JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, October 16, 2007)
JAMA NEWS RELEASES
DRUG-RESISTANT STAPH INFECTION APPEARS MORE WIDESPREAD THAN PREVIOUSLY THOUGHT
MULTIRESISTANT BACTERIAL STRAIN THAT CAN CAUSE EAR INFECTIONS EMERGES; RESISTANT TO ANTIBIOTICS, NOT COVERED BY PNEUMOCOCCAL VACCINE
RELATIONSHIPS INVOLVING FINANCIAL INTERESTS BETWEEN INDUSTRY AND MEDICAL SCHOOLS, TEACHING HOSPITALS REPORTEDLY ARE HIGHLY PREVALENT
JAMA REPORT (VIDEO SCRIPT)
VIDEO: Windows Media | Quicktime
MRSA INFECTIONS ASSOCIATED WITH MORE THAN 18,000 U.S. DEATHS IN 2005
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
TV Note: This week's JAMA Report video is on the prevalence of a drug-resistant staph infection. The report will be fed Tuesday, October 16, from 9:00 - 9:30 a.m. ET and 2:00 - 2:30 p.m. ET, on Galaxy 26 (formerly Intelsat America 6) C-Band, Transponder 14, downlink frequency: 3880 vertical, audio 6.2/6.8. For more information, call 312/464-JAMA.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org.
JOURNALISTS CAN NOW ACCESS EMBARGOED JAMA/ARCHIVES STUDIES ONLINE
Go to www.jamamedia.org for more information and to apply for access.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 16, 2007
Media Advisory: To contact R. Monina Klevens, D.D.S., M.P.H., call Nicole Coffin at 404-639-4071. To contact editorial author Elizabeth A. Bancroft, M.D., S.M., call the L.A. County Public Health Communications Office at 213-240-8144.
DRUG-RESISTANT STAPH INFECTION APPEARS MORE WIDESPREAD THAN PREVIOUSLY THOUGHT
CHICAGO—Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) appears to be more prevalent than previously believed, affecting certain populations disproportionately and is being found more often outside of health care settings, according to a study in the October 17 issue of JAMA.
MRSA has become the most frequent cause of skin and soft tissue infections among patients presenting to emergency departments in the United States, and can also cause severe, sometimes fatal invasive disease, according to background information in the article. "As the epidemiology of MRSA disease changes, including both community- and health care–associated disease, accurate information on the scope and magnitude of the burden of MRSA disease in the U.S. population is needed to set priorities for prevention and control," the authors write.
R. Monina Klevens, D.D.S., M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues conducted a study to determine the incidence of invasive MRSA disease in certain U.S. communities in 2005 and to use these results to estimate the prevalence of invasive MRSA infections in the U.S. The study consisted of a population-based surveillance for invasive MRSA in nine sites participating in the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network from July 2004 through December 2005. Reports of MRSA were investigated and classified as either health care–associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA).
There were 8,987 observed cases of invasive MRSA reported during the surveillance period. Most were health care–associated, with 5,250 (58.4 percent) community-onset infections, 2,389 (26.6 percent) hospital-onset infections, 1,234 (13.7 percent) community-associated infections, and 114 (1.3 percent) that could not be classified. After adjusting for age, race and sex, the incidence rate of invasive MRSA for 2005 was 31.8 per 100,000 persons. Incidence rates overall were highest among persons 65 years and older (127.7 per 100,000), blacks (66.5 per 100,000), and males (37.5 per 100,000). Rates were lowest among persons age 5 to 17 years (1.4 per 100,000).
"Based on 8,987 observed cases of MRSA and 1,598 in-hospital deaths among patients with MRSA, we estimate that 94,360 invasive MRSA infections occurred in the United States in 2005; these infections were associated with death in 18,650 cases," the authors write.
Molecular testing identified strains historically associated with community-associated disease outbreaks recovered from cultures in both hospital-onset and community-onset health care–associated infections in all surveillance areas.
"In conclusion, invasive MRSA disease is a major public health problem and is primarily related to health care but no longer confined to acute care. Although in 2005 the majority of invasive disease was related to health care, this may change," the researchers write.
(JAMA. 2007;298(15):1763-1771. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
EDITORIAL: ANTIMICROBIAL RESISTANCE — IT’S NOT JUST FOR HOSPITALS
In an accompanying editorial, Elizabeth A. Bancroft, M.D., S.M., of the Los Angeles County Department of Public Health, Los Angeles, writes that antimicrobial resistance is an increasing problem.
"The rate of invasive MRSA [as determined by Klevens and colleagues] was an astounding 31.8 per 100,000. To put this number into context, the estimated rate of invasive MRSA is greater than the combined rate in 2005 for invasive pneumococcal disease (14.1 per 100,000), invasive group A streptococcus (3.6 per 100,000), invasive meningococcal disease (0.35 per 100,000), and invasive H influenzae (1.4 per 100,000)." Dr. Bancroft adds that if the projection on the number of deaths (18,650) is accurate, these deaths would exceed the total number of deaths attributable to human immunodeficiency virus/AIDS in the United States in 2005.
"The reports in this issue of JAMA [including the study by Pichichero and Casey on drug-resistant S pneumoniae] reveal that infections with significant antimicrobial-resistant pathogens, the types formerly seen only in hospitals, now have onset in the community. Old diseases have learned new tricks. Consequently, new collaborations between the public health and medical communities are needed to identify and control antimicrobial resistance. It is not practical for public health departments to perform surveillance for MRSA or other highly prevalent resistant organisms without a robust system of electronic laboratory reporting. In the meantime, population surveillance can be achieved by public health personnel working with hospitals and laboratories in their jurisdictions to develop aggregate antibiograms [an examination that measures the biological resistance of substances causing disease]. Clinicians also should be encouraged to report to the health department any new trends in antibiotic resistance that they identify."
(JAMA. 2007;298(15):1803-1804. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 16, 2007
Media Advisory: To contact Michael E. Pichichero, M.D., call Greg Williams at 585-273-1757.
MULTIRESISTANT BACTERIAL STRAIN THAT CAN CAUSE EAR INFECTIONS EMERGES; RESISTANT TO ANTIBIOTICS, NOT COVERED BY PNEUMOCOCCAL VACCINE
CHICAGO—A strain of the bacteria Streptococcus pneumoniae, which can cause ear infections in children, has been detected that is resistant to all FDA-approved antibiotics for treatment of ear infections and is not covered by the pneumococcal 7-valent conjugate vaccine, according to a study in the October 17 issue of JAMA.
Antibiotic resistance to the bacteria pneumococci has been a focus in community-based pediatric medicine because it is the most frequent cause of bacterial respiratory infections, especially acute otitis media (AOM; middle ear infection), which is the most commonly treated bacterial infection in children. "The introduction in 2000 of a pneumococcal 7-valent conjugate vaccine (PCV7) in the United States offered considerable promise in curtailing pneumococcal infections in children, with a particularly favorable impact on penicillin- and multidrug-resistant strains," the authors write. In the early years following widespread use of PCV7, the incidence of AOM decreased by 20 percent and the frequency of persistent and recurrent AOM has been reduced by 24 percent, according to background information in the article. Because of overuse of antibiotics for children, there has been concern that a bacterial strain could emerge that would be untreatable by U.S. Food and Drug Administration–approved antibiotics.
Michael E. Pichichero, M.D., and Janet R. Casey, M.D., of the University of Rochester and Legacy Pediatrics, Rochester, New York, examined the shifts in bacteria causing ear infections following the introduction of PCV7 in the strains of Streptococcus pneumoniae that cause AOM, with particular attention to certain pneumococcal serotypes and antibiotic susceptibility. S pneumoniae strains that caused AOM in children receiving PCV7 between September 2003 and June 2006 were identified. All children were from their Rochester, New York, pediatric practice.
Among 1,816 children in whom AOM was diagnosed, tympanocentesis (puncture of the tympanic membrane with a needle to remove fluid from the middle ear) was performed in 212, yielding 59 cases of S pneumoniae infection. The researchers found that one strain of S pneumoniae belonging to serotype 19A was a new genotype and was resistant to all antibiotics approved by the FDA for use in children with AOM. This strain was identified in nine cases (2 in 2003-2004, 2 in 2004-2005, and 5 in 2005-2006).
Four children infected with this strain had been unsuccessfully treated with two or more antibiotics, including high-dose amoxicillin or amoxicillin-clavulanate and three injections of ceftriaxone; three had recurrent AOM; and for two others, the infection was the first one in their life. The first four cases required tympanostomy (the creation of a hole in the tympanic membrane) tube insertion after additional unsuccessful antibiotic therapies. Levofloxacin was used in the subsequent five cases, with resolution of infection without surgery.
"While the studied children represent a relatively small subset of all children in our practice with AOM, these observations are clearly worrisome, especially since there are no new antibiotics in phase 3 clinical trials for AOM in children. The study suggests that an expanded pneumococcal conjugate vaccine to include additional serotypes may be needed sooner than previously thought, with an outer-membrane protein-based vaccine to follow," the authors write.
"Changes in the pathogen distribution and antibiotic resistance patterns of bacteria that cause AOM will require continuous monitoring, especially as new vaccines become available."
(JAMA. 2007;298(15):1772-1778. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
Embargoed for Release: 3:00 p.m. CT, Tuesday, October 16, 2007
Media Advisory: To contact Eric G. Campbell, Ph.D., call Sue McGreevey at 617-724-2764.
RELATIONSHIPS INVOLVING FINANCIAL INTERESTS BETWEEN INDUSTRY AND MEDICAL SCHOOLS, TEACHING HOSPITALS REPORTEDLY ARE HIGHLY PREVALENT
CHICAGO—In a national survey of department chairs at medical schools and teaching hospitals, more than half report relationships with industry, including receiving financial and in-kind support, according to a study in the October 17 issue of JAMA. The authors suggest that these findings underscore the need for the disclosure and management of these relationships.
"Institutional academic–industry relationships (IAIRs) exist when academic institutions, or any of their senior officials, have a financial relationship with or financial interests in a public or private company," the researchers write. "Similar to relationships between individual faculty members and industry, relationships between academic institutions and industry, when they conflict, or have the appearance of conflicting, with the core missions of academic medical centers create an institutional conflict of interest, which exists when a department chair supervises faculty who conduct research for companies with which the chair has a personal financial relationship." There have been calls for the establishment of policies and practices for disclosure, evaluation, and management of IAIRs. No national data exist that describe the extent of IAIRs or that could be used for the development of policy.
Eric G. Campbell, Ph.D., of Massachusetts General Hospital, Boston, and colleagues conducted a study to determine the nature, extent, and consequences of IAIRs by surveying department chairs of 125 accredited allopathic medical schools and the 15 largest independent teaching hospitals in the United States. The survey was administered between February 2006 and October 2006. A total of 459 of 688 eligible department chairs completed the survey, yielding an overall response rate of 67 percent.
The researchers found almost two-thirds (60 percent) of department chairs had some form of personal relationship with industry, including having served: as a paid consultant for a company (27 percent); as a member of a scientific advisory board (27 percent); as an officer or executive of a company (7 percent); as a founder of a company (9 percent); as a member of a board of directors (11 percent); and as a paid speaker (14 percent). Clinical chairs were significantly more likely than nonclinical chairs to have served on a speakers’ bureau.
Two-thirds (67 percent) of departments as administrative units had relationships with industry. Clinical departments were significantly more likely than nonclinical departments to receive research equipment (17 percent vs. 10 percent), unrestricted funds (19 percent vs. 3 percent), support for research seminars (36 percent vs. 13 percent), support for residency and fellowship training (37 percent vs. 2 percent), and support for department-administered continuing medical education (65 percent vs. 3 percent).
Clinical departments were also significantly more likely than nonclinical departments to receive discretionary funds to purchase food and beverages in the department, support for professional meetings, and subscriptions to professional journals. Nonclinical departments were significantly more likely to receive money from licensing of intellectual property developed by researchers in the department.
More than two-thirds of department chairs perceived that having a relationship with industry had no effect on their professional activities, 72 percent viewed a chair’s engaging in more than one industry-related activity (substantial role in a start-up company, consulting, or serving a company’s board) as having a negative impact on a department’s ability to conduct independent unbiased research.
"This study presents the first empirical data showing that IAIRs are frequent in medical schools and teaching hospitals and thus deserving of attention. Future research is needed to better understand the impact of IAIRs on the independent unbiased performance of the education and research missions of medical schools, the management and disclosure of these relationships at the institutional level, and the impact of institutional policies. Failure to address the existence and influence of industry relationships with academic institutions could endanger the trust of the public in U.S. medical schools and teaching hospitals," the authors conclude.
(JAMA. 2007;298(15):1779-1786. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
Go back to the top.
JAMA REPORTS
VIDEO: Windows Media | Quicktime
MRSA INFECTIONS ASSOCIATED WITH MORE THAN 18,000 U.S. DEATHS IN 2005
INTRO:
A new study finds that a potentially deadly kind of infection called a MRSA (mer-sa) infection is most often acquired through hospital or other healthcare visits, and has become a major public health problem. The researchers estimate that in the U.S., every 30 minutes someone dies from a serious form of this infection. Mavis Prall explains in this week’s JAMA Report.
VIDEO:
B-ROLL
Dr. Ray and colleague looking at cultures
Close up microscope
Dr. Ray at microscope
Patient in hospital bed with IV
AUDIO:
IN THIS LABORATORY AT GRADY HOSPITAL IN ATLANTA, THEY’RE LOOKING AT BLOOD SAMPLES FOR STAPH GERMS, WHICH GENERALLY LIVE ON THE SKIN, BUT CAN GET INTO THE BLOOD THROUGH THINGS LIKE INTRAVENOUS LINES, IVs.
VIDEO:
SOT/FULL
@:13
Super: Susan Ray, M.D.
Grady Memorial Hospital (and study co-author)
Runs :14
AUDIO:
“Because IVs go through skin into the blood stream, skin, where we might had a low level of a staph germ on our body, the staff germ can follow the IV line into the blood stream and gain easy access and make a person quite ill.”
VIDEO:
B-ROLL
Close up of MRSA infections as seen through microscope
GFX/JAMA COVER
Different man in hospital bed
AUDIO:
THAT CAN LEAD TO METHICILLIN (meth-ih-SILL-in)-RESISTANT STAPHYLOCOCCUS (staff-ill-oh-COCK-us) AUREUS (OR-ee-us), OR MRSA, INFECTIONS. ACCORDING TO A NEW STUDY IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, SERIOUS FORMS OF THESE INFECTIONS ARE ALL TOO COMMON IN THE U.S. HOW COMMON?
VIDEO:
SOT/FULL
@ :41
Super: R. Monina Klevens, D.D.S., M.P.H.
Centers for Disease Control and Prevention
Runs :10
AUDIO:
“Over 94,000 infections and about 18,650 deaths in one year alone, in 2005.”
VIDEO:
B-ROLL
Dr. Klevens and colleagues discussing data
More lab/microscope shots of MRSA
FULL SCREEN GRAPHIC
Title: U.S. MRSA Infection Rates, 2005
26.6% Hospital-Onset
13.7% Community-associated
58.4% Healthcare-associated
1.3 % origin unknown
B-ROLL
Woman having dialysis
AUDIO:
DR. MONINA (moe-NEE-na) KLEVENS (KLEH-vins) AND COLLEAGUES AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION COLLABORATED WITH RESEARCHERS ACROSS THE COUNTRY TO STUDY THOUSANDS OF MRSA INFECTIONS. THEY FOUND THAT IN ABOUT TWENTY-SEVEN PERCENT OF THE CASES, PEOPLE GOT THE INFECTION WHILE THEY WERE PATIENTS IN HOSPITALS. ABOUT FOURTEEN PERCENT GOT THE INFECTION IN THE COMMUNITY. AND ABOUT FIFTY-EIGHT PERCENT GOT THE INFECTION AFTER A HEALTHCARE ENCOUNTER, SUCH AS DIALYSIS OR SURGERY.
VIDEO:
SOT/FULL
R. Monina Klevens, D.D.S., M.P.H.
Centers for Disease Control and Prevention
Runs :16
AUDIO:
“This study finds that the majority of these infections were healthcare associated, and that’s not to say that healthcare is not safe, but rather that healthcare has its risks.”
VIDEO:
B-ROLL
Man receiving dialysis
AUDIO:
SHE SAYS THE BENEFITS STILL OUTWEIGH THE RISKS, BUT...
VIDEO:
SOT/FULL
R. Monina Klevens, D.D.S., M.P.H.
Centers for Disease Control and Prevention
Runs :14
AUDIO:
“There’s more that we can do to prevent these infections that are healthcare associated. There are a lot of things that hospitals and other healthcare settings can do and those are outlined in the guidelines that CDC published in 2006.”
VIDEO:
B-ROLL
Hospital staff walking in hospital corridor (no faces)
Woman in scrubs washing her hands at lab sink
AUDIO:
THE GUIDELINES ARE DETAILED AND SPECIFIC, BUT INCLUDE SOMETHING HEALTHCARE PROVIDERS AND PATIENTS CAN DO… KEEP HANDS VERY CLEAN. THIS IS MAVIS PRALL WITH THE JAMA REPORT.
TAG:
The study authors emphasize that 18,000 people with MRSA infections died in 2005, but this is not to say that all of them died because they had MRSA. The researchers call the deaths MRSA-related. For more information, visit www.jama.com.
