Nasia Safdar, University of Wisconsin-Madison

A new study from the National Institutes of Health shows a jump in both hospital-acquired infections and resistance to the antibiotics used to treat them. The findings are based on data gathered at 120 U.S. hospitals from January 2018 to December 2022, a five-year period that included the COVID-19 pandemic. Dr. Nasia Safdar, a professor of infectious medicine at the University of Wisconsin-Madison, discusses why infection rates have gone up and how you can protect yourself as a hospital patient or visiting family member.

The Conversation has collaborated with SciLine to bring you highlights from the discussion that have been edited for brevity and clarity.

What are health care-associated infections?

Nasia Safdar: These are infections that occur as a result of exposure to the health care system. People coming in for care are typically quite sick, so they're at risk of acquiring bacteria that can then cause an infection while they're in the hospital, or shortly after they're discharged from the hospital.

Why do infections, particularly antibiotic-resistant ones, spread so easily in hospitals and other health care settings?

Nasia Safdar: There is a certain profile of bacteria and germs that develop in health care facilities. And that profile is typically bacteria that are resistant to many commonly used antibiotics.

Patients are already vulnerable and may have compromised immune systems. On top of that, add the risks associated with heavy-duty antibiotic usage, surgeries, procedures and medical devices like urinary catheters and intravascular catheters, which go into the bloodstream. The result is a population at risk for acquiring these bacteria circulating in the environment.

What does it mean for an infection to be antibiotic-resistant?

Nasia Safdar: For any typical infection, there might be a range of choices for treatment. There is what's called first-line treatment, which is the first antibiotic you would go to. These are typically antibiotics that can treat the infections really well, but without harming the good bacteria that live in your intestine.

But when bacteria get resistant to antibiotics, we have to go to more broad-spectrum antibiotics, which might still be effective for treatment but also might have more side effects or destroy some of the good bacteria in the intestine.

What can hospitals and clinics do to prevent or reduce the spread of infections?

Nasia Safdar: One is infection prevention, and the other is antibiotic stewardship, or the judicious use of antibiotics. Both work synergistically with each other.

Within the infection prevention category, you have hand hygiene, which is critical not just for health care personnel but also for patients themselves.

There is also the use of gowns and gloves, when necessary, to make sure that if one patient has a transmittable condition, that pathway is interrupted by health care workers wearing the right PPE, or personal protective equipment. I also think only using devices such as urinary catheters or intravascular catheters when they're truly needed is another way to prevent patients from becoming infected.

And then, within the antibiotic stewardship category, there's a need to prevent the overuse of antibiotics.

What has happened in recent years regarding the rates of health care-associated infections?

Nasia Safdar: Before the pandemic, I think the field was quite optimistic because we were seeing reduced rates of antibiotic-resistant, device-related infections.

A lot of those gains were reversed after the arrival of the pandemic. There was a lot of unnecessary use of antibiotics during that time. And so now we see sharp increases in many of those antibiotic-resistant bacteria. This has led to concern that whatever success we had was fragile and short-lived. We now want to make sure we're not as vulnerable as we became during the pandemic.

Can you give us some background on Candida auris?

Nasia Safdar: Candida auris is an emerging pathogen. Unlike some other antibiotic-resistant germs in health care systems, this one is a fungus – or a yeast, which is the other terminology for it.
And it spreads quite quickly in health care systems.

Candida auris persists in the environment and on the skin and can cause severe bloodstream infections in vulnerable patients. It has been responsible for a number of outbreaks, and the treatment options are much more limited when compared with other infectious germs.

With the arrival of the pandemic, there was a sharp increase in Candida auris infections. They rose by several hundred percent nationwide after smoldering for a while. That sharp spike concerns us.

Can the spread of these infections be reduced by manipulating the gut microbiome?

Nasia Safdar: Many of these germs live in the intestine. They are generally kept at bay by the good bacteria that we all have in our intestines. But sometimes, when we use antibiotics, or use devices or do surgery, those good bacteria are destroyed. And then these germs can find a hospitable niche and grow and cause infections.

Diet plays an important role in keeping our gut microbiome healthy. Most Americans don't get enough fiber. But a high-fiber diet keeps your gut bacteria healthy and helps you put up more of a resistance to germs when they try to invade.

What can patients or their families do to reduce the odds of getting an infection in a health care setting?

Nasia Safdar: Make sure that both patient and health care workers observe hand hygiene. Use hand sanitizer. It works. It's convenient. It's readily available. It's a great way to prevent infections in health care systems.

But there are some instances where you would want to use soap and water instead. Soap and water is a better option when hands are soiled with blood, stool, diarrhea or other body secretions.

Also ask about the health care system's rates of infections. Those are things typically tracked closely by health care systems, and the information is often publicly available. Ask your health care team about the medication you're getting for treatments, particularly if they're antibiotics. Then ask how long you should take them, what side effects to anticipate, and the effect they'll have on your gut bacteria.

Watch the full interview to hear more.

SciLine is a free service based at the American Association for the Advancement of Science, a nonprofit that helps journalists include scientific evidence and experts in their news stories.

Nasia Safdar, Professor of Infectious Disease, University of Wisconsin-Madison

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Mark R. O'Brian, University at Buffalo

Vaccinations have provided significant protection for the public against infectious diseases. However, there was a modest decrease in support in 2023 nationwide for vaccine requirements for children to attend public schools.

In addition, the presidential candidacy of Robert F. Kennedy Jr., a leading critic of childhood vaccination, has given him a prominent platform in which to amplify his views. This includes an extensive interview on the “Joe Rogan Experience,” a podcast with over 14 million subscribers. Notably, former President Donald Trump has said he is opposed to mandatory school COVID-19 vaccinations, and in a phone call Trump apparently wasn't aware was being recorded, he appeared to endorse Kennedy's views toward vaccines.

I am a biochemist and molecular biologist studying the roles microbes play in health and disease. I also teach medical students and am interested in how the public understands science.

Here are some facts about vaccines that skeptics like Kennedy get wrong:

Vaccines are effective and safe

Public health data from 1974 to the present conclude that vaccines have saved at least 154 million lives worldwide over the past 50 years. Vaccines are also constantly monitored for safety in the U.S.

Nevertheless, the false claim that vaccines cause autism persists despite study after study of large populations throughout the world showing no causal link between them.

Claims about the dangers of vaccines often come from misrepresenting scientific research papers. Kennedy cites a 2005 report allegedly showing massive brain inflammation in monkeys in response to vaccination, when in fact the authors of that study state that there were no serious medical complications. A separate 2003 study that Kennedy claimed showed a 1,135% increase in autism in vaccinated versus unvaccinated children actually found no consistent significant association between vaccines and neurodevelopmental outcomes.

Kennedy also claims that a 2002 vaccine study included a control group of children 6 months of age and younger who were fed mercury-contaminated tuna sandwiches. This claim is false.

Aluminum adjuvants help boost immunity

Kennedy is co-counsel with a law firm that is suing the pharmaceutical company Merck based in part on the unfounded assertion that the aluminum in one of its vaccines causes neurological disease. Aluminum is added to many vaccines as an adjuvant to strengthen the body's immune response to the vaccine, thereby enhancing the body's defense against the targeted microbe.

The law firm's claim is based on a 2020 report showing that brain tissue from some patients with Alzheimer's disease, autism and multiple sclerosis have elevated levels of aluminum. The authors of that study do not assert that vaccines are the source of the aluminum, and vaccines are unlikely to be the culprit.

Notably, the brain samples analyzed in that study were from 47- to 105-year-old patients. Most people are exposed to aluminum primarily through their diets, and aluminum is eliminated from the body within days. Therefore, aluminum exposure from childhood vaccines is not expected to persist in those patients.

Vaccines undergo the same approval process as other drugs

Clinical trials for vaccines and other drugs are blinded, randomized and placebo-controlled studies. For a vaccine trial, this means that participants are randomly divided into one group that receives the vaccine and a second group that receives a placebo saline solution. The researchers carrying out the study, and sometimes the participants, do not know who has received the vaccine or the placebo until the study has finished. This eliminates bias.

Results are published in the public domain. For example, vaccine trial data for COVID-19, human papilloma virus and rotavirus is available for anyone to access.

Vaccine manufacturers are liable for injury or death

Kennedy's lawsuit against Merck contradicts his insistence that vaccine manufacturers are fully immune from litigation.

His claim is based on an incorrect interpretation of the National Vaccine Injury Compensation Program, or VICP. VICP is a no-fault federal program created to reduce frivolous lawsuits against vaccine manufacturers, which threaten to cause vaccine shortages and a resurgence of vaccine-preventable disease.

A person claiming injury from a vaccine can petition the U.S. Court of Federal Claims through the VICP for monetary compensation. If the VICP petition is denied, the claimant can then sue the vaccine manufacturer.

The majority of cases resolved under the VICP end in a negotiated settlement between parties without establishing that a vaccine was the cause of the claimed injury. Kennedy and his law firm have incorrectly used the payouts under the VICP to assert that vaccines are unsafe.

The VICP gets the vaccine manufacturer off the hook only if it has complied with all requirements of the Federal Food, Drug and Cosmetic Act and exercised due care. It does not protect the vaccine maker from claims of fraud or withholding information regarding the safety or efficacy of the vaccine during its development or after approval.

Good nutrition and sanitation are not substitutes for vaccination

Kennedy asserts that populations with adequate nutrition do not need vaccines to avoid infectious diseases. While it is clear that improvements in nutrition, sanitation, water treatment, food safety and public health measures have played important roles in reducing deaths and severe complications from infectious diseases, these factors do not eliminate the need for vaccines.

After World War II, the U.S. was a wealthy nation with substantial health-related infrastructure. Yet, Americans reported an average of 1 million cases per year of now-preventable infectious diseases.

Vaccines introduced or expanded in the 1950s and 1960s against diseases like diphtheria, pertussis, tetanus, measles, polio, mumps, rubella and Haemophilus influenza type B have resulted in the near or complete eradication of those diseases.

It's easy to forget why many infectious diseases are rarely encountered today. The success of vaccines does not always tell its own story. It must be retold again and again to counter misinformation.

Mark R. O'Brian, Professor and Chair of Biochemistry, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Rachael Rzasa Lynn, University of Colorado Anschutz Medical Campus

Hundreds of millions of people around the world experience chronic pain – meaning pain that lasts longer than three months. While the numbers vary from country to country, most studies estimate that about 10% of the global population is affected, so more than 800 million people.

The Centers for Disease Control and Prevention estimates that in 2021, about 20% of U.S. adults – or more than 50 million people – were experiencing chronic pain. Of those, about 7% experienced what's called high-impact chronic pain, which is pain that substantially limits a person's daily activities.

In the past, physicians have been quick to prescribe medication as an easy solution. But the opioid crisis in the U.S. has led doctors to reevaluate their reliance on drugs and look at new treatments for patients with chronic pain.

The Conversation spoke with Rachael Rzasa Lynn, a pain management specialist from the University of Colorado Anschutz Medical Campus for our podcast The Conversation Weekly. She explains some of the new developments in pain treatment and why there's hope for patients with chronic pain.

What is the cause of chronic pain, at the most basic level?

In general, pain is a complex interplay between tissue injury or inflammation, nerves and brain processing.

There are several different biological processes that can result in pain. The one that's happening to most people when they experience acute pain is called nociceptive pain. This is pain that occurs when tissue is being injured or potentially harmed in some way, which triggers the activation of surrounding nerves. These nerves are like electrical wires that send signals from the injured tissue, through the spinal cord and to the brain, where pain is ultimately perceived.

But activation of those nerves alone does not equal pain, because those electrical signals are amplified or diminished at multiple points throughout their transit to the brain. The brain's perception of pain is critical because pain does not occur when people are unconscious.

Nociceptive pain can also result from ongoing tissue injury or inflammation, as in the case of arthritis. With these injuries, the peripheral nerves are chronically reporting to the brain, resulting in an ongoing perception of pain.

There are other disease processes, such as diabetic peripheral neuropathy, in which nerves themselves become injured. In these cases, the nerves send pain signals to the brain that are reflective of injury to the nerves themselves, not the tissues they report from. This is called neuropathic pain.

In other forms of chronic pain called nociplastic pain, the initial tissue injury may fully heal, but the brain and nervous system continue to generate pain signals.

Many chronic pain conditions actually involve a combination of all three of these phenomena – nociceptive, neuropathic and nociplastic pain – which adds to the difficulty of diagnosis and treatment.

How do doctors like you measure pain?

I think everybody who's been to a hospital, at least in the United States within the past decade, is familiar with the numerical scale where you're asked to rate your pain. That is a one-dimensional assessment of pain that only asks how severe it is.

But pain is a very complex phenomenon that has a lot more pieces to it than just the severity. So a single numerical value based on severity of pain really misses the impact that pain may be having on a patient's daily life, such as their activities, their relationships, their ability to sleep, their happiness and their overall satisfaction with their life.

I think the most difficult thing about all pain, truly, but especially many forms of chronic pain, is that you cannot see it. There's no external, validated way to really know how much pain someone is in. We do have newer methods for measuring pain that attempt to get at some of those more complex aspects, but it's still a very incomplete science. It's all still subjective based on what the patient tells you their experience is.

What are some of the most promising new pain treatment options?

One newly popular treatment is called pain reprocessing therapy, which takes a behavioral approach to eliminating pain.

Here at our medical campus, therapists guide patients in understanding what causes chronic pain and then reevaluating the sensations they experience as painful – for example, while engaging in typically painful movements. The goal of pain reprocessing therapy is to help patients perceive the pain signals being sent to their brain as less threatening, so that their brain “unlearns” the pain.

Another approach being applied in new ways is called nerve ablation, a procedure in which the nerves around an area of pain are numbed with medication and then purposely damaged. In those cases, doctors inject a chemical around the nerves or gently heat them so they can no longer effectively send pain signals for months or even years. This approach has been used for spine pain for decades, but it is now being applied more widely to pain from other areas of the body.

A similar approach is to use electricity to stimulate the nerves serving a painful area in order to alter or block the way pain signals flow through them. This method involves placing a tiny electrical device alongside the nerve to deliver the low level of electricity. This is an example of neuromodulation, which is increasingly being used to treat a wide variety of chronic pain conditions throughout the body, from foot pain to migraines. It has even shown promise in the management of acute pain after surgeries like knee replacement.

A classic example of neuromodulation is spinal cord stimulation, which is used to treat a variety of conditions that cause chronic pain. A surgeon places wires underneath the bones of the back, but outside of the spinal cord and the spinal fluid. The wires connect to a battery, much like a pacemaker battery, that delivers electrical signals to the nerves in the spinal cord in order to scramble the pain signals.

What role has the opioid crisis played?

These new treatment options for patients with chronic pain may not have progressed as quickly as they have if not for the opioid crisis.

For decades, opioids were too widely prescribed for chronic pain. However, there are some patients with chronic pain for whom opioids truly provide benefit in terms of pain relief and quality of life. In my view, doctors have overcorrected a bit to the point where it can now be difficult for such patients to gain access to the opioid therapies that have worked so well for them. Due in part to a slowdown in manufacturing opioids over the past several years, in some parts of the U.S., many patients are no longer able to access these drugs at all.

As a result, researchers are now working to identify new drugs that relieve pain without the risks of addiction and overdose that opioids present, including cannabinoids. The focus in patient care in recent years has shifted away from medication and toward behavioral and procedural interventions, including neuromodulation.

Looking ahead: What's next?

I think the holy grail of pain medicine is trying to figure out which patients with the same condition are going to respond to the same treatment. For example, two patients with a degenerative tissue disease like osteoarthritis of the knee can have nearly identical X-rays and yet their pain experience and response to treatments are completely different. One patient may do well with physical therapy, while another might fail to improve with physical therapy alone and require multiple medications, injections and ultimately surgery – and could potentially still be living with pain.

Researchers like me don't yet know what the defining characteristics are of one patient versus another in terms of those outcomes. This means current treatment plans involve a lot of trial and error, which can be slow and frustrating for patients in pain.

So my goal and my No. 1 hope for the future of pain medicine is that researchers find a better way of predicting who is going to respond to a particular treatment, which would allow them to match each patient to the right treatment regimen the first time.

Rachael Rzasa Lynn, Associate Professor of Anesthesiology, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.