Stewardship / Resistance Scan for Jun 18, 2019

Rapid test for bloodstream infections
Funds for new antibiotic class
Resistant E coli in Alaskan gulls

T2Bacteria panel shown to accurately detect ESKAPE bacteria in BSIs

A diagnostic accuracy study has determined that the T2Bacteria Panel rapidly and accurately diagnoses bloodstream infections (BSIs) caused by five common pathogenic bacteria, according to a study today in the Annals of Internal Medicine.

Researchers from several US universities compared results from the panel with those of blood culture for suspected BSI in 1,427 adults at 11 US hospitals from Dec 8, 2015, through Aug 4, 2017.

The T2Bacteria Panel is made by T2 Biosystems of Lexington, Massachusetts. It is designed to identify the most common ESKAPE bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli).

The investigators found that blood culture and T2Bacteria results were positive for targeted bacteria in 39 (3%) and 181 (13%) of patients, respectively. Per-patient sensitivity and specificity of T2Bacteria for proven BSIs were both 90%, and its negative predictive value was 99.7%. If probable BSIs and both probable and possible BSIs were assumed to be true positives missed by blood culture, per-patient specificity of T2Bacteria was 94% and 96%, respectively.
Jun 18 Ann Intern Med abstract


CARB-X announces funding for new antibiotic class

CARB-X announced yesterday that is awarding United Kingdom–based Oxford Drug Design up to $2.55 million with the possibility of $4.24 million more to develop a new class of antibiotics to treat gram-negative bacterial infections using an approach designed to reduce the likelihood of emerging resistance.

The company is working on drugs that inhibit aminoacyl-tRNA synthetases (aaRSs), enzymes that are essential for bacteria survival. Though aaRSs are a clinically validated target family, no inhibitors with systemic activity have reached the market. Also, the company has developed a new class of small-molecule aaRSs inhibitors that are active against gram-negative ESKAPE pathogens. The compounds target more than one synthetase site to decrease the probability of resistance development.

Oxford Drug Design also received £2 million ($2.5 million) from Innovate UK, on behalf of the country's Department for Health and Social Care, to support other aspects of the company's tRNA synthetase inhibitor research portfolio.

Kevin Outterson, JD, executive director of CARB-X, said in a press release from the group that CARB-X partners are making steady supporting innovative antibacterial research and development like the Oxford Drug Design project to treat drug-resistant bacterial infections. "But we know that much more is needed—more investment and global leadership to establish incentives that will ensure that life-saving products reach the market and patients who need them," he added.

Since its inception in 2016, CARB-X, a public-private partnership, has announced awards for 44 projects in 44 countries exceeding $216 million. Its goal is to invest more than $500 million by 2021 in innovative research and development to combat antimicrobial resistance.
Jun 17 CARB-X press release


Researchers detect multidrug-resistant E coli in Alaskan gulls

A study led by US Geological Survey scientists yesterday in Antimicrobial Agents and Chemotherapy highlights the repeated detection of carbapenemase-producing E coli in gulls in Alaska, the first such report in US wildlife.

The researchers collected 939 gull feces samples from seven locations in late spring and summer of 2016. Seven samples, four from the Kenai Peninsula sampled in June and August and three from Anchorage sampled in August, yielded E coli isolates exhibiting non-wild-type susceptibility to meropenem. All three of the Anchorage isolates harbored the blaKPC-2 carbapenemase gene. They also harbored genes associated with resistance to as many as eight antibiotic classes.

The four Kenai E coli isolates harbored the blaOXA-48 carbapenemase gene, and they also harbored genes demonstrating resistance to five antibiotic classes.

The authors conclude, "The isolation of CPE [carbapenemase-producing Enterobacteriaceae] from environmental samples collected in Alaska is both unprecedented and potentially relevant to local public health."

In an accompanying commentary, two experts from the Czech Republic write, "Wild animals are not only useful sentinels mirroring the presence of the AMR [antimicrobial resistance] in the contaminated environment in a particular area, but they also have been recognized as possible reservoirs, melting-pots, vectors and secondary sources of multi-drug resistant bacteria for humans and animals. Wild birds are ubiquitous and their faeces are freely dispersed into the environment, possibly contaminating surface waters and soils where crops are grown.

"However, at this stage it is difficult to assess human health risks of the AMR in wildlife as it requires active surveillance of clinically relevant resistant bacteria in the environment including wildlife which is currently very limited. The use of antibiotics and human to human transmission is clearly the driving force in CPE dissemination."
Jun 17 Antimicrob Agent Chemother study
Jun 17 Antimicrob Agent Chemother commentary

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