ASP Scan (Weekly) for Jun 22, 2018

Antibiotics-in-animals bill
AMR research in Africa, Asia
Antibiotic-resistant urinary E coli
Pizza Hut antibiotic policy
Triclosan-induced resistance

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

Senators introduce bill to bolster oversight of antibiotics in food animals

Today Democratic US Senators Elizabeth Warren (Mass.), Kirsten Gillibrand (N.Y.), Dianne Feinstein (Calif.), and Richard Blumenthal (Conn.) introduced the Strengthening Antibiotic Oversight Act to strengthen regulation of medically important antibiotics administered to food-producing animals.

If passed, the legislation would require the Food and Drug Administration (FDA), which oversees the drugs in food animals, to review the duration of use of approved indications for medically important antibiotics labeled for animal use and would give the agency authority to withdraw approvals for unjustified durations. The bill also directs the FDA to use funds collected through animal drug user fees to collect and report data on antibiotics delivered to farms, through sampling of veterinary feed directives and feed distribution reports.

Current FDA rules do not contain duration limits regulating how much of an antibiotic can be used in an animal for a specified amount of time for all medically important antibiotics, according to a news release on Sen. Warren's website.

"The FDA has taken a number of steps to address the issue of antibiotic resistance, but with two million Americans developing antibiotic-resistant infections every year, it's clear that more work needs to be done," said Sen. Warren."One way to approach this is to reduce the overuse of antibiotics in animals. I'm glad to partner with my colleagues on a bill to help the FDA collect better data and support more careful use of antibiotics."

Sen. Feinstein added, "Our bill will give the FDA greater oversight and ensure medically-important antibiotics are used sparingly."

Matt Wellington, antibiotics program director for U.S. PIRG, said in a release emailed to journalists, "About a third of the medically important antibiotics approved for use in food-producing animals through feed or water have label indications without duration limits. That means meat producers can use these drugs continuously, which would further increase drug-resistant bacteria.

"There are few instances in human medicine where such prolonged antibiotic use would be appropriate. We should apply the same standard to animal medicine and farming."
Jun 22 Sen. Warren news release


UK awards $16 million for AMR research in low-, middle-income countries

The UK's Medical Research Council (MRC) today announced $15.9 million in grants to four universities to study drivers of antimicrobial resistance (AMR) in low- and middle-income countries (LMICs) in Africa and Asia.

The AMR in a Global Context Consortia awards, totaling £12 million, are jointly funded by the cross-research council AMR initiative and the National Institute for Health Research's (NIHR's) Global Health Research Programme. Teams at the University of Bristol, the University of St. Andrews, the Liverpool School of Tropical Medicine, and the University of Glasgow won the awards.

The 3-year awards will connect UK researchers with scientists and policy makers in partner countries. They will use a range of research approaches—from clinical and microbiological studies to geography, modeling, and social sciences—to address various AMR issues in Kenya, Tanzania, Uganda, Malawi, and Thailand.

"The NIHR, working in partnership with the cross-research council AMR initiative, is pleased to be supporting four multidisciplinary consortia to identify the factors driving microbial resistance in LMICs and contribute to the development of context-specific interventions to tackle this global health challenge," said Prof. Chris Whitty, NIHR chief scientific adviser, in an MRC news release.
Jun 22 MRC press release


Study shows how antibiotic regimen affects resistance in urinary E coli

Originally published by CIDRAP News Jun 19

A retrospective multicenter study showed a dose-response relationship between antimicrobial use and resistance in uropathogens in older adults, Belgian researchers reported yesterday in Antimicrobial Resistance and Infection Control.

In the study, microbiological results for individual patient samples, retrieved from 15 voluntary participating clinical laboratories in 2005, were linked with individual antimicrobial consumption and sociodemographic data. The purpose of the research was to study the influence of different variables of antimicrobial prescribing on the occurrence of resistance in Escherichia coli isolated from urine samples in Belgian adults over the age of 65.

The final data used in the study contained information on resistance status for 7,397 E coli isolates obtained from 5,650 patients. The results demonstrated that resistance in E coli was higher when more antibiotics (more than nine prescriptions) had been prescribed before isolation of the sample, especially in women (significant interaction P = 0.0016).

In addition, the effect of route administration interacted with the number of preceding prescriptions, provided that the number of preceding prescriptions is not extremely high. With up to nine prescriptions, when other variables held constant, the probability of resistance decreased by increase in the proportion of preceding parenteral antibiotic prescriptions (significant interaction P = 0.0067).

The authors say the findings on route of administration and antimicrobial resistance, which has previously received little attention, should be further explored.
Jun 18 Antimicrob Resist Infect Control study


Pizza Hut to stop serving chicken raised with medically important antibiotics

Originally published by CIDRAP News Jun 19

The nation's second-largest pizza chain today announced that it would stop serving chicken raised with medically important antibiotics by 2022.

In a statement on its website, Pizza Hut said that the commitment comprises all chicken sold by the company, including chicken wings. Pizza Hut, which stopped using chicken raised with antibiotics important to human medicine in its pizza last year, is the first national pizza chain to commit to an antibiotic policy for chicken wings.

Matt Wellington, antibiotics program director for U.S. PIRG, praised the decision. "Pizza Hut's announcement is another step toward preserving life-saving medicines for what they're meant for, treating illness," Wellington said in a press release.

The move means that all of the Yum! Brands restaurant chains, which also include KFC and Taco Bell, have now pledged to reduce the use of medically important antibiotics in their chicken supply. 
Jun 19 Pizza Hut statement
Jun 19 U.S. PIRG statement


Triclosan found to induce multidrug resistance in E coli

Originally published by CIDRAP News Jun 19

A team of scientists from the University of Queensland has found that an environmentally relevant concentration of the antimicrobial chemical triclosan induces heritable multidrug resistance in E coli.

In a study published recently in the journal Environment International, researchers from Queensland's Advanced Water Management Centre exposed wild-type E coli to varying amounts of triclosan, ranging from a sub-minimum inhibitory concentration (0.02 and 0.2 milligrams per liter (mg/L), which are environmentally relevant concentrations) to a near-lethal concentration of 2 mg/L. After 30 days of exposure, they measured resistance to eight types of antibiotics.

The tests revealed that after 30 days, exposure to 0.2 mg/L of triclosan induced resistance to several antibiotics. Further investigation found that the oxidative stress induced by triclosan caused mutations in several key genes—fabL, frdD, marR, acrR, and soxR. These mutations led to resistance by up-regulating genes encoding beta-lactamases and multidrug efflux pumps—two important resistance mechanisms—and down-regulating genes related to membrane permeability.

Study author Jianhua Guo, PhD, said the findings suggest the environmental impact of triclosan—a chemical commonly found in consumer products such as soap and toothpaste—should be investigated.

"This discovery provides strong evidence that the triclosan found in personal care products that we use daily is accelerating the spread of antibiotic resistance," Guo said in a University of Queensland press release. 

In September 2016, the FDA banned the use of triclosan and other antimicrobial ingredients in over-the-counter soaps, saying they were no more effective at killing germs than plain soap and water. 
Jun 11 Environ Int abstract
Jun 19 University of Queensland news release

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