Stewardship / Resistance Scan for Aug 27, 2018

News brief

Study: Swapping bedaquiline for injectables improves MDR-TB outcomes

The substitution of bedaquiline for second-line injectable antibiotics (SLIs) in a small group of patients with multidrug-resistant tuberculosis (MDR-TB) resulted in improved outcomes, South African researchers report in Clinical Infectious Diseases.

In South Africa, the oral antibiotic bedaquiline is now widely being used in MDR-TB regimens for patients who are unable to tolerate SLIs, which have been associated with significant adverse events, such as hearing loss. To determine the effectiveness of this strategy, the retrospective cohort study looked at patients with laboratory-confirmed MDR-TB who received bedaquiline as a substitute for SLIs from October 2014 through October 2016. The study also included a group of MDR-TB patients who did not receive bedaquiline.

The primary outcome measure was the proportion of patients with unfavorable outcomes at 12 months, defined as a composite of death, loss to follow-up, and failure to achieve sustained culture conversion. The patients were matched 1:1 for clinic location and time of treatment.

The study included 330 patients overall (162 patients who received bedaquiline and 168 controls), 70.6% of whom were also HIV-infected. Unfavorable outcomes occurred in 23.9% of patients (35/146) in the bedaquiline group, compared with 36.2% of patients (51/141) in the control group (relative risk [RR], 0.66). The reduction in unfavorable outcomes with bedaquiline use was mainly influenced by differences in sustained culture conversion rates: Only 5.9% of patients (7) who switched to bedaquiline failed to achieve sustained culture conversion at 12 months, compared with 17.4% of patients (19) in the control group. In addition, the number of patients with culture reversion was significantly lower in the bedaquiline group (1 patient [0.8%] vs 12 patients [10.3%] in the control group). Mortality in the two groups was similar at 12 months (11 deaths in each group).

The authors of the study say the findings provide additional evidence to support the routine inclusion of bedaquiline in MDR-TB regimens.
Aug 24 Clin Infect Dis abstract

 

Australian GP stewardship program reduces prescribing, saves money

A study of general practitioners (GPs) in Australia indicates that a multifaceted package of interventions to reduce antibiotic prescribing for acute respiratory infections (ARIs) was effective, well-received, and feasible.

The summary report of the General Practitioner Antimicrobial Stewardship Programmes Study (GAPS) describes a cluster randomized trial that compared two parallel groups of GPs in 27 clinics in Queensland before and after implementation of an evidence-based package of interventions. The interventions included a poster on antibiotic prescribing policy in GP waiting rooms or examination rooms, a patient information leaflet, an online communication training package, delayed antibiotic prescribing, patient decision aids, and near-patient testing with C-reactive protein.

The primary objective of the study was to assess the effectiveness of the package in reducing antibiotic prescribing for ARIs. The researchers also looked at the costs and cost-effectiveness of the intervention package and assessed feasibility and uptake.

While the results showed that there were measurable declines in antibiotic prescribing in both the intervention and control groups during the intervention phase compared with the baseline phase, a secondary analysis found a statistically significant reduction in prescribing rates of 7% for the intervention group compared with the control group (RR, 0.93), resulting in a net decrease of 3.8 antibiotic prescriptions per GP per month. Including the economic benefit of avoiding adverse antibiotic reactions (rashes and diarrhea) and Clostridium difficile, the researchers estimated that the cost savings from the reduced prescribing was just over $57,000.  If rolled out to 250 practices over 3 years, the researchers calculated, these savings could offset the cost of implementing the intervention package by over $200,000.

Phone interviews with GPs from the intervention practices found that the intervention package was well-received, was considered adaptable to individual practices, and provided GPs with the opportunity to reflect on their management of patients with suspected ARIs.

The authors say the findings should help inform policy for future national implementation.
Aug 27 GAPS final summary report

News Scan for Aug 27, 2018

News brief

USDA issues alert over raw chicken tied to Salmonella illnesses

The US Department of Agriculture's Food Safety and Inspection Service (FSIS) and Empire Kosher Poultry, Inc. late last week issued a public health alert over Salmonella illnesses in several states that might be tied to raw chicken products.

FSIS was notified of multiple Salmonella I 4,[5],12:i:- illnesses in northeastern  and mid-Atlantic states on Jun 18. "Working in conjunction with public health partners, FSIS determined that there is a potential link between Empire Kosher brand raw chicken products and this illness cluster," the agency said in a news release. "Based on available epidemiological information, multiple case-patients have been identified in the northeastern and mid-Atlantic United States, many of whom reported consumption of Empire Kosher brand chicken products."

The Empire Kosher brand raw chicken items include whole chicken and chicken parts that were produced and sold from September 2017 to June 2018. Officials issued the alert "out of an abundance of caution." FSIS did not specify the number of cases, and Empire, of Mifflintown, Pa., has not recalled its products at this point.

About half of affected patients have been hospitalized, and illness-onset dates range from September 2017 to June 2018. "FSIS continues to work with the company and public health partners and will provide updated information should it become available," the agency said.

The FSIS recommends cooking raw poultry to 165°F before eating it.
Aug 24 FSIS news release

 

Senate passes big spending bill with increased public health funding

Late last week the US Senate passed an $857-billion "minibus" package for the fiscal year beginning on Oct 1 that increases National Institutes of Health (NIH) funding by 5.4% ($2 billion) to $39.1 billion and includes historic amounts for the Department of Health and Human Services (HHS) and other departments.

The bill, which also funds the departments of education, defense, and ;abor, is considered a bipartisan success, passing on a vote of 85-7, according to Genetic Engineering & Biotechnology (GEN) News. The House has until Sep 30 to pass the bill.

The bill includes $550 million dedicated to the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), up $37 million from last year's budget.

The Biomedical Advanced Research and Development Authority (BARDA) would get $562 million, up $25 million from last year, and $120 million would go toward funding research on a universal flu vaccine. That's $20 million more than was designated in last year's budget.

According to a story published by Medpage Today, NIH Director Francis Collins, MD, PhD, said at a Senate hearing on the bill that the funds will allow for 1,100 new grants to first-time investigators through the Next Generation Researchers Initiative.

Other proposals include $425 million for Alzheimer's research and $190 million for cancer research. An additional $3.7 billion will go toward targeting the opioid abuse crisis, including increasing spending on mental health services, and funding research for the development of non-opioid painkillers.
Aug 24 GEN News story

Aug 24 Medpage Today story

 

PAHO urges measles vaccination ramp-up in South America

With an ongoing measles outbreak in Venezuela, the Pan American Health Organization (PAHO) urged member states to aggressively vaccinate against the disease.

"It is vital that we continue vaccinating in order to reach more than 95% of our children everywhere," said PAHO Director Carissa F. Etienne, MD, in a press release. "We must also strengthen national epidemiological surveillance and establish rapid response teams to expeditiously manage suspected cases, prevent new cases and halt outbreaks. These measures to sustain elimination were agreed to by Ministers of Health in 2017. These commitments must be renewed.”

Endemic transmission of measles was reestablished in Venezuela in 2017. As of Aug 20 of this year, Venezuela confirmed 3,545 cases of measles, including 62 deaths.

Although measles remains eliminated from all other PAHO countries, 10 countries in South America besides Venezuela have reported 1,459 confirmed cases of measles and 6 deaths since the outbreak in Venezuela began: Antigua and Barbuda (1 case), Argentina (8), Brazil (1,237, including 6 deaths), Canada (19), Colombia (60), Ecuador (17), Guatemala (1), Mexico (5), Peru (4), and the United States (107).

In Brazil, most cases have been connected to the Venezuelan outbreak.

The current outbreak in South America occurred just 1 year after World Health Organization Americas Region became the first in the world to obtain the measles elimination certification. Most countries in the region reported their last endemic cases more than 18 years ago, PAHO said.
Aug 24 PAHO press release
Aug 20 PAHO epidemiologic update

This week's top reads

Our underwriters