Chief of Staph - Pharmaceutical Executive


Chief of Staph
Many said it couldn't be done, but one small company is about to get a step ahead of one giant killer bug.

Pharmaceutical Executive

Mark L. Smith Like the man at the top, Smith is a CPA by training and spent eight years at Price Waterhouse in Sydney, Australia and San Jose, California. Before Nabi, Smith worked for various healthcare companies, including Genzyme Genetics, a subsidiary of the Genzyme Coproration. Words of wisdom: "It's good to make a better decision slowly than a bad decision very quickly. But unless you act, you have not done something strategic. You have only thought about being strategic."
Although healthcare professionals and patients have learned to take precautions with gloves, masks, antiseptics, and other obvious measures, infection prevention is still a lost cause for most ESRD patients. That's where the threat of antimicrobial resistance comes in, especially the threat of methicillin-resistant staph aureus (MRSA), which has the CDC, FDA, WHO, and just about every other public health agency in world in a justifiable state of emergency.

A resistant infection can keep otherwise healthy or recovering people in the hospital for days or even weeks after they are scheduled for discharge. The costs associated with that extended stay were the subject of a presentation at the annual meeting of the International Society for Pharmacoeconomics and Outcomes Research. Larry Liu, MD, PhD, director of US outcomes research for Pfizer and lead investigator of a study examining the economic burden of MRSA on the healthcare system, concluded that patients with MRSA stay an extra 10 days in the hospital, including time spent in the ICU, costing hospitals between $3.2 and $4.2 billion every year. And although that study was ostensibly done to support the use of Pfizer's antibiotic Zyvox (linezolid), it illustrates how serious—and costly—the resistance problem has become.

H. LeRoux Jooste He spent 20 years at companies such as Cephalon, Aton, Eli Lilly, and Wyeth, where he led the marketing team that launched Enbrel (etanercept) with Immunex. At Lilly, he directed the launch of Prozac (fluoxetine) in South Africa–the first country in the world to launch the drug. Words of wisdom: "What's our vision? It's that ultimately, there is recognition that prevention is better than cure and that we will get there over time. If we try to achieve that tomorrow, we'll fail. We need to make some sacrifices and do what's realistic in the short-term."
"Hospital infections are caused by a number of bacteria, but the most common bug in the skin is Staph aureus, which is the meanest one of them," Husserl says. "It sometimes accounts for up to 50 percent of the bacteria that we see in cultures. And it varies from area to area in the country and different programs. If patients are in nursing homes, there is a much higher incidence. It is becoming more and more of a problem."

Husserl explains that ESRD patients are especially susceptible to staph infections because of the way the dialysis machines are connected to their bodies. Hemodialysis patient have three options for access:
  • an external catheter, which has the highest risk of infection and is used short-term
  • an internal access which can either be made of a synthetic material such as Gore-Tex, or
  • a surgical procedure called an arteriovenous (AV) fistula, in which an artery is connected to a vein.

What all these options have in common is that they require needle sticks—an average of six times a week. Even patients on peritoneal dialysis, in which a catheter directs fluid into the abdomen, have a high infection rate.

"It is probably the second most common cause of death of our patients on dialysis," says Husserl. "The most common cause of death is some kind of a cardiovascular event, but of the cardiovascular deaths, a large number are also due to infection. About 30 percent have to do with gangrene of an extremity."


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