unknowingly transmit the germs to a cancer patient, someone getting an organ transplant, a vulnerable newborn or a frail elderly person. That’s when an infection can take hold and kill.

“What the CDC is highlighting is the need, once you identify people carrying these bugs, to screen them and also their contacts to make sure they haven’t passed these bugs,” Price said.

The CDC tested for two of the best-known superbug germs: carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Pseudomonas aeruginosa (CRPA) bacteria.

They compared the new strategy to a more limited approach aimed at fighting another type of bacteria that resist antibiotics called extended-spectrum beta-lactamases (ESBLs). The more assertive approach worked better.

“We have seen that an aggressive strategy is needed and it works well,” Schuchat said.

The intensive approach is expensive and time-consuming. It calls for rapid identification of resistance, something that itself requires a specialized lab. Then the affected clinic, hospital or nursing home has to make an infection control assessment and test patients without symptoms who may carry and spread the germ.

“The strategy requires a coordinated response among health care facilities, labs, health departments and CDC through the Antibiotic Resistance Lab Network," the CDC said.

“This is a very aggressive approach but containment of new resistance germs is really important," Schuchat added. "Otherwise we could see these new nightmare bacteria become very common and essentially untreatable.”

Funding is key, said Dr. Paul Auwaerter, president of the Infectious Diseases Society of America.

"The efforts detailed in the Vital Signs report were made possible through new congressional funding in 2016 to combat antibiotic resistance," Auwaerter said. "We urge Congress to sustain and to grow that investment so that further progress will prepare us to meet the future challenges of antibiotic resistance from a position of strength."

Price said it is already difficult to get doctors, hospitals and clinics to implement other programs that work, which include regular hand washing and disinfection, as well as testing and the appropriate use of antibiotics.

“I am a fan of what they are proposing to do,” he said.

But it will do little to catch superbugs that are already spreading in communities.

“I think what we need to do is not always wait for somebody to get sick. We need an active surveillance system,” Price said.

Plus, doctors need to do the right thing when people do turn up sick.

“They should be getting a culture before they write a prescription for an antibiotic,” he said.

But doctors are not using the quick tests that already exist.

“We need point-of-care tests, so that people can get that answer while they still at the doctor. Until payers start paying for these tests, no one is going to develop them,” Price said.

In the meantime, doctors who want good ratings give patients what they demand: a prescription, even though antibiotics do not help viral infections and are helping drive the evolution of superbugs.

“Nobody is writing a five-star review for that doctor who is a really good steward of antibiotics,” Price said.

Diagnosing Antimicrobial Resistance

Diagnosing antimicrobial resistance

Carey-Ann D. Burnham, Jennifer Leeds, Patrice Nordmann, Justin O’Grady and Jean Patel


Antimicrobial resistance constitutes a global burden and is one of the major threats to public health. Although the emergence of resistant microorganisms is a natural phenomenon, the overuse or inappropriate use of antimicrobials has had a great effect on resistance evolution. Rapid diagnostic tests that identify drug-resistant bacteria, determine antimicrobial susceptibility and distinguish viral from bacterial infections can guide effective treatment strategies. Moreover, rapid diagnostic tests could facilitate epidemiological surveillance, as emerging resistant infectious agents and transmission can be monitored. In this Viewpoint article, several experts in the field discuss the drawbacks of current diagnostic methods that are used to identify antimicrobial resistance, novel diagnostic strategies and how such rapid tests can inform drug development and the surveillance of resistance evolution.

Full article

Diagnostics Makers Encouraged to Help Fight Antimicrobial Resistance

Posted in IVD by Daphne.Allen on June 26, 2017

Education and additional rapid diagnostics are needed to help save lives, say advocates.

Daphne Allen

Deaths from antimicrobial resistance (AMR) could reach 10 million annually by 2050, fears a new industry alliance. Diagnostics manufacturers (along with those developing pharmaceutical and biotechnology products) have an important role to play in combating AMR, and these industries have formed an alliance to support such work.

Antibiotics may be losing their effectiveness faster than newer ones are being introduced, reported the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) last year as these industries came together at the World Economic Forum in Davos in 2016 to begin formulating an action plan.

The AMR Industry Alliance officially kicked off this May, when IFPMA Director-General Thomas Cueni announced its launch at the B20 Health Conference in Berlin. “It is estimated that, unless action is taken, the burden of deaths from antimicrobial resistance could be as high as 10 million lives each year by 2050 – more than cancer,” claimed the alliance in a May 17 news statement marking the launch. 

AdvaMedDx joined the alliance as a board member to raise awareness about diagnostics along with bioMerieux and Labcorp. “Diagnostics play a critical role in any strategy to fight AMR,” Tharini Sathiamoorthy, the Vice President of AdvaMedDx, told Qmed. “Diagnostics can help distinguish between infections that require antibiotic treatment and those that do not.”

The challenge is that diagnostics are often overlooked, she said. “Rapid diagnostic tests are available,” she said, but “one issue we have is that healthcare providers don’t always know about them.”

In addition, “a number of tests are being underutilized primarily because of reimbursement issues,” she added. “There are few incentives to use them under private insurance or CMS. The economic piece on why they should be reimbursed should be improved.”

AdvaMedDx encourages diagnostics manufacturers to raise awareness of these issues and to focus on education. “Speak up and go to events and conferences with other stakeholders,” she advised. “Make sure discussions include diagnostics, particularly at the Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria and the World Health Organization.”

There is also more work to be done in diagnostics development. “One test that is needed is a rapid diagnostic test to determine whether an infection is bacterial or viral,” Sathiamoorthy said.

AdvaMedDx is also embarking on its own separate initiative to fight AMR, a global commitment it announced in January 2017 to drive adoption of diagnostics tests, she added.

In the meantime, the AMR Alliance is developing a set of metrics to gauge progress since more than 100 companies and trade associations came together in Davos in 2016. A progress report is expected to be available in January 2018. The pharma industry also established its own roadmap for a common set of principles for global action that focus on reducing the development of antimicrobial resistance, investing in R&D to meet public health needs, and improving access to antibiotics, vaccines, and diagnostics.

[Image source: Evgeny Atamanenko/Shutterstock]

Daphne Allen is executive editor of Pharmaceutical & Medical Packaging News and a contributor to Qmed. Reach her at daphne.allen@ubm.com and on Twitter at @daphneallen


Drug-resistant ‘nightmare bacteria’ show worrisome ability to diversify and spread

For immediate release: Monday, January 16, 2017

Boston, MA – A family of highly drug-resistant and potentially deadly bacteria may be spreading more widely—and more stealthily—than previously thought, according to a new study from Harvard T.H. Chan School of Public Health and the Broad Institute of MIT and Harvard. 

Researchers examined carbapenem resistant Enterobacteriaceae (CRE) causing disease in four U.S. hospitals. They found a wide variety of CRE species. They also found a wide variety of genetic traits enabling CRE to resist antibiotics, and found that these traits are transferring easily among various CRE species. The findings suggest that CRE is more widespread than previously thought, that it may well be transmitting from person to person asymptomatically, and that genomic surveillance of this dangerous bacteria should be increased.

The study was published online January 16, 2017 in PNAS (Proceedings of the National Academy of Sciences)

“While the typical focus has been on treating sick patients with CRE-related infections, our new findings suggest that CRE is spreading beyond the obvious cases of disease. We need to look harder for this unobserved transmission within our communities and healthcare facilities if we want to stamp it out,” said William Hanage, associate professor of epidemiology at Harvard Chan School and senior author of the study.

CRE are a class of bacteria that is resistant to multiple antibiotics, including carbapenems, which are considered last-resort drugs when other antibiotics have failed. CRE, which tend to spread in hospitals and long-term care facilities, cause an estimated 9,300 infections and 600 deaths in the U.S. each year, according to the U.S. Centers for Disease Control and Prevention—and incidence is on the rise. CDC director Tom Frieden has called these ‘nightmare bacteria’ because they are resistant to some of the last-ditch treatments available to doctors battling resistant infections. 

The researchers looked at about 250 samples of CRE from hospitalized patients from three Boston-area hospitals and from one California hospital. Their goal was to obtain a snapshot of the genetic diversity of CRE, to define the frequency and characteristics of outbreaks, to find evidence of strains being transmitted within and between hospitals, and to learn how resistance is being spread among species. Previous studies have typically examined just one outbreak at a time.

Researchers found what Hanage termed a “riot of diversity,” both among CRE species and among carbapenem resistance genes. They also found that resistance genes are moving easily from species to species, contributing to a continually evolving threat from CRE.

In addition, the researchers found resistance mechanisms that hadn’t been seen before—implying that there are more to be discovered. The finding highlights the need for vigilance in searching for as yet unknown forms of resistance as they evolve and emerge. 

“The best way to stop CRE making people sick is to prevent transmission in the first place,” said Hanage. “If it is right that we are missing a lot of transmission, then only focusing on cases of disease is like playing Whack-a-Mole; we can be sure the bacteria will pop up again somewhere else.” 

Lead authors were Gustavo Cerqueira and Ashlee Earl of the Broad Institute of Harvard and MIT. Yonatan Grad, assistant professor of immunology and infectious diseases at Harvard Chan School, was a co-author of the study.

Funding for the study came from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN272200900018C and Grant Number U19AI110818 to the Broad Institute. YHG was supported by K08AI104767 and JEK was supported by R21AI112694 and R21AI119114 from the NIH/NIAID. JLRC was supported by CAPES fellowship, process 99999.010768/2014-09. 

“Multi-institute analysis of carbapenem resistance reveals remarkable diversity, unexplained mechanisms and limited clonal outbreaks,” Gustavo C. Cerqueira, Ashlee M. Earl, Christoph M. Ernst, Yonatan H. Grad, John P. Dekker, Michael Feldgarden, Sinéad B. Chapman, João L. Reis-Cunha, Terrance P. Shea, Sarah K. Young, Qiandong Zeng, Mary L. Delaney, Diane Kim, Ellena M. Peterson, Thomas F. O’Brien, Mary J. Ferraro, David C. Hooper, Susan S. Huang, James E. Kirby, Andrew B. Onderdonk, Bruce W. Birren, Deborah T. Hung, Lisa A. Cosimi, Jennifer R. Wortman, Cheryl I. Murphy, William P. Hanage, PNAS, online January 16, 2017, doi: 10.1073/pnas.1616248114

Visit the Harvard Chan website for the latest newspress releases, and multimedia offerings.

For more information:

Karen Feldscher

photo: CDC


Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.


Medscape: Use of Broad Spectrum Antibiotics on the Rise

Use of Broad-Spectrum Antibiotics Rising

Nicola M. Parry, DVM

September 20, 2016

Overall rates of antibiotic use in US hospitals remained unchanged from 2006 to 2012, according to a new study. However, use of certain antibiotic classes, including some broad-spectrum antibiotics, has increased significantly.

James Baggs, PhD, from the Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues published the results of their study online September 19 in JAMA Internal Medicine.

"There were significant decreases in fluoroquinolones (20%) and first- and second-generation cephalosporins (7%) usage, but these decreases were offset by significant increases in vancomycin (32%) and agents with broad-spectrum activity against gram-negative bacteria, including carbapenem (37%), third- and fourth-generation cephalosporin (12%), and β-lactam/β-lactamase inhibitor combination antibiotics (26%)," the authors write. "Despite substantial reduction in fluoroquinolone use, this class remained the most commonly used antibiotic class in US hospitals in 2012."

Promotion of appropriate antibiotic use in the United States has become a national priority to address the public health implications associated with rising bacterial resistance to antibiotics. As a consequence, the National Strategy for Combating Antibiotic-Resistant Bacteria was released by the US government as an executive order that aims to control the problem of resistance.

Antibiotic use surveillance plays a key role in this strategy, as well as within hospital antibiotic stewardship programs identified by the Centers for Disease Control and Prevention.

"A better understanding of antibiotic use in US hospitals can inform stewardship efforts by identifying targets for reducing inappropriate or unnecessary prescribing," the authors note.

However, previous national surveys of antibiotic use in hospitals have been limited by diversity in patient populations and hospital facilities.

Therefore, in the current study, Dr Baggs and colleagues analyzed data from the Truven Health MarketScan Hospital Drug Database to estimate adult and pediatric inpatient use of antibiotics in the United States. Their analysis comprised data from approximately 300 hospitals and more than 34 million discharges, from January 1, 2006, to December 31, 2012.

Across all study years, the authors found that 55.1% of patients received at least one dose of antibiotics during a hospital stay, and the overall national days of therapy (DOT) was 755 per 1000 patient-days.

The analysis showed that overall antibiotic use did not change significantly over time (total DOT increase, 5.6; 95% confidence interval [CI], −18.9 to 30.1; P = .65).

Nevertheless, the authors identified important trends within individual antibiotic classes, including significant decreases in the use of fluoroquinolones, aminoglycosides, first- and second-generation cephalosporins, sulfa antibiotics, metronidazole (P < .001 for all), and penicillins (P = .01), with the greatest decrease seen among fluoroquinolones.

However, they also found significant increases in the use of third- and fourth-generation cephalosporins, 10.3 (95% CI, 3.1-17.5); macrolides, 4.8 (95% CI, 2.0-7.6); glycopeptides, 22.4 (95% CI, 17.5-27.3); β-lactam/β-lactamase inhibitor combinations, 18.0 (95% CI, 13.3-22.6); carbapenems, 7.4 (95% CI, 4.6-10.2); and tetracyclines, 3.3 (95% CI, 2.0-4.7).

"Our study is the first, to our knowledge, to provide national estimates of temporal trends in antibiotic use among US hospitals," the authors write, adding that this is the largest study of antibiotic use in US hospitals to date, including a wide variety of hospital types.

They also acknowledge the study's limitations, including its reliance on administrative data, which probably contained some misclassified pharmacy, clinical, and facility information.

Dr Baggs and colleagues emphasize concern about increasing use of some broad-spectrum antibiotics, and note that analyzing patterns of antibiotic use in US hospitals may have important implications for combating resistance to antibiotics.

"Our findings can help inform national efforts to improve antibiotic use by suggesting key targets for improvement interventions," the authors conclude.

Overuse Is a Psychological Problem

In an accompanying editorial, Ateev Mehrotra, MD, MPH, and Jeffrey A. Linder, MD, MPH, from Harvard Medical School, Boston, Massachusetts, stress that overuse of antibiotics is largely a psychological problem, not a knowledge problem or a diagnostic problem.

"We, as physicians, want to appear capable to our patients and not give the impression they have wasted either our time or their own," they say. "In addition, it feels easier for us as physicians to do something now rather than wait for a problem to arise."

To help reduce inappropriate antibiotic prescribing, Dr Mehrotra and Dr Linder therefore suggest three strategies. First, instead of describing antibiotic prescribing as a public health concern, they suggest presenting it as an individual patient concern: clinicians should inform patients that the harms of antibiotic use include rashes, diarrhea, Clostridium difficile infection, and harboring antibiotic-resistant bacteria for a time.

Second, they also recommend greater use of social psychology and behavioral science strategies to reduce antibiotic overprescribing. "Order entry systems that force physicians to provide a publically visible justification for prescription reduced inappropriate antibiotic prescribing from 23% down to 5%," the editorialists say. Similarly, peer comparison feedback, including informing clinicians when they are "not a top performer," makes them think about their professional reputation when they prescribe an antibiotic. In one study, "[s]uch feedback reduced inappropriate antibiotic prescribing from 20% to 4%," they add.

Third, they recommend preventing ambulatory visits whenever possible, describing office visits for colds, for example, as "wasteful, error-prone events." Instead, patients' use of self-triage Internet tools or smartphone apps could avoid many inappropriate antibiotic prescriptions.

Although clinician education and new diagnostics may help reduce the growing problem of antibiotic resistance, Dr Mehrotra and Dr Linder emphasize the need to recognize the emotional factors that drive clinicians to inappropriately prescribe antibiotics. "Future interventions need to counterbalance these factors using tools from behavioral science to reduce the use of inappropriate antibiotics," they conclude.

This study was funded by the Centers for Disease Control and Prevention. The authors and editorialists have disclosed no relevant financial relationships.

JAMA Intern Med. Published online September 19, 2016. Article full textEditoral extract

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Cite this article: Use of Broad-Spectrum Antibiotics Rising. Medscape. Sep 20, 2016.

Use of Broad-Spectrum Antibiotics Rising

A newly published Centers for Disease Control and Prevention study in JAMA Internal Medicine shows that while overall use of antibiotics is unchanged in U.S. hospitals, there has been a significant shift to increased use of broad-spectrum antibiotics.  Overuse of broad-spectrum antibiotics is believed to contribute to the crisis of antimicrobial resistance. The full article can be found here.

UN meeting tackles the 'fundamental threat' of antibiotic-resistant superbugs

The UN secretary general, Ban Ki-moon, said antimicrobial resistance is a “fundamental threat” to global health and safety at the first general assembly meeting on drug-resistant bacteria.

 A microbiologist works with tubes of bacteria samples in a US antimicrobial resistance and characterization lab. Photograph: David Goldman/AP

A microbiologist works with tubes of bacteria samples in a US antimicrobial resistance and characterization lab. Photograph: David Goldman/AP

Amanda Holpuchin New York

The Guardian, US Edition

Wednesday 21 September 2016 00.01 EDTLast modified on Wednesday 21 September 2016 17.00 EDT

It is only the fourth time the general assembly has held a high-level meeting for a health issue.

“If we fail to address this problem quickly and comprehensively, antimicrobial resistance will make providing high-quality universal healthcare coverage more difficult if not impossible,” said Ban. “It will undermine sustainable food production. And it will put the sustainable development goals in jeopardy.”

Just before world leaders convened for the meeting, all 193 member states agreed in a declaration signed on Wednesday to combat the proliferation of antibiotic resistance.

The declaration routes the global response to superbugs along a similar path to the one used to combat climate change. In two years, groups including UN agencies will provide an update on the superbug fight to the UN secretary general.

It is estimated that more than 700,000 people die each year due to drug-resistant infections, though it could be much higher because there is no global system to monitor these deaths. And there has been trouble tracking those deaths in places where they are monitored, like in the US, where tens of thousands of deaths have not been attributed to superbugs, according to a Reuters investigation.

Resistance isn’t futile – how to tackle drug-resistant superbugs

Scientists have known for more than half a century that patients could develop resistance to the drugs used to treat them – one of the first people to sound the alarm was Alexander Fleming, who is credited with creating the first antibiotic, penicillin, in 1928. He cautioned of the impending crisis while accepting his Nobel prize in 1945: “There is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

But scientific innovation, and increased awareness, has shown the severity of the threat. The World Bank announced this week that without containment, the economic impact of the crisis makes it unlikely for the UN to reach its sustainable development goals for 2030.


“The scale and nature of this economic threat could wipe out hard-fought development gains and take us away from our goals of ending extreme poverty,” said the World Bank president, Jim Yong Kim. “We must urgently change course to avert this potential crisis.”

There has also been considerable advocacy by health officials, like Sally Davies, chief medical officer of the UK.

“Drug-resistant infections are firmly on the global agenda but now the real work begins,” Davies said in a statement. “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine.”

The World Health Organization director general, Margaret Chan, said on Wednesday that it was imperative for consumers and medical providers to rely less on antibiotics for disease treatment.

“On current trends, a common disease like gonorrhea may become untreatable,” Chan said. “Doctors facing patients will have to say, ‘I’m sorry - there’s nothing I can do for you.’”

 Margaret Chan, director general for the World Health Organization, speaking at another UN event on refugees and migrants. Photograph: Julie Jacobson/AP

Margaret Chan, director general for the World Health Organization, speaking at another UN event on refugees and migrants. Photograph: Julie Jacobson/AP

She also called for more innovation in antibiotic development, noting that only two new classes of antibiotics reached the market in the past half century. “The emergence of bacterial resistance is outpacing the world’s capacity for antibiotic discovery,” Chan said.

She warned specifically about gram-negative bacteria, which causes infections like pneumonia, wound or surgical site infections and meningitis in healthcare settings, and is proving increasingly resistant to antibiotics.

“With few replacement products in the pipeline, the world is heading to a post-antibiotic era in which common infections, especially those caused by gram-negative bacteria, will once again kill.”

Signatories to the UN declaration committed to encouraging innovation in antibiotic development, increasing public awareness of the threat and developing surveillance and regulatory systems on the use and sales of antimicrobial medicine for humans and animals.

Only three other health issues have been the subject of general assembly high-level meetings: HIV/Aids, non-communicable diseases and Ebola.

Mark Woolhouse, professor of infectious disease epidemiology at the University of Edinburgh, said he was encouraged that unlike with HIV/Aids and Ebola, the UN is addressing this health crisis before it has spun out of control. 

“It’s very serious indeed – it’s killing people around the world at the rate of hundreds of thousands of year and we all expect it to get worse if something isn’t done now,” Woolhouse said. “But the UN is coming in at just the right time, in a sense.”

New Mexico Startup Avisa Pharma Chosen by National Startup Association as a Top University Company


August 19, 2016

Albuquerque, NM, August 19, 2016—Avisa Pharma, a New Mexico startup commercializing diagnostic breath test technology developed at the University of New Mexico, has been selected as a “Best University Startups 2016” company by the National Council of Entrepreneurial Tech Transfer (NCET2), an association of university startup officers.

Out of the 800 startups created each year from universities around the country, 200 companies were submitted by their universities and screened by NCET2 to find the top university startups for 2016.  Avisa was among 18 university companies chosen in the first round of winners.  During the week of August 29, a second round of 17 winners will be announced from the finalists. The selected companies were scored by a selection committee of 25 Fortune 500 corporate representatives.

The 35 winning companies will present in front of an audience of Global 1000/Fortune 500 companies, VCs and angels looking for investment opportunities at NCET2’s inaugural University Startups Demo Day to be held at the National Press Club and Congress on September 20 in Washington, DC.

STC CEO Lisa Kuuttila was thrilled to hear the news.

“Avisa’s breath test technology is an innovation based on outstanding research and development focused on improving the diagnosis and treatment of bacterial lung diseases that affect the young, the elderly, and poor populations around the world.  Along with Avisa, four other STC companies are finalists for the Best University Startup 2016 award—more than any other university start-up program in the country.   This is recognition of the high quality of these young companies being formed from UNM technologies.”

Avisa CEO David Joseph, co-founder of Avisa with UNM faculty member Graham Timmins, added:

“This is great news and a recognition that we are on the forefront of dealing with severe lung infections and the overuse of broad spectrum antibiotics.  Our breath test technology is targeted at emergency rooms, hospital floor units and intensive care units where serious cases of pneumonia are seen and antibiotic resistant superbugs are more likely to be present. The test will aid clinical decision making on use and choice of antibiotics within 10 minutes.”

Dr. Timmins is a faculty member in the Department of Pharmaceutical Sciences at UNM’s College of Pharmacy and chief science advisor to Avisa Pharma Inc.  The breath test is quick and non-invasive.  It measures the presence of the urease enzyme found in certain bacteria that cause pulmonary infection using a proprietary, nebulized drug inhaled by the patient.

Tony Stanco, Executive Director of NCET2, added his perspective on the selection and event:

“These are some of the most exciting early-stage investment opportunities presented by the country’s great universities. Universities, with deep networks of students, alumni, researchers, faculty and staff, are uniquely positioned to create the world’s most important new companies. These companies create high-value jobs and solve real problems with great promise to have a major impact on the world. The University Startups Demo Day is the university community’s opportunity to show investors and Congress the jobs and companies they help create.”

For more information about the University Startups Demo Day, visit the NCET2 website at http://ncet2.org.


Avisa is a clinical stage company that is developing an exciting, next-generation technology that enables the rapid detection of a variety of respiratory pathogens within minutes after the patient inhales its proprietary drug substrate, AV-U13. The AV-BreathTest™ is a rapid 10-minute test that screens and detects respiratory infections including pneumonia, tuberculosis, COPD and cystic fibrosis with the speed and sensitivity that can also facilitate the monitoring of antibiotic therapy. The AVISAR SPEC™ laser spectrometer, under development by Avisa, incorporates major design advancements that have resulted in a highly portable, laptop-size detection device that will have enormous utility in point-of-care settings—from rural health clinics in the developing world to modern medical clinics and hospitals.  For more information, contact Avisa at info@avisapharma.com or 505-820-1400.  Visit the website at http://avisapharma.com/.


As the technology-transfer and economic-development organization for the University of New Mexico (UNM), STC.UNM (STC) protects and commercializes technologies developed at UNM by filing patents and copyrights and transferring them to the marketplace.  We connect the business community (companies, entrepreneurs and investors) to these technologies for licensing opportunities and the creation of start-up companies. STC’s vision is to play a vital role in New Mexico’s economic development and to be a leader in technology commercialization.  Under the leadership of CEO Lisa Kuuttila, STC is substantially growing its program using the Rainforest model to develop an innovation economy in New Mexico.  For additional information, contact Cara Michaliszyn, STC University Ventures & Engagements Manager, at cmichaliszyn@stc.unm.edu or 505-750-7592.  Visit the website at http://www.stc.unm.edu.

Proof of Concept Study to Detect Urease Bacteria in Lungs Using Aerosolized 13C Urea1 Published in Pediatric Allergy, Immunology and Pulmonology Journal

The results of a proof of concept study to determine if aerosolized 13C urea could detect Pseudomonas aeruginosa, a urease producing bacteria, in the lungs of cystic fibrosis patients was recently published in the peer-reviewed journal, Pediatric Allergy, Immunology, and Pulmonology. The lead author of the article and principal investigator of the study was Hengameh H. Raissy, PharmD from the Department of Pediatrics at the University of New Mexico’s School of Medicine.

In this study 20 mg and 50 mg doses of 13C-urea were administered via a jet nebulizer to three subjects with cystic fibrosis and known to be colonized with P. aeruginosa and three healthy controls. Breath samples were collected in bags prior to nebulization and then at 5, 10 and 15 minutes post-nebulization. Both the 20 mg and 50 mg doses were well tolerated by all study subjects. Both the 20 mg and 50 mg doses showed distinct separation in the 13CO2/12CO2 delta over baseline (DOB) between the CF subjects and the controls with the 5 and 10 minute post-nebulization breath samples. The 50 mg dose had better separation than the 20 mg dose and the largest separation was seen at 5 minutes post-nebulization with CF subjects having an average DOB of 9.5‰ vs 2.1‰ for the healthy controls.

1Raissy Hengameh H., Timmins Graham, Davies Lea, Heynekamp Theresa, Harkins Michelle, Sharp Zachary D., and Kelly H. William. Pediatric Allergy, Immunology, and Pulmonology. June 2016, 29(2): 68-73.

ATS and IDSA Release New Guidelines for Management of Adults with Hospital-acquired and Ventilator-associated Pneumonia

The American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) have released new guidelines for the management of adults with hospital-acquired and ventilator-associated pneumonia. Major updates include a recommendation to shorten antibiotic therapy to 7 days (from 8 to 15) and consider discontinuation of antibiotic therapy based on procalcitonin levels and clinical criteria. In diagnosed cases of HAP and VAP, Avisa believes that once approved, its 13C-Urea BreathTest will aid antibiotic choice and similar to procalcitonin, will provide quantitative measures of antibiotic efficacy to aid decisions on antibiotic de-escalation. The 2016 guidelines replace the last update done in 2005.

New CDC Antibiotic Stewardship Program Will Affect Most US Prescribers

The crisis of antibiotic resistance has spurred the White House, Centers for Disease Control and Prevention (CDC), and the World Health Organization to promote the implementation of antibiotic stewardship programs in healthcare facilities. The CDC has put together a comprehensive antibiotic stewardship program that US healthcare facilities must implement if they wish to receive funding from the Centers for Medicare and Medicaid Services (CMS). Avisa believes that once approved, its 13C-Urea BreathTest will facilitate antibiotic stewardship efforts by providing rapid identification of urease pathogens at the point of care in patients diagnosed with pneumonia and aiding clinical decision making regarding antibiotic use and choice of antibiotics.

Matt Culler joins the Avisa team as VP of Finance

Matt Culler has joined the Avisa team as Vice President of Finance. Matt will work closely with CEO David Joseph to secure Avisa’s Series B financing for commercial development, pivotal clinical trials and FDA regulatory submission of the Avisa BreathTestTM as aid to antibiotic usage and selection for patients diagnosed with pneumonia in the emergency department. Prior to joining Avisa, Mr. Culler was Vice President, Finance & Operations at xF Technologies, a venture-backed renewable chemistry start-up. Before his work at xF Technologies, Mr. Culler was a Principal at Sun Mountain Capital, one of the largest venture capital firms headquartered in the Southwest. Prior to Sun Mountain Capital, Mr. Culler participated in financings totaling over $2 billion as a Senior Analyst in the Private Equity Placements Group of Bank of America’s investment banking business in New York City. Matt has a BBA in Finance with honors from the University of Texas at Austin.

New Antibiotic Stewardship Guidelines Issued by IDSA and SHEA

In response to the antibiotic resistance crisis, the Infectious Disease Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) have released new national guidelines regarding antibiotic stewardship for inpatient populations including long term care. These guidelines replace those issued in 2007. In cases of diagnosed pneumonia, Avisa believes that once approved, its 13C-Urea BreathTest will facilitate guideline recommendations to increase use of oral antibiotics and reduce antibiotic therapy to the shortest effective duration for inpatient populations.