Understanding C. auris transmission with the healthcare environment

Researchers have now shown that patients who are heavily colonized with Candida auris on their skin can shed the fungus and contaminate their surroundings. This finding provides an explanation for the extensive contamination that often occurs in healthcare facilities with C. auris outbreaks. These results can help inform infection control efforts. The research is presented at ASM Microbe, the annual meeting of the American Society for Microbiology.

C. auris is an emerging fungal pathogen that can cause large outbreaks in healthcare facilities. Understanding how C. auris spreads in healthcare facilities is essential for infection control. Because C. auris can be present on the skin without causing symptoms, it has been hypothesized that the spread of C. auris occurs as patients naturally shed their skin cells. This process could lead to substantial contamination of the surrounding environment and therefore increase chances of transmitting C. auris.

To test this hypothesis, the researchers developed methods to count C. auris in samples collected from patients’ skin and their rooms. We found that patients can have very high concentrations of C. auris on their skin, and higher levels of C. auris on their skin were correlated with higher levels of C. auris on the patient’s bed.

“This finding supported our hypothesis that patients are actively shedding C. auris cells into their environment,” said Joe Sexton, ORISE post-doctoral fellow in the Mycotic Diseases Branch at the Centers for Disease Control and Prevention, who designed and led the study. The researchers were able to culture live C. auris from the beds of all patients who tested positive, and even beds that were previously, but no longer, occupied by patients with C. auris.

“These results should be considered in developing more effective strategies for infection control efforts during a C. auris outbreak,” said Dr. Sexton.

Patient and environmental samples were processed in the Mycotic Diseases Branch laboratory in Atlanta by Joe Sexton, Meghan Bentz, and Rory Welsh and Anastasia Litvintseva, who served as a principal investigator (PI). These samples were collected by the City of Chicago’s Public Health Department led by Massimo Pacilli.

Additional groups within CDC also supported this work including the Department of Scientific Resources and the Division of Healthcare Quality and Promotion, and the Oak Ridge Institute for Science and Education. This work will be presented at American Society of Microbiology (ASM) Microbe 2019 conference in San Francisco, California (June 20-24, 2019).

https://www.eurekalert.org/pub_releases/2019-06/asfm-uca061819.php

How Martian Microbes Could Survive in the Salty Puddles of the Red Planet

In extraordinarily salty puddles of water resembling ones you might find on Mars, bacteria can survive getting completely dried out, suggesting that the Red Planet may be more habitable than previously thought, according to a new study.

Since there is life virtually wherever there is water on Earth, research into whether Mars was once capable of hosting life — and whether it still might host it — typically focuses on the past or current presence of liquid water on or below its surface. However, the cold, thin atmosphere that Mars has nowadays means liquid water likely cannot exist on its surface for any length of time.

Still, just before dawn, evaporating frost on the Martian surface can drive humidity up to 100 percent, said the study’s senior author Mark Schneegurt, an astrobiologist at Wichita State University in Kansas. At its peak, the humidity on Mars can resemble the drier parts of the Atacama Desert in Chile, the driest place on Earth aside from its poles, which nevertheless is home to life.

In addition, a variety of salts often found on the surface of Mars could absorb this moisture. Because the briny fluids that result have a lower freezing point than water, they could withstand the frigid temperatures that prevail on the Red Planet’s surface — and potentially harbor life.

However, the humidity on the Martian surface plummets during the daytime as temperatures rise. As such, any microbes on Mars would likely have to deal with constantly getting dried out.

To see if life on Mars could survive these cycles of desiccation, scientists experimented with two species of bacteria taken from two highly salty areas — Hot Lake in Washington and the Great Salt Plains in Oklahoma. They grew them in the lab in a solution that was half water and half magnesium sulfate, commonly known as Epsom salt, a kind of salt common on the Martian surface.

The researchers next dried small drops of this bacterial-laden solution using water-absorbing chemicals under a vacuum, to mimic how brines on the Martian surface might evaporate. Finally, they locked the dried drops in a jar with either regular water or saltwater and let the jar fill with humidity.

Within a day, the scientists found the dried drops absorbed enough moisture from the air to make a liquid brine, at which point the bacteria revived and began to grow. Typically more than half the cells survived.

“We have the first data showing the growth of bacteria after drying and then rehydration through humidity alone, in the presence of salts that absorb moisture from the air,” Schneegurt told Space.com.

These findings may expand what scientists consider habitable when it comes to dry or cold worlds, Schneegurt said. It also could mean there is a greater risk than previously thought that Earth microbes can contaminate other worlds.

In the future, the researchers may examine how well these bacteria perform at the colder temperatures typical of Mars, as well as with other kinds of salts found on the Martian surface, Schneegurt said.

The scientists detailed their findings on June 21 at the annual meeting of the American Society for Microbiology in San Francisco.

https://www.space.com/salt-tolerant-microbes-life-on-mars.html

Beckman Coulter: how to know sooner, act faster in diagnosing, treating sepsis

Beckman Coulter, a global leader in clinical diagnostics will be demonstrating its microbiology and interdisciplinary testing solutions that help laboratorians future-proof the lab and advance patient care at the American Society for Microbiology conference, ASM Microbe, in San Francisco. During the conference, Beckman Coulter is also sponsoring an Industry and Science Showcase where attendees will learn how to know sooner and act faster when diagnosing and treating sepsis. 

Sepsis is a global crisis, affecting millions of people and costing healthcare organizations billions of dollars. Additionally, sepsis is difficult to diagnose, treatment is resource intensive, and time is critical for positive patient outcomes. Beckman Coulter’s comprehensive solutions spanning hematology, microbiology, immunoassay, chemistry and urinalysis can be utilized from the moment the patient enters the emergency department through time spent in intensive care.

The Industry and Science Showcase entitled, Identify, Diagnose and Manage Sepsis Efficiently with Interdisciplinary Testing, will be held at 1:00pm on Saturday, June 22, 2019 in the Industry & Science Showcase Theater North, Exhibit Hall, Moscone Convention Center.

https://www.selectscience.net/product-news/beckman-coulter-highlights-microbiology-and-interdisciplinary-testing-solutions-to-help-advance-patient-care-at-asm-microbe?artID=49233

Dow 30,000 by 2021 – Barron’s

The S&P 500 is up 18% YTD and powering toward its biggest first half since 1997. For bulls, the next question is “how long until Dow 30,000?” writesJack Hough in Barron’s.

“In early 2017, when the DJIA hit 20,000, Barron’s wrote in a cover story that 30,000 by 2025 looked likely, assuming a cut to corporate taxes, and no trade war. A 50% gain over nine years is 4.6% a year, compounded. Investors got the tax cut, but also the early salvos of a trade war. Yet the Dow has already climbed by one-third since our cover story. That’s a rip-roaring 12.7% a year. It doesn’t count dividends.”

“The real wild card is interest rates, or more specifically, how investors respond to them. Futures markets show near-certainty of the Fed returning to rate cuts this year. Looking at seven initial rate cuts since Ronald Reagan, the market has returned a median of 14% over the following year.”

“U.S. stocks trade at 17 times forward earnings estimates, about where they were in early 2017. Assuming they hold that valuation, the earnings outlook implies potential for yearly gains of 5% or so from here.”

“Where does that leave us on the Dow? So long as we can agree that precise targets are folly, we’ll drop our date but stick with our 4% to 5% yearly return. From here, that means 30,000 by the end of 2021.”

https://seekingalpha.com/news/3473114-dow-30000-2021-barrons

CVS just laid out a big reason why health companies are worried about Amazon

When word spread that Amazon would move into health care in 2017, health-care executives had a ready answer: We are not afraid.

“I honestly don’t believe that Amazon will be interested in the near future in the next few years in this market,” Walgreens’ CEO Stefano Pessina told investors in an earnings call in July 2017.

“I think we have a lot of capabilities and a value proposition that can compete effectively in the market,” CVS CEO Larry Merlo said back in August.

But recent legal actions tell a different story.

In April, CVS filed a lawsuit against John Lavin, a former senior vice president in charge of CVS Caremark’s retail pharmacy network, after Lavin told the company he was leaving to take a job at Amazon’s pharmacy arm, PillPack. The judge this week ruled in CVS’ favor, preventing Lavin from taking immediate employment at PillPack.

That follows another case from January of this year, where insurance giant UnitedHealth sued one of its employees for attempting to join a different Amazon initiative. That was Haven, Amazon’s joint employer health venture with Berkshire Hathaway and J.P. Morgan.

These lawsuits suggest incumbents are more concerned than they’re letting on in public.

The underlying concern: Amazon going directly to insurers

Amazon has said almost nothing in public about its health-care strategy.

But Amazon could disrupt the space dramatically by negotiating directly with insurance companies on drug pricing, cutting out the existing pharmacy benefits managers, or PBMs. All of that could potentially lower health-care costs for consumers.

Among other functions, PBMs help insurance companies negotiate lower drug costs. Manufacturers arrange discounts, called rebates, with the benefits managers so they can fix a spot for their products on a PBM’s list of preferred drugs. It’s a huge business — CVS’ PBM business represented approximately 60% of its overall revenues in 2018, or around $116 billion, according to a person familiar with CVS’ business.

Amazon PillPack CEO TJ Parker, in a deposition in the Lavin case, admitted to the court that the company had “explored a number of different things.”

But he said the company had “no immediate plans” to compete with CVS Caremark’s core offering, its PBM.

CVS certainly seems to think differently, according to the lawsuit to prevent Lavin from working for PillPack.

“Given its robust infrastructure, operational capacity, and distribution reach, Amazon-PillPack is uniquely positioned to negotiate directly with payers (insurers) and displace CVS Caremark’s mail-based services,” CVS argued in support of its motion for a preliminary injunction.

In other words, CVS worries that Amazon is hiring Lavin to approach its clients — insurance plans — for deals that could undercut its PBM.

In particular, CVS said PillPack is already approaching Blue Cross Blue Shield. (CNBC reported talks between PillPack and the insurance network in May.)

“Most recently, Amazon-PillPack engaged in direct discussions with Blue Cross Blue Shield, a federation of 36 health insurance plans that cover more than 100 million Americans, to provide its members with prescription home delivery,” CVS’ motion reads.

Lavin, who has extensive background working with payers, would be well positioned if Amazon PillPack did decide to take that step toward direct contracting over time.

According to Jefferies’ analyst Brian Tanquilut, who also reviewed the legal documents, there’s a real threat that Amazon could chip away at CVS Caremark’s business over time by going directly to insurers. “The lawsuit shows that pharmacy benefits managers are now also at risk of being dis-intermediated,” he wrote.

To that assertion, a PillPack spokesperson responded: “It is important to keep in mind that what’s being reported here is another company’s speculation about our business strategy for a lawsuit to which neither Amazon nor PillPack is a party.”

However, other drug supply chain experts agree that the PBMs have reason to worry, especially as the health industry consolidates and policymakers are pushing PBMs to be more transparent about their practices.

“PBMs are going to be more protective of their mail pharmacy business than ever and less welcoming to outsiders like PillPack,” said Stephen Buck, a drug supply chain expert who previously worked at McKesson.

For his part, Lavin said in communications to his former employer that he would not be competing head-on with them but would be negotiating from the opposite side of the table.

“I’ll be … handling [PillPack’s] negotiations with PBMs … in other words, it’ll be the opposite of what I did for CVS,” he noted in an email to CVS’ human resources department that was disclosed during the case.

The judge disagreed and granted CVS’ motion to enforce the noncompete agreement and block Lavin from working for PillPack for 18 months.

In his ruling, Judge John J. McConnell wrote, “Mr. Lavin will also negotiate and build relationships with private Payers and public Payers, both of whom are current CVS clients.” McConnell wrote, “It also appears that PillPack will be looking to negotiate directly with the insurers and others on the Payer level.”

CVS, in a statement to CNBC, denied any claim that it is working to block competition and said that it will continue to work with new players.

“We remain focused on delivering innovative solutions to transform the health care experience, but there is always room for new players in health care, as competition can help lower overall costs for payers and patients,” said a spokesperson for CVS Caremark.

https://www.cnbc.com/2019/06/20/new-cvs-lawsuit-to-block-exec-from-working-for-amazon-reveals-concern.html

Array-size deals don’t come around too often

A chunky buyout always raises hopes for more M&A action, although those anticipating further deals like the Array Biopharma takeout, launched by Pfizer yesterday, should remember that transactions of this size are relatively rare beasts. Still, the price gives 2019’s tally a well-needed boost: the acquisition ranks as the second largest so far this year, EvaluatePharma data show.

Described as a bolt-on by Pfizer, the $11.4bn bid is at the upper end of what many would consider the “sweet spot” for tuck-in acquisitions, though few truly comparable deals happen to enable any more rigorous benchmarking of this particular move. Only nine notable takeouts of commercial-stage oncology companies have occurred since 2015, as far as Vantage can determine.

This is largely because promising R&D projects tend to get snapped up before they reach the market, though it is notable that Array stands as fourth largest in this list. Gilead’s purchase of Kite has been included here because approval of the latter’s CAR-T therapy Yescarta happened only a couple of weeks after the takeover closed, and was widely considered a dead cert.

The table below shows how substantial a move the Array takeout represents, particularly when considering that oncology tends to dominate the deal-making space (Following the M&A money, by phase and therapy area, January 29, 2019).

Little wonder that Pfizer struggled to defend the price tag yesterday (Rich recognition finally arrives for Array, June 17, 2019).

NOTABLE TAKEOUTS OF COMMERCIAL-STAGE CANCER COMPANIES SINCE 2015
Acquirer	Target	Value ($bn)	Year
Abbvie	Pharmacyclics	20.8	2015
Pfizer	Medivation	14.0	2016
Gilead Sciences	Kite Pharma	11.9	2017
Pfizer	Array Biopharma	11.4	2019
Eli Lilly	Loxo Oncology	8.0	2019
Takeda	Ariad Pharmaceuticals	5.2	2017
Glaxosmithkline	Tesaro	5.1	2018
Novartis	Advanced Accelerator Applications	3.9	2017
Bausch Health	Dendreon	0.5	2015
Source: EvaluatePharma.

How companies define the “sweet spot” will vary greatly, of course, though traditionally this has been pitched at around the $5bn mark, for big drug developers at least. Whether this remains the case today, when valuations in many sectors remain testing, is a point for discussion, though a look at the distribution of deal values does point to a clustering around this price point.

The analysis below, extracted from EvaluatePharma, includes all full company takeouts struck by biopharma since 2015. It focuses only on those involved in the development of human therapeutics, and excludes medtech or genomics companies, for example. Deals between $1bn and $20bn only have been included, though the transaction on the far right just tips over this scale.

This was Abbvie’s huge $20.8bn swoop on Pharmacyclics, essentially a single-asset company and a move that could arguably be described as a bolt-on. That single asset was the blockbuster Imbruvica, but even so this analysis underlines just how infrequently deals of this size occur.

It also shows that deals above $10bn are rare; even for the world’s biggest drug makers, acquisitions that stray into this territory must prompt some serious board discussion. This is something for investors to bear in mind when they scroll through the list of purported takeout targets, whose market cap plus any premium could take them into this barren M&A territory.

Think Amarin, which is currently valued at $6.2bn, or Sage Therapeutics or Sarepta, both at over $9.2bn.

More recently, rumours have surfaced for the gene therapy company Uniqure, and Biohaven, which owns a late-stage migraine asset. At $3bn and $2.5bn market caps respectively their valuations would presumably take them into a more populated region of the deal space, though of course talk of any bid for either is little more than speculation at this stage.

Either way, Pfizer’s move yesterday means that biopharma companies have committed to spend $19bn on M&A so far this quarter. The Array deal counts for a large proportion of that, and has rescued the second quarter from looking like a very weak period for deal-making, in value terms.

Coming after Lilly’s acquisition of Loxo Oncology and Roche’s bid for Spark in the first quarter, hopes are high that 2019 will deliver more such deals. And, while the data suggest that Array could be an outlier, investors will hope that buyers have the appetite for at least one more sizeable transaction before the year is out.

https://www.evaluate.com/vantage/articles/data-insights/ma/array-size-deals-dont-come-around-too-often

Shionogi presents on investigational compounds at ASM

Shionogi & Co., Ltd. (hereafter “Shionogi”) today announced there will be one oral presentation and 17 poster presentations featuring two of the company’s investigational compounds at the American Society for Microbiology (ASM) Microbe meeting, being held June 20–24, 2019 in San Francisco. Sixteen poster presentations are on cefiderocol, a late-stage investigational, novel siderophore cephalosporin, and one is on COT-143, a humanized monoclonal antibody.

“Cefiderocol has a unique mechanism of cell entry and is able to overcome the three major mechanisms of carbapenem-resistance of Gram-negative pathogens. The totality of cefiderocol data to be presented at ASM Microbe adds to the growing body of evidence of its potential activity against some of the world’s deadliest pathogens and we look forward to sharing these findings with the scientific community,” said Dr. Tsutae Den Nagata, Chief Medical Officer, Shionogi.

In addition, Shionogi will also present a poster on COT-143, an investigational humanized monoclonal antibody demonstrating anti-virulence activity targeting the PcrV protein of Pseudomonas aeruginosa.

Presentations will include data on these Shionogi agents from company-sponsored or investigator-initiated investigational studies.

https://www.businesswire.com/news/home/20190617005516/en/Shionogi-Present-Cefiderocol-COT-143-Data-American-Society