ASP Scan (Weekly) for Jan 06, 2017

VA MRSA decline
;
Predatory pathogen research
;
Drug-resistant gonorrhea
;
Fast-food antibiotics petition
;
FDA animal antibiotic guidance
;
Drop in MRSA pneumonia

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Study finds MRSA infections in significant decline at VA hospitals

An initiative to reduce rates of methicillin-resistant Staphylococcus aureus (MRSA) infections at Veterans Administration (VA) hospitals continues to be associated with marked declines, researchers reported yesterday in the American Journal of Infection Control.

The study, in which investigators from the Veterans Health Administration examined monthly data from a national database that included 127 acute-care facilities, 22 spinal cord injury units (SCIUs), and 133 long-term care facilities (LTCFs), found that from October 2007 through September 2015, monthly MRSA healthcare-associated infection (HAI) rates fell by 87% in intensive care units (ICUs), 80.1% in non-ICUs, and 80.9% in SCIUs. From July 2009 through September 2015, MRSA HAIs declined by 49.4% in LTCFs.

All declines were statistically significant. In September 2015, there were only 2 MRSA HAIs reported in ICUs, 20 in non-ICUs, and 31 in LTCFs nationwide.

The study supports trends that were first observed when the investigators measured monthly MRSA HAI rates from October 2007 through June 2012. The VA's MRSA Prevention Initiative began in 2007, in response to high rates of MRSA infections at VA hospitals.

The authors suggest that the bundle of infection control interventions introduced under the initiative, such as universal active surveillance; unit-to-unit transfer, and discharge; contact precautions for those colonized or infected with MRSA; a continued emphasis on hand hygiene; and an overall institutional culture change likely all played a role in driving down MRSA HAIs. But they suspect that active surveillance might be the most significant factor, given that other interventions had been in place prior to the initiative.

"Understanding how and why rates of MRSA have diminished in recent years is essential for the continued progress of effective prevention programs," lead study author Martin E. Evans, MD, said in a press release from Elsevier, the journal's publisher. "As we seek to protect patients from MRSA and other resistant organisms, our study supports the need for strong infection prevention programs at every healthcare facility."
January Am J Infect Control study
Jan 5 Elsevier Health Sciences press release

 

Pew: Predatory pathogen program could help fight drug resistance

A new analysis by the Pew Charitable Trusts says a research program aimed at examining the potential of predatory pathogens to fight antibiotic-resistant infections could be a model for research into other novel treatments for drug-resistant bacteria.

The Pathogen Predators program, led by a team of researchers funded by the Defense Advanced Research Projects Agency (DARPA), is using a framework that will help move investigations from basic research to clinically relevant studies by asking a series of guiding questions. Those questions include whether predatory pathogens will be toxic to the organisms they are meant to treat, what kind of bacterial infections they are effective against, and whether bacteria could develop resistance to these pathogens over time.

Pew says that the Pathogen Predators program, which involves a collection of scientists from a variety of disciplines, has already begun to generate promising data on the effects of predatory bacteria on infections in animals, which could provide support for later testing in humans.

"If successful, the Pathogen Predators program will help lay the groundwork for safe and efficacious novel treatments for bacterial diseases," the authors write, adding that the model deserves attention from academic institutions, governments, pharmaceutical companies, and other stakeholders working to combat antimicrobial resistance.
Jan 5 Pew Charitable Trusts analysis

 

Decreasing susceptibility to front-line antibiotics seen in Dutch gonorrhea

Originally published by CIDRAP News Jan 5

An analysis of Neisseria gonorrhea isolates from a sexually transmitted infection (STI) clinic in Amsterdam shows a rise in decreased susceptibility to azithromycin and ceftriaxone, researchers report today in Eurosurveillance.

Researchers found that, of the 3,151isolates obtained from the STI Outpatient Clinic from January 2012 through September 2015, only 38 (1.2%) were resistant to azithromycin, while none were resistant to ceftriaxone. But analysis of minimum inhibitory concentrations (MICs) showed that the percentage of isolates with intermediate MICs (> 0.25 and ≤ 0.5 mg/L) for azithromycin increased from 3.7% in 2012 to 8.6% in 2015, an indication of decreased susceptibility. In addition, the proportion of isolates showing decreased susceptibility to ceftriaxone rose from 3.6% in 2012 to 8.4% in 2015.

Decreasing susceptibility to both azithromycin and ceftriaxone was noted particularly among men who have sex with men, with isolates from more recent infections (those diagnosed in 2014) were also more likely to show decreased susceptibility. Among heterosexuals, decreased susceptibility to azithromycin and ceftriaxone was more likely to be observed in individuals who had more than 10 sexual partners, while being diagnosed in 2014 or 2015 was only significantly associated with decreased susceptibility to ceftriaxone.

International guidelines currently recommend dual therapy with ceftriaxone and azithromycin as the primary treatment for gonorrhea. But the bacterium's history of developing resistance to antibiotics, along with recent reports of high-level azithromycin-resistant gonorrhea in the United Kingdom and rising resistance to ceftriaxone in other countries, has raised the concern that the STI could become much more difficult to treat.

While the study shows that resistance to azithromycin and ceftriaxone is lower in Amsterdam than in other European countries, the authors caution that the rise in decreased susceptibility, coupled with higher resistance in other countries and increasing globalization, highlights the need for continued surveillance and development of new treatment strategies.
Jan 5 Eurosurveill research article

 

Petition calls for fast-food companies to ban antibiotics in meat, poultry

Originally published by CIDRAP News Jan 5

A petition signed by more than 125,000 people was delivered today to the CEOs of 16 fast-food companies, calling on them to stop selling meat and poultry raised on medically important antibiotics.

The fast-food companies targeted in the petition effort all received an "F" in the most recent Chain Reaction report from the Center for Food Safety, Consumers Union, Friends of the Earth, Natural Resources Defense Council, and Food Animals Concerns Trust. The report grades America's 25 largest fast-food and fast-casual chains on their meat and poultry antibiotics policies. Experts believe the use of medically important antibiotics in food-producing animals is contributing to the emergence of antibiotic resistance.

The petition is the latest in a series of campaigns to put public pressure on restaurant chains to commit to eliminating the use of medically important antibiotic in the meat and poultry they sell. The Center for Food Safety, Consumers Union, and US Public Interest Group have been gathering signatures since the Chain Reaction report was released in September.

"Antibiotics should only be used to treat disease, not wasted on healthy animals or to compensate for filthy conditions on factory farms," Jean Halloran, director of food policy initiatives at Consumers Union, said in a press release. "It's time for restaurants to help protect public health by demanding that their suppliers end the irresponsible use of these important medications."

One of the targeted companies is Burger King, whose parent company—Restaurant Brands International—announced last week that it would stop selling chicken raised on antibiotics in 2017. But that move was deemed insufficient because the company agreed only to eliminate those antibiotics considered "the most critical" in human medicine.

Other companies on the list include Wendy's, KFC, Arby's, and Taco Bell.
Jan 5 Consumers Union press release

 

FDA notes full implementation of rules on antibiotic use in food animals

Originally published by CIDRAP News Jan 3

The US Food and Drug Administration (FDA) announced today that it has reached a "significant milestone" in efforts to reduce the use of medically important antibiotics in food producing animals.

Under Guidance for Industry #213, all pharmaceutical companies that sell medically important antibiotics for use in food animals were asked to voluntarily commit to making two label changes to their products by Jan 1: (1) remove any "growth promotion" claims and (2) change the marketing status of products administered to food animals via water and feed so that they can be used only under veterinary supervision. Companies have had 3 years to make these changes.

As of last week, FDA records showed that the labels for several products remained unchanged. But as of Jan 3, the FDA says, all affected drug applications "have either aligned with the recommendations outlined in GFI #213, or their approvals have been voluntarily withdrawn."

"As a result of these changes, these products cannot be used for production (e.g., growth promotion) purposes and may only be used under the authorization of a licensed veterinarian," the agency said in a press release.

Of the 292 new animal drug applications initially affected by Guidance #213, 84 have been completely withdrawn, 93 products intended for use in water have been converted from over-the-counter to prescription status, and 115 products intended for use in feed have been converted from over-the-counter to veterinary feed directive status. Twenty-two products have had growth promotion claims withdrawn from their applications

The agency says that it will now focus its efforts on promoting antimicrobial stewardship in veterinary settings.
Jan 3 FDA press release

 

Study: MRSA pneumonia cases declining in US hospital patients

Originally published by CIDRAP News Jan 3

A new longitudinal study in the American Journal of Infection Control indicates that the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia is declining in US hospital patients, a trend that is accompanied by improvements in mortality and length of hospital stay.

Using the National Inpatient Sample (NIS) database, investigators from the University of Buffalo analyzed adult patients who had been discharged from US hospitals from 2009 through 2012 and had a primary diagnosis code for MRSA pneumonia or methicillin-susceptible S aureus (MSSA) pneumonia. The main outcome variables include overall S aureus pneumonias (a composite of MRSA and MSSA diagnoses), in-hospital mortality, and length of stay.

The investigators found that 104,562 patients had a primary diagnosis code for S aureus pneumonia during the study period, with MRSA accounting for 77.7% of the cases. Overall S aureus pneumonia cases dropped from 96.4 per 100,000 hospital discharges in 2009 to 73.7 cases per 100,000 in 2012 (a decline of 24%), while MRSA pneumonia cases declined from 75.6 cases per 100,000 in 2009 to 56.6 cases per 100,000 in 2012 (a 19% drop). MSSA pneumonia cases fell from 20.8 per 100,000 to 17.1 during the study period.

Mortality rates for MRSA and MSSA pneumonia also decreased during the study period, dropping from 7.9% to 6.4% and from 6.9% to 4.7%, respectively. In addition, median length of hospital stay fell from 7.4 to 6.8 days for MRSA pneumonia patients. Among MSSA pneumonia patients, however, median length of stay rose slightly, from 6.1 to 6.2 days.

The authors say the decline in S aureus pneumonia-related infections is "highly encouraging," and add that it could be attributable to increased awareness, improved training of healthcare workers, implementation of infection control procedures, and an increase in antimicrobial stewardship programs. What's more, they write, "Declining rates of MRSA pneumonia could provide an opportunity for antimicrobial stewardship where vancomycin is withdrawn early or even withheld empirically."

But they note that their study may underestimate the burden of MRSA pneumonias, and they caution that vigilance is still warranted, given that MRSA pneumonia is associated with more adverse outcomes compared with other types of pneumonia. 
Dec 30 Am J Infect Control study

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