Stewardship / Resistance Scan for Oct 08, 2018

Vaccines for AMR
;
Stewardship guide for low-resource settings
;
Resistant bacteria transmission in nursing homes

Report identifies bacterial pathogens that could be addressed by vaccines

A new report from the Wellcome Trust and Boston Consulting Group identifies antibiotic-resistant pathogens that could be addressed by increased vaccine uptake and vaccine development.

The report evaluates the potential health impact of vaccines against all strains of bacterial pathogens identified by the World Health Organization (WHO) as "priority pathogens." It also considers the feasibility of developing vaccines for these pathogens and the likelihood of implementing a successful vaccination program. Through this assessment, the report identifies pathogen clusters that would most benefit from a vaccine.

In the "increase uptake" cluster are the pathogens Haemophilus influenza, Streptococcus pneumoniae, and Salmonella typhi. While vaccines have been developed for these pathogens, the report recommends expanding coverage for these vaccines to increase their health impact. In the "bring to market" category are Escherichia coli, non-typhoidal Salmonella, and Shigella—pathogens with significant health impact and sufficiently advanced research and development (R&D) to recommend accelerated clinical development of a vaccine. In the "advance early R&D" cluster are pathogens with significant health impact that require more early-stage investment in R&D. These include Mycobacterium tuberculosis, Neisseria gonorrhoeae, Pseudomonas aeruginosa, Staphylococcus aureus, and urinary E coli.

The report concludes that other pathogens on the WHO priority list—Acinetobacter baumannii, Enterobacteriaceae, Campylobacter, Klebsiella pneumoniae, Enterococcus faecium, Helicobacter pylori, and Salmonella paratyphi—are less well-suited to vaccine development because of significant outstanding epidemiological questions and low incidence and associated morbidity and mortality. It recommends exploring alternative strategies for addressing these pathogens.

"By employing a carefully considered prioritisation framework to evaluate these pathogens, this report enables comprehensive comparisons across pathogens," the report states. "This assessment and prioritisation provides a guide for research priorities, policy focus and investment decisions, while recognising that individuals and institutions have varied areas of focus and seek to interact at different parts of the value chain."
Oct 5 Vaccines for AMR report


New CDC document highlights ASP strategies for low-resource settings

The US Centers for Disease Control and Prevention (CDC) has released the latest in a series of guidelines for developing and implementing antibiotic stewardship programs (ASPs).

The Core Elements of Human Antibiotic Stewardship Programs in Resource-Limited Settings guide contains ASP strategies that can be implemented in low- and middle-income countries with weak health systems, based on the resources available. "Such strategies must be feasible, sustainable, and tailored to the resources that are currently available in such countries while capacity is built in areas of need to ensure access and reduce the inappropriate use of antibiotic agents," the report states.

The document includes both national and facility-level activities. National-level activities are grouped into basic, intermediate, and advanced categories, with basic activities requiring only limited resources and intermediate and advanced categories requiring additional resources and staff. Basic activities include setting up a national ASP committee and developing a national antibiotic stewardship plan, while intermediate and advanced activities include developing and ensuring access to recommended formularies, measuring antibiotic use, and setting national targets for improvement.

At the facility level, the guide recommends that hospitals in resource-limited settings begin by identifying a single point of contact for an ASP. That individual should preferably be an infectious disease (ID) trained physician, but could be a physician without formal ID training if necessary. In addition, the ASP focal point should have support from the hospital administration. Beyond this foundation, the guide recommends that hospitals form antibiotic stewardship committees, identify a single priority area for reducing antibiotic use, educate staff, and implement stewardship activities targeted at the priority area.

The CDC says the document, which is based on expert opinion and experiences in implementing ASPs in the United States and elsewhere, is intended to serve as a starting point for stakeholders in resource-limited settings.
Sep 24 CDC core elements guide

 

Nursing home study illustrates risk of resistant bacteria transmission

A multicenter study of nursing home residents has found that 11% of interactions with healthcare workers resulted in the transmission of antibiotic-resistant gram-negative bacteria (RGNB) to gloves and gowns worn by those workers when providing care.

In the study, which was published today in Infection Control and Hospital Epidemiology, investigators collected perianal swabs from 399 residents of 13 community-based nursing facilities in Maryland and Michigan to detect RGNB. Healthcare personnel (HCP) at the facilities were asked to wear gowns and gloves during usual care activities, and those items were swabbed when HCP were finished with those activities. The objective was to estimate the risk of transmission of RGNB to gloves and gowns worn by HCP when providing care and to identify the types of care and resident characteristics associated with transmission.

Overall, 19% of the residents were colonized with at least one RGNB at enrollment. Either gloves or gowns were contaminated with RGNB during 11% of 584 interactions with colonized residents. RGNB transmission to HCP varied by activity, but showering and bathing residents, changing wound dressings, and assisting with hygiene and toilet needs were associated with a high risk of transmission, while glucose monitoring and assisting with feeding or medication were associated with low risk of transmission. Residents with a pressure ulcer were three times more likely to transmit RGNB than residents without one.

The findings are noteworthy because though previous studies have found that more half (57%) of nursing home residents are colonized with multidrug-resistant organisms, there are few evidence-based guidelines describing best practices for preventing transmission of these organisms in nursing homes. The authors of the study suggest that glove and gown use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.
Oct 8 Infect Control Hosp Epidemiol abstract

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