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Marc Sprenger, director of the WHO secretariat for antimicrobial resistance, says WHO is working to develop a more complete understanding of the global burden of antibiotic resistance. To understand the real damage antibiotic resistance is doing, he says we need to know how many deaths antibiotic-resistant infections cause, how long they extend hospital stays, and how much they increase costs.


WHO is trying to get a better handle on worldwide antibiotic resistance rates and trends through its Robert Clergerie Pointed Mary Jane Pumps cheap popular Manchester sale online cheap great deals CVhAd
(GLASS), a global data-sharing platform that WHO launched to standardize antibiotic resistance data collection and analysis. Laboratories submit their data to state or national systems, which in turn submit it to GLASS. In January, WHO released a GLASS report that found that antibiotic resistance is widespread across 500,000 people with suspected infections in 22 countries, though the rates vary by country.

Even with new GLASS data, Sprenger says the picture of antibiotic resistance is only “partially reliable.” GLASS is a voluntary system, and only 52 countries have enrolled . Of those, 22 submitted data about their levels of antibiotic resistance. Some of the countries with high antibiotic-resistance rates, like Italy and China, don’t participate. In some developing countries, patients don’t need a prescription to buy an antibiotic, upping bacteria’s exposure to the drugs through overuse and allowing them to speed toward becoming resistant.

“If you travel from Sweden to Italy, there is a real chance you will pick up one of these superbugs,” Sprenger says. “If you travel from the States to countries in Asia and you have a traffic accident, there is a big chance you will get one of these highly resistant bacteria, so if you return to a hospital in the States, you really need to be checked. If you’re healthy, it’s no big deal, but if you go to hospital with a lot of vulnerable patients, you will spread it for sure.”

Only seven of the countries that participate in GLASS are low-income. Often, developing nations can’t conduct antibiotic-resistance surveillance because they don’t have the basic health care infrastructure: There are few hospitals or no reliable labs. But in an interconnected, mobile world, not knowing where antibiotic-resistant bacteria are and how much they’re hurting people endangers everyone, from people living rural areas of China to the US soldier who injures his finger and goes to a local hospital in Reno.

Since Carl’s death, Chris and Joyce Romm have spoken out about the growing dangers of antibiotic resistance and met with policymakers to try to generate RD funding for new antibiotics. They’re working with the Pew Charitable Trusts’ Antibiotic Resistance Project to tell Carl’s story and raise awareness. It’s their way of trying to create something positive out of Carl’s death.

Considerable reduction of restenosis and reintervention rates was recently reported with the introduction of drug-eluting stents [, ]. In a recent report of 459 patients with single LAD stenosis, drug-eluting stents significantly decreased restenosis and reintervention rates compared with bare-metal stents [ 6 ].

Most patients with single-vessel disease involving the proximal LAD referred for bypass surgery in our institution are operated on using the minimally invasive direct coronary artery bypass (MIDCAB) technique. We therefore decided to compare their outcome with that of matched patients who underwent PCI with drug-eluting stents.

Between June 2002 and December 2003, 104 patients underwent MIDCAB with left ITA to the LAD, and 272 underwent PCI with LAD revascularization by means of sirolimus drug-eluting stents (Cypher, Cordis, Johnson Johnson, Miami Lakes, FL). The preoperative characteristics of MIDCAB and Cypher patients were not similar. Cypher patients were younger and had an increased prevalence of multivessel disease (35% versus 16%). To control for these differences between MIDCAB and Cypher patients, we compared results between the two treatment modalities only after matching for age, sex, and the extent of coronary artery disease ( Table 1 Table 1 ). Each of the two matched groups thus created contained 83 patients. Baseline characteristics of patients in both groups are summarized in Table 2 Table 2 .

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Left anterior descending artery + diagonal.

CRF = chronic renal failure (serum creatinine mg/dL >1.8); COPD = chronic obstructive pulmonary disease; MI = myocardial infarction; PCI = percutaneous coronary intervention angioplasty or stent; LAD = left anterior descending artery.

Follow-up was obtained by telephone questionnaire and the national registry database after Institutional Review Board approval and patients’ consent. Follow-up was 100% complete.

During the study period, selection criteria for surgery versus PCI were mainly technical. In principle, there was a preference to refer patients for surgery for the following reasons:

Comorbid diseases such as diabetes mellitus and renal failure.

In-stent restenosis or thrombosis of a coronary artery.

Complex type C lesions (calcified coronary arteries, lesion length exceeding 20 mm, twisted arteries, suspicion of a thrombus in an artery), or bifurcation lesion involving a major diagonal branch.

Cypher drug-eluting stents were not available.

Complete occlusion.

Patient’s or cardiologist’s preference.

All MIDCAB patients were operated on without extracorporeal circulation, and all surgical procedures included implantation of a single graft (left ITA) to the LAD. The MIDCAB technique was described in detail by Diegeler and colleagues [ 7 ]. In brief, a limited left anterolateral thoracotomy was performed through the fourth intercostal space. The internal thoracic artery was harvested under direct vision. After administration of heparin (200 U/kg), the activated clotting time was kept on an elevated level of more than 400 seconds by repeat application of heparin, if needed.

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