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<p class="MsoNormal"><span style="font-size:12.0pt;color:#0000CC"><a href="http://www.cnn.com/2017/02/27/health/who-bacteria-antibiotics-list-amr/">http://www.cnn.com/2017/02/27/health/who-bacteria-antibiotics-list-amr/</a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#0000CC"><o:p> </o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:3.75pt;margin-right:0in;margin-bottom:3.75pt;margin-left:0in">
<span style="font-size:21.0pt;font-family:CNN;color:#262626">WHO: These 12 bacteria pose greatest risk to human health<o:p></o:p></span></p>
<p class="MsoNormal" style="margin-bottom:12.0pt;vertical-align:middle"><b><span style="font-size:9.0pt;font-family:CNN;color:#262626">By Meera Senthilingam, CNN<o:p></o:p></span></b></p>
<p class="MsoNormal" style="mso-margin-top-alt:0in;margin-right:3.75pt;margin-bottom:12.0pt;margin-left:0in;vertical-align:middle">
<span style="font-size:9.0pt;font-family:CNN;color:#262626">Updated 11:50 AM ET, Mon February 27, 2017
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</v:shapetype><v:shape id="AutoShape_x0020_2" o:spid="_x0000_s1026" type="#_x0000_t75" alt="Campylobacter are among the most common cause of food poisoning and diarrhea. They are now showing resistance against the drug fluoroquinolone." style='width:24pt;height:24pt;visibility:visible;mso-left-percent:-10001;mso-top-percent:-10001;mso-position-horizontal:absolute;mso-position-horizontal-relative:char;mso-position-vertical:absolute;mso-position-vertical-relative:line;mso-left-percent:-10001;mso-top-percent:-10001'>
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</v:shape><![endif]--><![if !vml]><img width="40" height="40" src="cid:image009.png@01D29114.CA1B5CD0" alt="Campylobacter are among the most common cause of food poisoning and diarrhea. They are now showing resistance against the drug fluoroquinolone." v:shapes="AutoShape_x0020_2"><![endif]><span style="font-size:11.5pt;font-family:CNN;color:#262626"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.5pt;font-family:CNN;color:#262626"><img border="0" width="299" height="168" id="Picture_x0020_7" src="cid:image010.jpg@01D29114.CA1B5CD0" alt="Topping the list as a "critical priority," Acinetobacter baumannii is a common cause of hospital-acquired infections, picked up both in hospital and in healthcare settings, such as nursing homes."></span><span style="font-size:11.5pt;font-family:CNN;color:#262626"><o:p></o:p></span></p>
<div style="mso-element:para-border-div;border:none;border-top:solid windowtext 1.0pt;padding:8.0pt 0in 0in 0in;margin-left:-.25in;margin-right:0in">
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;border:none;padding:0in">
<![if !supportLists]><span style="font-size:10.0pt;font-family:Symbol;color:#262626"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:10.5pt;font-family:CNN;color:#262626">Three bacteria typically acquired in hospitals are listed as critical<o:p></o:p></span></p>
<p class="MsoNormal" style="mso-margin-top-alt:auto;mso-margin-bottom-alt:auto;margin-left:.25in;text-indent:-.25in;mso-list:l0 level1 lfo1;border:none;padding:0in">
<![if !supportLists]><span style="font-size:10.0pt;font-family:Symbol;color:#262626"><span style="mso-list:Ignore">·<span style="font:7.0pt "Times New Roman"">
</span></span></span><![endif]><span style="font-size:10.5pt;font-family:CNN;color:#262626">New drugs can take up to 10 years to reach the market, experts say<o:p></o:p></span></p>
</div>
<p class="MsoNormal" style="margin-bottom:11.25pt"><b><span style="font-size:13.5pt;font-family:CNN;color:#262626">(CNN)
</span></b><span style="font-size:13.5pt;font-family:CNN;color:#262626">Twelve types of bacteria were deemed "priorities" in urgent need of new antibiotics, according to
<a href="http://www.who.int/medicines/publications/global-priority-list-antibiotic-resistant-bacteria/en/" target="_blank">
<span style="color:#006598;text-decoration:none">a list released by the World Health Organization</span></a> on Monday.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The first list of its kind, it highlights bacteria that global health experts believe pose the greatest threats to human health. The WHO is calling on governments and pharmaceutical
companies to prioritize the development of new drugs against them.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Factors used to determine the bacteria posing the most risk included the levels of resistance seen already, the mortality rates of these bacteria today, their prevalence<b>
</b>out in communities and the burden they place on health systems.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:16.0pt;font-family:CNN;color:#262626">Hospital acquired infections<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:16.0pt;font-family:CNN;color:#262626"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Topping the list were bacteria classed as "gram negative" bacteria, which have already shown resistance to multiple drugs.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">These include Acinetobacter baumannii and pseudomonas aeruginosa, which are predominantly linked to hospital-acquired infections or infections in healthcare settings, such as
nursing homes, and in patients who require equipment such as ventilators or blood catheters, which can become contaminated.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Enterobacteriaceae, which include bacteria such as E.coli and klebsiella, were listed third and also pose a greater threat in healthcare settings.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">"These bacteria are responsible for high mortality rates," said Dr. Marie-Paule Kieny, WHO's assistant director-general for health systems and innovation. "New, effective therapies
are imperative."<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><img border="0" width="774" height="474" id="Picture_x0020_1" src="cid:image011.png@01D29114.CA1B5CD0"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">In the United States, one in 25 hospital patients are estimated to have at least one hospital-acquired infection, according to the
<a href="https://www.cdc.gov/hai/surveillance/index.html" target="_blank"><span style="color:#006598;text-decoration:none">US Centers for Disease Control and Prevention</span></a>.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Globally, antibiotic resistance has been seen in every country, according to WHO, and drug-resistant bacteria are
<a href="http://edition.cnn.com/2016/09/21/health/what-is-antimicrobial-resistance-amr/">
<span style="color:#006598;text-decoration:none">estimated to cause 700,000</span></a> deaths each year. If no action is taken, they are expected to kill 10 million people annually by 2050.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The risk of death from a resistant pathogens is two to three times greater said Dr. Carmem Pessoa da Silva, coordinator of antimicrobial resistance at WHO.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.5pt;font-family:CNN;color:#262626"><a href="http://www.cnn.com/2017/01/16/health/cre-superbug-disease-study/index.html"><span style="color:#006598;text-decoration:none"><img border="0" width="384" height="216" id="Picture_x0020_31" src="cid:image012.jpg@01D29114.CA1B5CD0" alt="Drug-resistant superbug may be more widespread than previously known"></span><span style="font-family:"Times New Roman","serif";color:#006598;text-decoration:none"><o:p></o:p></span></a></span></p>
<p class="MsoNormal"><span style="font-size:11.5pt;font-family:CNN;color:#006598"><a href="http://www.cnn.com/2017/01/16/health/cre-superbug-disease-study/index.html"><span style="color:#006598;text-decoration:none"><img alt="Drug-resistant superbug may be
more widespread than previously known" class="media__image" src="http://i2.cdn.cnn.com/cnnnext/dam/assets/170116114101-cre-superbug-disease-large-169.jpg"></span></a></span><span style="font-size:12.0pt;color:#262626"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:CNN;color:#262626"><a href="http://www.cnn.com/2017/01/16/health/cre-superbug-disease-study/index.html"><span style="color:#006598;text-decoration:none">Drug-resistant superbug may be craftier, more
widespread </span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The top three bacteria listed have shown resistance against multiple antibiotics, including those known as carbapenems, which are considered to be the most effective against multi-drug
resistance.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">WHO has released its list in hope of guiding and promoting the research and development of new drugs -- which can take as long as 10 years to reach the market.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">"The (drug) pipeline is practically dry," Kieny said during a press conference, adding that new antibiotics are difficult to develop.
<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">She also highlighted the fact that antibiotics are typically used as short-term treatment, not long-term, meaning they have less market incentives to pharmaceutical companies.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><b><span style="font-size:16.0pt;font-family:CNN;color:#262626">Critical, high and medium priorities<o:p></o:p></span></b></p>
<p class="MsoNormal"><b><span style="font-size:16.0pt;font-family:CNN;color:#262626"><o:p> </o:p></span></b></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The bacteria listed are divided into three categories based on the urgency with which new antibiotics are needed against them. They're classified as critical, high and medium
priority.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">"The top three (bacteria) have nothing to treat them," said Dr. Vicky Enne, a clinical microbiologist at UCL in the UK.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Though Enne did not help with the final list, she agrees that these 12 types of bacteria are the ones in need of most attention, adding that the top three types on the list currently
require use of a less than ideal drug, known as Colistin, to treat them. "At the moment, (Colistin) is the antibiotic of last resort ... but resistance is also becoming more common," she said.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The second and third groups name bacteria that are increasingly showing resistance against the main drugs used against them, but which still have a few options remaining. "These
still have some drugs to fight them ... but doctors are being forced to use last resort drugs because resistance levels are so high," Enne said.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:11.5pt;font-family:CNN;color:#262626"><a href="http://www.cnn.com/2016/05/23/health/stopping-superbugs/index.html"><span style="color:#006598;text-decoration:none"><img border="0" width="384" height="216" id="Picture_x0020_33" src="cid:image013.jpg@01D29114.CA1B5CD0" alt="How to stop superbugs from killing 10 million people a year"></span><span style="font-family:"Times New Roman","serif";color:#006598;text-decoration:none"><o:p></o:p></span></a></span></p>
<p class="MsoNormal"><span style="font-size:11.5pt;font-family:CNN;color:#006598"><a href="http://www.cnn.com/2016/05/23/health/stopping-superbugs/index.html"><span style="color:#006598;text-decoration:none"><img alt="How to stop superbugs from killing 10 million
people a year" class="media__image" src="http://i2.cdn.cnn.com/cnnnext/dam/assets/140416155332-cnn10-healing-superbugs-large-169.jpg"></span></a></span><span style="font-size:12.0pt;color:#262626"><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:CNN;color:#262626"><a href="http://www.cnn.com/2016/05/23/health/stopping-superbugs/index.html"><span style="color:#006598;text-decoration:none">We can protect the world from antibiotic resistance
if we act now, experts say</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Salmonella and
<a href="http://www.cnn.com/2016/07/14/health/std-gonorrhea-azithromycin-resistance/">
<span style="color:#006598;text-decoration:none">gonorrhoea </span></a>are included among those considered a high priority, as well as campylobacter and helicobacter pylori, which cause food poisoning and gastritis, respectively.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">Enne believes the drugs named in these lower groups also require the development of better rapid diagnostics so any resistance can be identified immediately, meaning drugs are
not used unnecessarily.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">"This fuels more resistance," she said.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><a href="http://www.cnn.com/2016/03/24/health/world-tuberculosis-day-bekker-oped/"><span style="color:#006598;text-decoration:none">Tuberculosis</span></a> is a bacterial disease
showing extreme resistance today, with some countries reporting cases with total resistance. WHO agreed with TB being a lead priority but left it off the list as it has its own arm of specific research and development to address the issue.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">The issue of resistance has received attention in recent years. It was
<a href="http://www.cnn.com/2016/09/21/health/what-is-antimicrobial-resistance-amr/">
<span style="color:#006598;text-decoration:none">addressed during the United Nations General Assembly</span></a> in 2016 and an independent
<a href="https://amr-review.org/" target="_blank"><span style="color:#006598;text-decoration:none">review on antimicrobial resistance</span></a>, commissioned by the UK government, concluded last year with a list of priorities to target the problem. But new
drugs are still yet to be identified.<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:13.5pt;font-family:CNN;color:#262626">"This shows that WHO see antibiotic resistance as a major global challenge. Hopefully this will focus efforts on these areas of greatest need," said Dr. Andrew Edwards, a molecular
microbiologist at Imperial College London, who believes governments must also set policies in place to support drug development. "There's no point having these drugs<b>
</b>if there are no policies in place."<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#0000CC"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:12.0pt;color:#0000CC"><o:p> </o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099">Deborah L. DeBiasi<br>
<b>Email: <a href="mailto:Deborah.DeBiasi@deq.virginia.gov"><span style="color:#000099">Deborah.DeBiasi@deq.virginia.gov</span></a><i><br>
</i></b>WEB site address: <a href="http://www.deq.virginia.gov/"><span style="color:#000099">www.deq.virginia.gov</span></a><br>
Virginia Department of Environmental Quality<br>
Office of Water Permits <br>
Industrial Pretreatment/Whole Effluent Toxicity (WET) Program<br>
PPCPs, EDCs, and Microconstituents<o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099"><a href="http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx"><span style="color:#000099">http://www.deq.virginia.gov/Programs/Water/PermittingCompliance/PollutionDischargeElimination/Microconstituents.aspx</span></a><o:p></o:p></span></p>
<p class="MsoNormal"><span style="font-size:9.0pt;color:#000099">Mail: P.O. Box 1105, Richmond, VA 23218<br>
Location: 629 E. Main Street, Richmond, VA 23219<br>
PH: 804-698-4028 FAX: 804-698-4032</span><span style="font-size:9.0pt;color:navy"><o:p></o:p></span></p>
<p class="MsoNormal"><o:p> </o:p></p>
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