Stewardship / Resistance Scan for Nov 13, 2017

US AMR progress
Antimicrobial use in Northern Ireland
Resistance in space

HHS report notes stewardship, resistance progress in the US

Almost two thirds of US hospitals now have full-scale antibiotic stewardship programs and the incidence of several antimicrobial-resistant (AMR) infections are declining in the country, according to a progress report on 2 years of US efforts to combat AMR, the Department of Health and Human Services (HHS) said today.

The report, published by the HHS Office of the Assistant Secretary for Planning and Evaluation, also highlights the US government response to the emerging threat of MCR-1, the gene that confers resistance to colistin, an antibiotic of last resort. In its case study on MCR-1 risk, HHS describes a targeted response across federal agencies.

The report highlights progress made and steps needed for the five goals established in the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) in 2015: (1) slow AMR bacteria; (2) strengthen national One Health efforts; (3) advance the development of rapid tests; (4) accelerate basic and applied science for developing new antibiotics, other drugs, and vaccines; and (5) improve international collaboration. Officials plan to implement these goals by 2020.

As part of its assessment of goal 1, the report notes that methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in US hospitals declined 13% from 2011 to 2014 and a further 5% by 2016. And Clostridium difficile infections dropped in US hospitals 8% from 2011 to 2014 and an additional 7% by 2016.

In addition, the percentage of US hospitals having programs that meet all seven of the Centers for Disease Control and Prevention's Core Elements of Antibiotic Stewardship rose to 46% in 2015 and to 64% in 2016. The report also noted that Veterans Health Administration centers saw a 10% decline in inpatient antimicrobial use.

As part of goal 2 efforts, HHS noted that the Food and Drug Administration doubled annual retail meat testing from 6,700 food samples in 2015 to about 17,280 in 2017. And testing of chicken parts by US Department of Agriculture inspectors increased from 3,850 facilities in 2015 to 8,000 in 2016.
Nov 13 HHS progress report
March 2015 CARB
Action Plan


Northern Ireland report rise in bacteremia, drug-resistant infections

Northern Ireland's first report on antimicrobial use and resistance, also published today, notes that resistance levels in several common pathogens have risen in recent years, but the country has seen no change in antibiotic use since 2014.

The report, published by the country's Public Health Agency (PHA), notes that the percentage of Escherichia coli resistant to piperacillin-tazobactam increased from 8.8% in 2009 to 15.6% in 2016. And Klebsiella pneumoniae resistant to the combination therapy increased from 8.6% to 19.0% in the same period. The PHA report also notes that the number of reported bloodstream infections caused by E coli increased from 980 to 1,487 and by K pneumonia from 143 to 208 from 2009 to 2016.

Total consumption of antibiotics in primary and secondary care remained at 32 doses per 1,000 inhabitants per day from 2014 through 2015, the report found. Of the doses prescribed, 85% were in primary care. The most frequently used antibiotics in both primary and secondary care in Northern Ireland were penicillins (37.7% and 31.1%, respectively), tetracyclines and related drugs (25.8% and 9.9%), and macrolides (14.3% and 8.5%).

The authors of the report concluded, "While the proportion of isolates that are resistant to key antibiotics has not changed very much over time, the absolute number of resistant infections has increased because of the overall rising number of infections."
Nov 13 PHA annual report


Experiments slated to test E coli resistance in space

Yesterday the National Aeronautics and Space Administration (NASA) launched E coli samples to the International Space Station (ISS) for experiments on antibiotic resistance, reported.

The bacterial specimens were launched to the ISS on Orbital ATK's Cygnus cargo spacecraft along with many other science experiments and supplies for the Expedition 53 crew. Experiments will examine how microgravity affects the ability of E coli to thrive while exposed to antibiotics. The project was developed through a partnership between NASA's Ames Research Center and the Stanford University School of Medicine.

"Bacterial antibiotic resistance may pose a danger to astronauts in microgravity, where the immune response is weakened," NASA said in a news release. "Scientists believe that the results of this experiment could help design effective countermeasures to protect astronauts' health during long-duration human space missions."

The experiment will determine the lowest concentration of antibiotic that inhibits E coli growth. The resulting data may be useful for prescribing correct antibiotic doses for future astronauts, NASA said.
Nov 12 story
Nov 3 NASA
news release

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