Study: White people fill twice as many antibiotic prescriptions as others
A new study examining racial and ethnic disparities in antimicrobial drug use in the United States shows that white people filled twice as many antibiotic drug prescriptions per capita compared with people of other races and ethnicities. The study was published yesterday in Emerging Infectious Diseases.
To conduct the study, researchers from Harvard University used data from the Medical Expenditure Panel Survey (MEPS) collected in 2014 and 2015 to determine the race and ethnicity of patients who filled antibiotic prescriptions.
According to the authors, the reported annual outpatient prescription fill rate for all antimicrobial drugs was 373 (95% CI 358–388) fills per 1,000 persons. Non-Hispanic whites reported the highest rate, followed by persons of other or multiple race/ethnicity, Hispanics, non-Hispanic blacks, and non-Hispanic Asians.
White people reported 2.0–fold more fills per capita than nonwhites.
"We found a large disparity in antimicrobial drug fill rates by race/ethnicity: white persons reported making twice as many antimicrobial drug prescription fills as persons who were not white. Disparities were apparent for each major antimicrobial drug class, rather than different drug classes being used more predominantly by persons of particular race/ethnicities," the authors wrote.
The authors said their findings could be used in targeted antimicrobial stewardship programs.
Sep 27 Emerg Infect Dis study
UK aid program announces partnership to boost stewardship in Africa
The Fleming Fund yesterday announced a new program to help healthcare workers in four African countries address antimicrobial resistance (AMR).
The Commonwealth Partnerships for Antimicrobial Stewardship project will form 12 new partnerships in Ghana, Tanzania, Uganda, and Zambia that aim to improve antimicrobial stewardship, strengthen infection control and prevention, and build in-country capacity for antimicrobial pharmacy. Volunteer pharmacists, specialists, and other healthcare workers from England's National Health Service will share their expertise with counterparts from the participating nations.
"AMR poses a risk to us all, wherever we call home—collaboration of this kind with our friends and neighbours internationally is hugely important if we are to tackle this challenge together," Dame Sally Davies, England's chief medical officer, said in a news release from the Fleming Fund. "This scheme will play a crucial role in strengthening antimicrobial stewardship efforts in participating hospitals by allowing specialists to share experience and expertise."
The project will be led by the Tropical Health and Education Trust in partnership the Commonwealth Pharmacists Association.
The Fleming Fund is an aid program of the UK government to help low- and middle-income countries fight AMR.
Sep 27 Fleming Fund news release
CDC reports multidrug-resistant fungus linked to fungicide exposure
Originally published by CIDRAP News Sep 27
A case report today from the Centers for Disease Control and Prevention (CDC) details the detection of a multidrug-resistant fungus in patients from three states.
The cases, described in today's Morbidity and Mortality Weekly Report, involve patients in Pennsylvania, Virginia, and California who were infected or colonized with Aspergillus fumigatus, an environmental mold that's the primary cause of invasive aspergillosis—an invasive infection that typically affects immunocompromised patients. Resistance to triazole antifungals in A fumigatus is associated with treatment failure and increased mortality. Increasingly common reports of triazole-resistant A fumigatus in Europe prompted the CDC to initiate passive laboratory monitoring for triazole-resistant A fumigatus isolates in 2011.
The monitoring identified a total of seven isolates (out of 2,300) collected from 2010 through 2017 that were carrying the resistance marker TR34/L98H. This resistance marker confers resistance to all triazoles and has been associated with triazole fungicide use in agriculture rather than previous patient exposure to triazole antifungals. Four of the seven patients identified had no known exposure to antifungal medications before culture of the resistant isolate, supporting environmentally acquired resistance. Three of the patients died from their infection.
The authors of the report note that A fumigatus spores are known to be carried long distances in the air, which can put patients at risk for infections with resistant strains, even when those patients live in areas without known agricultural fungicide use.
"Given that A. fumigatus can undergo selection for antifungal resistance during triazole fungicide exposure in the environment, and spores of resistant strains might be transmitted through the air and inhaled, further exploration of triazole fungicide use and presence of triazole-resistant A. fumigatus in these areas is warranted," the CDC researchers write.
Sep 27 CDC MMWR report
Stakeholders recommend incentivizing antibiotic development
Originally published by CIDRAP News Sep 26
Twelve European third-party stakeholders made recommendations for ensuring antibiotic development and the equitable availability and responsible use of effective antibiotics, focusing on new incentives, according to a commentary yesterday in Clinical Infectious Diseases.
Unlike patients or providers, third-party stakeholders represent governments, regulatory agencies and professionals working in research and development. In interviews, the 12 stakeholders emphasized the lack of sufficient financial incentives for the development of new antibiotics.
The experts, interviewed in 2016 and 2017, recommended a new model of antibiotic development, one not based on the volume of sales (which promotes overuse) but instead one that rewards the discovery of new antimicrobial agents. The stakeholders also said there was a need for "better" drugs (eg, single-dose oral regimens with fewer side effects).
The stakeholders also recommended sustained global coordination to ensure antibiotic access throughout the world, in line with the World Health Organization's Medicines and Health Products Programme Strategic Framework 2016-2030.
"The recommendations presented here should be further developed in to cross-sectoral international policies to address these challenges. Indeed, no single sector can possibly curb [antimicrobial resistance] on its own," the authors concluded.
Sep 26 Clin Infect Dis commentary
Auto-fecal transplant shown effective in stem cell transplant patients
Originally published by CIDRAP News Sep 26
US scientists have used auto–fecal microbiota transplantation (FMT) to successfully restore the integrity of the gut microbiome in a vulnerable population—stem cell transplant patients who receive antibiotics—according to the results of a phase 2 clinical trial published today in Science Translational Medicine.
Antibiotics wipe out beneficial bacteria vital to patients' gut microbiomes and their ability to fight infection, so the findings present a potential strategy to counter the persistent problem.
The researchers' approach aims to reestablish gut bacteria in patients who received antibiotics after a form of stem cell transplantation known as allo-HSCT. The team used a type of transplantation known as autologous FMT, which involves taking stool samples from a patient before a procedure and reintroducing them into the intestines afterward.
The investigators sequenced fecal samples from a cohort of allo-HSCT patients and confirmed that antibiotic treatment reduced microbial diversity. The scientists then gathered and froze stool samples from 25 patients who underwent allo-HSCT and performed auto-FMT on 14 of the patients after stem cell transplantation. The other 11 served as controls.
Analysis of stool samples taken over the course of a year showed that auto-FMT was associated with a higher diversity of bacterial species and restored microbial composition, an effect not seen with the 11 controls.
Sep 25 Sci Transl Med study
Antifungal stewardship tied to an 89% drop in inappropriate prescribing
Originally published by CIDRAP News Sep 25
A small single-center UK study has demonstrated that a diagnostics-driven antifungal stewardship (AFS) program was tied to an 89% drop in inappropriate prescribing, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.
University of Manchester researchers assessed the AFS program at Wythenshawe Hospital, which has been developed over the past 8 years. It includes: (1) updating and clarifying antifungal guidelines, (2) involving and educating stewardship champions, (3) improving access to timely diagnostic testing, and (4) reducing unnecessary antifungal use.
The study included all patients who were prescribed micafungin for suspected or proven invasive candidiasis during 4-month audit periods in 2014 and 2016. The team reviewed prescriptions and patient records against AFS guidelines, as well as antifungal consumption and mortality data.
The investigators found that the number of patients treated for invasive candidiasis decreased from 39 in 2014 to 29 in 2016, mainly because of a reduction in patients initiated on antifungal therapy inappropriately—18 in 2014 and only 2 in 2016, an 89% drop. Antifungal therapy was stopped following negative biomarker results in 12 patients in 2014 and 10 patients in 2016. Crude mortality caused by proven or probable invasive candidiasis decreased from 45% to 19% (a 58% reduction), and antifungal consumption dropped by 49%.
Sep 24 J Antimicrob Chemother study
CARB-X calls for open data sharing to spur antibiotic innovation
Originally published by CIDRAP News Sep 25
Kevin Outterson, JD, the executive director of CARB-X, is calling on antibacterial researchers around the world to "help others learn from their setbacks" by openly sharing data from unsuccessful research in an effort to accelerate development to combat drug-resistant infections, CARB-X said in a news release yesterday.
As part of this effort, CARB-X (Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership, has reached an agreement with Achaogen to the non-exclusive transfer of compounds, scientific data, and assays to Forge Therapeutics from its innovative LpxC program. Achaogen announced last year that it had stopped the early development program over unexpected toxicity findings. Forge plans to review Achaogen's body of LpxC knowledge and apply the findings to its on-going LpxC research program.
Using a different chemistry approach than Achaogen, Forge is developing a novel class of antibiotics to treat gram-negative bacteria such as Pseudomonas aeruginosa and multidrug-resistant Enterobacteriaceae.
"Science is hard; most projects end for any number of reasons," Outterson said. "Typically, this knowledge and even the compounds themselves would be shuttered and locked away after a project is stopped. Given the economic realities of antibacterial research and the urgent need for new antibiotics, we need to adopt a more collaborative approach where it makes sense to do so."
CARB-X is encouraged by public data-sharing initiatives like the SPARK initiative announced by PEW Charitable Trusts last year and Wellcome Trust's Open Research initiative, launched in 2016, according to the release.
Sep 24 CARB-X news release
New platform to detect and track drug-resistant infections in the works
Originally published by CIDRAP News Sep 24
The office of New York Governor Andrew Cuomo announced today that the New York State Department of Health (DOH) will partner with ILÚM Health Solutions to develop a research program to detect, track, and manage antibiotic-resistant infections at healthcare facilities across the state.
According to a press release from the governor's office, DOH and ILÚM—a wholly owned subsidiary of Merck & Co.—will work together to develop an infectious disease platform and real-time information service that tracks drug-resistant organisms, patients, and outcomes, delivers relevant insights to help healthcare providers make better treatments decisions, and connects DOH to state facilities. The collected data will also be used to aid in the development of new diagnostic tools.
"Through public-private partnerships and investments in advanced research, New York State is working to help curb the spread of infectious diseases," Lieutenant Governor Kathy Hochul said in the press release. "This new partnership will make significant strides in detecting and managing infections, helping to ensure the health and safety of New Yorkers."
Under the terms of the agreement, ILÚM will invest up to $48.6 million in the project over 5 years, and the New York State Life Sciences Initiative will commit $22.4 million. A pilot program at select facilities will be evaluated for efficiency and efficacy before the program is expanded throughout the state.
Sep 24 NY governor's office press release
CTX-M genes found in E coli isolates from US cattle, retail meat samples
Originally published by CIDRAP News Sep 24
A new study by US Food and Drug Administration (FDA) researchers has identified and characterized Escherichia coli carrying the extended-spectrum beta-lactamase (ESBL) gene CTX-M in food-producing animals and animal products in the United States. The study was published in the September issue of Microbial Drug Resistance.
While CTX-M-producing E coli strains have become increasingly prevalent in hospitals in the United States and around the world and have been identified in bacteria from healthy animals in several countries, there have been fewer reports of CTX-M ESBLs in bacteria from food animals and animal products in the United States. Intestinal carriage of CTX-M–producing bacteria in food-producing animals and contamination of retail meat is a concern because it may contribute to increased incidences of infections with ESBL-producing bacteria in humans.
To investigate the presence of CTX-M–carrying E coli in US food animals, the researchers conducted antibiotic susceptibility tests to determine which E coli isolates from cattle, chicken breasts, ground turkey, ground beef, and pork chops collected by the National Antimicrobial Resistance Monitoring System (NARMS) from 2011 through 2015 were likely ESBL producers. They then performed whole-genome sequencing on the 18 phenotypically positive ESBL E coli isolates to characterize the resistome, plasmids, and resistance genes in all strains.
Their analysis revealed that all of the isolates were resistant to at least three antimicrobial classes and carried various CTX-M genes, including blaCTX-M-1, blaCTX-M-14, blaCTX-M-15, blaCTX-M-27, and blaCTX-M-32. Notably, this is the first report of E coli isolates from the NARMS retail meat program carrying blaCTX-M-14 and blaCTX-M-15, the two most frequently identified CTX-M genes worldwide. In addition, conjugation testing performed on seven of the isolates showed the CTX-M genes could be transferred to other E coli strains.
The authors conclude, "While the prevalence of these two successful CTX-M enzymes is low from domestic food animal sources, monitoring will continue to help determine whether this mechanism is becoming more widespread among animal and food strains of E. coli in the United States."
Sep 1 Microb Drug Resist study
