Stewardship / Resistance Scan for Mar 22, 2018

News brief

CARB-X funds potential antibiotic against CRE superbugs

In a first for a Japanese company, CARB-X, a public-private collaboration that supports companies to combat antimicrobial resistance, has awarded Shionogi, of Osaka, $4.7 million to support the development of a novel beta-lactam antibiotic with potent activity against the worrisome superbugs that produce carbapenemase, including BL/BLI-resistant carbapenem-resistant Enterobacteriaceae (CRE), CARB-X said in a news release today.

Under the award, Shionogi can receive an additional $2.4 million if it meets certain project milestones, according to CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator).

"We are very excited to welcome the first Japanese company into the Powered by CARB-X portfolio, strengthening the global fight against drug-resistant bacteria," said Kevin Outterson, JD, executive director of CARB-X. "The world urgently needs innovative approaches, like the Shionogi project, to protect us from drug-resistant bacteria."

CRE bacteria represent a significant and increasing public health threat globally, are difficult to treat because of their high levels of antibiotic resistance, and are associated with high death rates.

Since the beginning of 2017, CARB-X has announced awards projects totaling $73.9 million, plus an additional $89.0 million if project milestones are met, to accelerate the development of antibiotics, diagnostics, and other products. The new award increases CARB-X's reach to seven countries.
Mar 22 CARB-X news release

Study: Gene sequencing possible to find resistance in low-income nations

Genetic sequencing can be a valuable tool for the surveillance of antibiotic resistance in low-income countries, according to a study today led by World Health Organization experts published in The Lancet Infectious Diseases.

The investigators conducted population-level surveys in hospitals and clinics in Azerbaijan, Bangladesh, Belarus, Pakistan, Philippines, South Africa, and Ukraine to evaluate the use of genetic sequencing to estimate resistance of Mycobacterium tuberculosis isolates to several common antibiotics. They analyzed isolates from 7,094 tuberculosis (TB) patients.

Overall pooled sensitivity values for predicting resistance by genetic sequencing were 91% for the rpoB gene (rifampicin resistance), 86% for katG, inhA, and fabG promoter combined (isoniazid resistance), 54% for pncA (pyrazinamide resistance), 85% for gyrA and gyrB combined (ofloxacin resistance), and 88% for gyrA and gyrB combined (moxifloxacin resistance).

A commentary in the same issue points out, "Studies on the real-time use of genomics in clinical settings have found whole genome sequencing-based DST [drug susceptibility testing] to be accurate, faster, and cheaper than phenotypic DST."

The commentator, Grant Hill-Cawthorne, MB BChir, PhD, from the University of Sydney, adds, "By showing that population-based surveillance in low-income settings is a reality, Zignol and colleagues have advanced our understanding of how genetic DST can be implemented in real-life scenarios." He also notes that the researchers in the new study still relied on a culture step, which is a common bottleneck in many healthcare systems, but in the coming years new technologies may help circumvent that step.
Mar 22 Lancet Infect Dis study
Mar 22 Lancet Infect Dis commentary

Alcohol misuse, HIV tied to worse outcomes with multidrug-resistant TB

Alcohol misuse and an HIV diagnosis were both tied to unsuccessful treatment outcomes for multidrug-resistant and extensively drug-resistant TB, according to a meta-analysis published yesterday in Scientific Reports.

The researchers included 48 studies that involved a cumulative 18,257 participants in their review. They found that the pooled relative risk (RR) of treatment failure unsuccessful outcome was higher in people living with HIV (RR, 1.41; 95% confidence interval [CI], 1.15-1.73) and in people with alcohol misuse (RR, 1.45;95% CI, 1.21-1.74). Outcomes were similar in people who had diabetes or in those who smoked.

The authors conclude, "Further research is required to understand the role of comorbidities in driving unsuccessful treatment outcomes."
Mar 21 Sci Rep study

News Scan for Mar 22, 2018

News brief

House budget bill lifts funding for infectious disease, public health efforts

The $1.3 trillion omnibus spending bill passed by the US House of Representatives today to fund the government through the end of September contains increases for the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), according to official and media sources.

If passed by the Senate tomorrow by the midnight deadline to avert another government shutdown, then signed into law by President Trump, the spending package would increase the NIH budget by $3 billion to $37 billion. According to a Science report today, the increase for NIH came from bipartisan support and lawmakers' recent agreement to raise mandatory spending caps. The bill includes $40 million in new money targeting work on a universal flu vaccine, for a total of $100 million. Though Trump's budget called for eliminating the NIH's Fogarty International Center, which helps train foreign researchers and health providers, the plan approved today includes $76 million for the center.

Meanwhile, the CDC would receive $1.1 billion above 2017 funding, putting the total at $8.3 billion, according to a Nature report. Budget summaries from the House Appropriations Committee said within the CDC budget is $1.45 million for public health preparedness and response programs, reflecting an increase of $45 million. CDC would also receive $480 million to build a new biosafety level 4 lab.

Regarding other infectious disease related items in the Department of Health and Human Services (HHS) budget, Project Bioshield would receive $710 million for medical countermeasures, an increase of $200 million, and the Biomedical Advanced Research and Development Authority (BARDA) would get $527 million, an increase of $25 million. Also, the budget includes $250 million for pandemic flu preparedness, an increase of $193 million.

Within the State Department, the budget puts $8.7 billion toward global health initiatives, including $6 billion to battle HIV/AIDS. Funding also provides $250 million for pandemic flu preparedness, an increase of $193 million.

Food safety spending at the US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) would increase $25 million above the 2017 spending level, putting the total at $1.06 billion. Total discretionary funding for the Food and Drug Administration (FDA) is $2.9 billion, which is $135 million higher than 2017 levels. With user’s feeds added in, the total FDA funding would be $5.15 billion.
Mar 22 Science report
Mar 22 Nature report
House Appropriation Committee background materials

CEPI announces first collaboration with a university

For the first time in the organization's brief history, the Center for Epidemic Preparedness Innovations (CEPI) has partnered with a university to collaborate on research initiatives.

CEPI US yesterday announced a partnership with Georgetown University to work on joint research opportunities. The partnership will focus on the development of infectious disease vaccines.

"CEPI US is pleased to collaborate with Georgetown, an academic leader in global health," said Dawn O'Connell, JD, CEPI US president, in a press release. "We look forward to working with Georgetown's faculty, staff and students on a wide range of issues critical to CEPI's success."

The collaboration will also provide research opportunities for Georgetown students and post-doctoral candidates.

CEPI was founded in 2017 as a way to streamline and fund research for new vaccine candidates. It is supported by the governments of Norway, Germany, India and Japan; the Bill & Melinda Gates Foundation; Wellcome Trust; and the World Economic Forum. CEPI US is the US arm of CEPI, which is headquartered in Norway.
Mar 21 Georgetown University press release