CIDRAP Antimicrobial Stewardship Project Newsletter – Oct 31, 2019


In this week's issue:

  • What's new at CIDRAP-ASP?
  • Poor-quality antibiotics and AMR across Africa
  • AMR in rivers and wastewater in LMICs
  • Pharmacist-led stewardship in a Canadian pediatric ED
  • UK investment in gonorrhea treatment in LMICs
  • Trials for new antibiotic for UTIs and gonorrhea
  • Diagnostic support for stewardship in Sierra Leone
  • Regulation and investment for stewardship and diagnostics
  • AMR in blood and respiratory cultures across 177 US hospitals
  • Sanitation and AMR in Bangladesh
  • Gram-negative isolates and high AMR in Nigeria
  • AMR and the convergence of infectious and noncommunicable diseases
  • Market problems and financial risks for antibacterial drug developers




[Register] Registration is open for our free Nov 5 webinar on "Value of Diagnostics in Antimicrobial Stewardship: An Asia-Pacific Outlook," featuring presentations from Deborah Williamson, MBChB, PhD, and David Lye, MBBS. The webinar is supported by an educational grant from bioMérieux, and participants will be eligible for continuing pharmacy education and continuing medical education. (Please note: The webinar will be held at a time that promotes access for people joining us from Asia, Australia, and Oceania.)


[Watch] Please head over to our YouTube channel to view the recording of our recent webinar on "Resistance Guided Therapy for Mycoplasma genitalium: Application of Macrolide Resistance Testing Results," which features a presentation from Barbara Van Der Pol, PhD, MPH.


[Connect] In a video for the International Pharmaceutical Federation, Philip Howard, BPharm, and CIDRAP-ASP Advisory Committee member Debbie Goff, PharmD, speak about antimicrobial stewardship in community pharmacies and hospitals in resource-limited settings.


[Read] CIDRAP News recently published stories on a Society for Healthcare Epidemiology of America (SHEA) white paper on research needs in antibiotic stewardship, ways to reframe messages on antimicrobial resistance (AMR) to boost empowered public and policymaker understanding, and much more.


[Research] Please take a moment to revisit our redesigned antimicrobial stewardship diagnostics resources, our database containing hundreds of publicly available clinical tools for antimicrobial stewardship programs, and our educational multimedia page. The diagnostics page is updated at least weekly, and we add new clinical and educational tools monthly.


[Stay Current] If you'd like to stay current on all our news and events, please follow CIDRAP-ASP on Twitter and Facebook, subscribe to our YouTube channel, and subscribe to our antimicrobial stewardship podcasts on iTunes.




[Rethink] On SciDev.Net, Elizabeth Shekalaghe, BPharm, MPharm, MSc, describes the problem of poor-quality antibiotics across Africa and the implications of low-quality drugs on AMR, along with efforts to boost regulation and quality assurance in the supply chain to ensure reliable access to safe antibiotics.


[Engage] In the European Commission's Horizon magazine, Aisling Irwin, MSc, highlights research that may link antibiotic residues in rivers and wastewater to AMR in clinical settings, with a focus on implications for low- and middle-income countries (LMICs). And in an article for the Pew Charitable Trusts, Karin Hoelzer, DVM, PhD, proposes a rationale for implementing with greater urgency the US Food and Drug Administration's policy on veterinary oversight for animal antibiotics.


[Learn] In the International Journal of Clinical Pharmacy, Kathleen M. MacMillan, BPharm, et al describe the implementation of a pharmacist-led antimicrobial stewardship service at a Canadian pediatric emergency department, noting that the intervention was associated with lower rates of return visits or hospitalizations, reduced inappropriate antimicrobial use, and a shorter time to notification of culture results after discharge.


[Examine] The UK government made a 3.5 million GBP ($4.53 million US) investment as part of a partnership with the Global AMR Innovation Fund and the Global Antibiotic Research and Development Partnership (GARDP) to enable access to gonorrhea treatment in LMICs and to fund the development of zoliflodacin for the treatment of gonorrhea. And GSK announced that it has begun phase 3 studies for gepotidacin, a first-in-class antibiotic, in patients with uncomplicated urinary tract infections or urogenital gonorrhea.


[Study] In the International Journal of Infectious Diseases, Sulaiman Lakoh, MD, MPH, et al assess antibiotic use in 688 patients receiving care in a Sierra Leone hospital, finding that none of the patients received a bacterial culture owing to a lack of a functional microbiology laboratory. Median duration for antibiotic use was 18 days, and 79% of patients missed doses likely due to a disrupted supply of antibiotics. The authors argue for greater investment in diagnostic support and antimicrobial stewardship in developing countries, with attention to how antibiotic choice and use are driven by availability and cost of drugs and laboratory services.


[Listen] On a SHEA podcast, Manisha Juthani, MD, Christopher Crnich, MD, PhD, and Cindy Prins, PhD, MPH, synthesize the evidence and rationale behind antibiotic stewardship for asymptomatic bacteriuria in long-term care. And in a podcast for the International History Applied Research Seminar at the Graduate Institute, Geneva, Michele Zampa, Phasawit Jutatungcharoen, Matteo Bernasconi, and Chaza Al Kanawati discuss the history of advocacy around AMR and the formation of GARDP.


[Assess] On the Scientific American blog, Javier Guzman, MD, describes the roles of regulation, the private sector, behavior change, and data management systems in applying knowledge about AMR to efforts that aid in its prevention and reduction. And on Stat, Eric Stern, PhD, MS, describes his personal experiences with AMR and delays in diagnostic and susceptibility testing, along with US progress on regulation, investment, innovation, and clinical use related to rapid diagnostics.


[Analyze] In the Journal of Pharmacy Practice, Daniel M. Parshall, PharmD, et al found that prolonged antibiotic therapy (more than 7 days) for community-onset pneumonia was not associated with a decrease in 30-day readmission rates when compared with antibiotic therapy administered for 7 days or less. And in Clinical Infectious Diseases, Sarah Haessler, MD, et al found in a study of 12,888 positive blood and/or respiratory cultures collected across 177 US hospitals from patients with pneumonia or respiratory-related diagnoses that 42% yielded isolates that were resistant to first-line therapy for community-acquired pneumonia, with respiratory isolates more often resistant than isolates obtained from blood cultures.


[View] The Phipps Conservatory posted recordings of presentations from the One Health One Planet 2019 Symposium, including talks from Alison Franklin, PhD, on AMR in the environment, and from Neil Clancy, MD, on a medical perspective on One Health approaches to AMR.


[Discover] In news from Washington State University (WSU), Josh Babcock describes a project led by WSU's Mohammad Aminul (Amin) Islam, PhD, MSc, to evaluate the impact of clean water, sanitation, and hygiene practices on AMR in children living in Bangladesh. And in Hospital and Healthcare, Fiona Gotterson, RN, MN, describes possible roles for nurses, including leadership roles, in antimicrobial stewardship programs.


[Evaluate] In the Journal of Global Antimicrobial Resistance, David O. Ogbolu, PhD, et al evaluate 306 gram-negative isolates obtained from patients with and without infections in three Nigerian hospitals, finding that 78.1%, 92.2%, and 52.6% of isolates were resistant to fluoroquinolones, third-generation cephalosporins, and carbapenems, respectively, with more AMR isolates obtained from uninfected patients than from infected patients.


[Explore] The US National Academies of Sciences, Engineering, and Medicine released a report on a workshop exploring the convergence of infectious and noncommunicable diseases, with an emphasis on the effect of antibiotics on the human microbiome and the impact of mass antibiotic administration.


[Review] In Antimicrobial Agents and Chemotherapy, David M. Shlaes, MD, PhD, explores possible solutions to market problems that present financial risks to companies developing antibacterial drugs.

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