ASP Scan (Weekly) for Aug 02, 2019

News brief

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

CDC reports illustrate link between medical care abroad, resistant organisms

Originally published by CIDRAP News Aug 1

Two case studies today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report highlight the importance of screening for drug-resistant organisms in patients who've had recent medical care outside the United States

In one study, researchers from the CDC and the Maryland Department of Health report that a Maryland resident with a recent month-long hospitalization in Kenya was admitted to an acute care hospital in Maryland with several infections, and carbapenemase-producing Klebsiella pneumoniaeand Pseudomonas aeruginosa were subsequently identified in blood and sputum. Because the multidrug-resistant fungus Candida auris had been reported in Kenya, and the hospital had previously identified a patient from India with carbapenemase-producing organisms (CPOs) who was colonized with C auris, MDH suggest testing the patient for C auris colonization.

On the patient's 12th day in the hospital, C auris was identified, and 21 other patients in the ward were also tested. All screening swabs were negative.

"This case highlights the importance of a high level of suspicion for C. auris in persons admitted to U.S. health care facilities with a history of health care abroad, even if C. auris is not known to be widespread in that location," the authors write. "Early identification of C. auris is critical to preventing further transmission."

In the other study, researchers from the CDC and Washington State Department of Health report that a patient at a Seattle hospital who had undergone urology procedures in India in November 2018 tested positive for carbapenem-resistant K pneumoniae in his urine in December 2018. The urinary isolate was carrying three different carbapenemase genes, and antimicrobial susceptibility testing showed resistance to 15 antibiotics. The patient was subsequently flagged for contact precautions, and no other patients with matching carbapenem-resistant K pneumoniae strains were identified.

The authors of the report suggest that hospitals should consider carbapenem-resistant Enterobacteriaceae screening for patients who've undergone medical procedures abroad and who will be hospitalized or undergo invasive procedures in the United States.
Aug 2 MMWR C auris report
Aug 2 MMWR Carbapenem-resistant K pneumoniae report

 

CARB-X awards $3 million for development of monoclonal antibody

Originally published by CIDRAP News Jul 31

CARB-X today announced funding for the development of an alternative treatment for infections caused by a multidrug-resistant strain of Escherichia coli.

The award of up to $3 million in non-dilutive funding from the CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) will help BB100 LLC, a subsidiary of Bravos Biosciences of Schenectady, New York, develop a monoclonal antibody (BB100) to treat infections caused by E coli ST131-025b, a virulent strain associated with complicated urinary tract, bloodstream, and prostate infections in Asia, Africa, and South America. The funding, part of which comes from the UK government's Global AMR Innovation Fund, will support Investigational New Drug-enabling studies and other pre-clinical development.

Under the agreement, BB100 LLC could receive an additional $6.2 million if certain project milestones are met.

"We are very excited and appreciative of the CARB-X award," Bravos President Christopher Rubino, PharmD, said in a CARB-X press release. "CARB-X support greatly enhances our ability to advance BB100, which holds the promise to be both life-saving and decrease our societal reliance on antibiotics prone to resistance."

Since 2016, CARB-X has awarded more than $130 million for early-phase development of new antibiotics, diagnostics, and alternative treatments that target antibiotic-resistant bacteria.
Jul 31 CARB-X press release

 

Lexagene approved to use AR Isolate Bank to test diagnostics platform

Originally published by CIDRAP News Jul 31

Biotechnology company LexaGene Holdings announced yesterday that it's been approved by the CDC and Food and Drug Administration Antibiotic Resistance (AR) Isolate Bank to receive samples for testing antibiotic resistance.

The company says it will use the fully characterized pathogens in the AR Isolate Bank to improve the detection capabilities of the LX Analyzer, a rapid diagnostic platform being designed for use in human and veterinary medicine, as well as for food safety testing and water quality monitoring. The analyzer pulls genomic material from liquid samples to quickly identify common pathogens and screen for the presence of antibiotic resistance mechanisms.

"Antibiotic resistant pathogens are predicted to kill 10 million people by 2050," LexaGene CEO Jack Regan, PhD, said in a company press release. "To avoid this dreadful prediction, we need better diagnostics to improve our antibiotic stewardship and to lower the potential for contagion transmission."

The isolates in the AR Isolate Bank are gathered through the CDC's outbreak response and surveillance programs and represent samples from healthcare-associated, foodborne, and community-associated infections. They're used by microbiologists to validate new lab tests, by researchers to better understand resistant pathogens, and by drug and diagnostics manufacturers to develop and test new products. 
Jul 30 Lexagene press release

 

Korean study evaluates rapid molecular test for carbapenemase screening

Originally published by CIDRAP News Jul 31

In a new study published in Antimicrobial Resistance and Infection Control, Korean researchers demonstrated the prevalence of carbapenemase-producing organisms (CPOs) in patients at a South Korean hospital using a rapid molecular test combined with cultures.

To determine the prevalence of rectal CPOs in high-risk patients admitted to the intensive care unit (ICU) at a South Korean tertiary care hospital, researchers from Korea University College of Medicine screened 408 rectal swabs obtained from December 2016 through December 2017 using the Xpert Carba-R assay, a polymerase chain reaction test that detects five common carbapenemase genes (blaKPC, blaNDM, blaVIM, blaIMP-1, and blaOXA-48).

When carbapenemase genes were detected with the assay, new rectal swabs were requested and cultured, and carbapenemase genes were confirmed using conventional polymerase chain reaction. The diagnostic performance of the assay was ascertained based on the culture results.

The prevalence of CPO carriage was 7.4% (30 of 408 swabs) according to the Carba-R assay and 3.7% (15 of 408) according to culture results. IMP-1 (13, 3.2%) and KPC (10, 2.5%) were predominantly detected by the Carba-R assay, followed by NDM (4, 1.0%), VIM (0.2%), KPC with OXA-48 (0.2%), and KPC with IMP-1 (0.2%). The overall sensitivity, specificity, positive predictive value, and negative predictive value of the Carba-R assay were 100.0% (95% confidence interval, 78.2% to 100.0%), 96.7% (94.4% to 98.2%), 53.6% (40.4% to 66.4%), and 100.0% (99.0% to 100.0%), respectively.

The authors of the study write, "The combined use of the Carba-R assay and culture was found to be a sensitive and specific screening method for CPOs. This combination is advantageous because the molecular method detects only the target gene and allows false-positive results, whereas rectal culture can identify which bacteria are carbapenem-resistant but may be less sensitive because of the abundance of other enteric bacteria."
Jul 29 Antimicrob Resist Infect Control study

 

Taco Bell to cut medically important antibiotics in beef supply by 25%

Originally published by CIDRAP News Jul 30

Taco Bell announced yesterday that it aims to reduce the amount of medically important antibiotics used in its US and Canadian beef supply chains by 25% by 2025.

The company said in a press release that as part of this new policy, it will favor suppliers that are reducing the use of antibiotics deemed by the World Health Organization (WHO) to be important to human health, and give preference to suppliers that increase veterinary oversight for treating sick animals. Taco Bell will also participate in the US Roundtable for Sustainable Beef and the CDC's Antimicrobial Resistance Challenge.

Taco Bell is the latest fast-food chain to commit to reducing medically important antibiotics in its beef supply chain. In December 2018, McDonald's announced it will work with its beef suppliers in the United States and nine other countries to cut the use of medically important antibiotics.

Although several fast-food chains have completely removed medically important antibiotics from their poultry supply chains in recent years, far fewer have committed to cutting antibiotics from their beef supply. Advocates for reduced antibiotic use in food-producing animals have been pushing the fast-food industry to make changes. 

"Fast food chains are seeing the writing on the wall: Customers want better beef," Lena Brook, director of food campaigns at the Natural Resources Defense Council (NRDC), said in a statement. "While its commitment leaves significant room for improvement, it's a move in the right direction and shows the pressure is on for competitors to take action."

According to the most recent report from the Food and Drug Administration, 42% of the medically important antibiotics sold for use in food-producing animals in the United States in 2017 were for cattle.

Taco Bell said it will report on its progress in 2022. 
Jul 29 Taco Bell press release
Jul 29 NRDC press release

 

New antifungal shows promise in phase 2 trial

Originally published by CIDRAP News Jul 30

Biotechnology company Cidara Therapeutics yesterday reported positive topline results from a phase 2 trial of it antifungal candidate rezafungin.

According to a company press release, the results from the STRIVE B trial indicate the rezafungin, a novel echinocandin developed for treatment of invasive fungal infections, met all of its objectives for efficacy, safety, and tolerability in patients with candidemia and/or invasive candidiasis. The objective of the trial, which included 91 patients in the microbiological intention-to-treat population, was to compare the efficacy and safety of rezafungin administered once-weekly versus caspofungin dosed daily. Efficacy measures included clearance of Candida from the blood or other normally sterile sites, resolution of systemic signs of infection, investigator assessment of clinical response, and overall survival.

Topline results showed that patients treated with rezafungin had numerically improved outcomes compared to caspofungin across all efficacy measures, and was generally safe and well-tolerated.

"Rezafungin has the potential to be the first safe and effective once-weekly, first-line treatment option for patients with difficult-to-treat and deadly invasive Candida infections, and we believe this trial moves us one step closer to market," said Cidara president and chief executive officer Jeffrey Stein, PhD.

The FDA has designated rezafungin as a Qualified Infectious Disease Product and granted it Fast Track status for treatment of candidemia and invasive candidiasis.
Jul 29 Cidara Therapeutics press release

 

WHO AWaRe index adapted to improve stewardship in England

Originally published by CIDRAP News Jul 30

A paper today in the Journal of Antimicrobial Chemotherapy describes the creation of an antibiotic use index in England based on the WHO AWaRe index.

The AWaRe index was recently created by the WHO to classify key antibiotics into three categories: Access antibiotics that should be widely available, Watch antibiotics that should be monitored for toxicity concerns and/or resistance potential, and Reserve antibiotics that should be saved for complex, multidrug-resistant infections. The tool was developed to help nations evaluate and optimize antibiotic use, but national variations in antibiotic resistance and use require each country to ensure that the index is relevant for country-specific use.

To adapt the AWaRe index for use in English hospitals, researchers from Public Health England collected national-level antibiotic prescribing data from 2011 through 2016 to see which antibiotics from the WHO AWaRe index were commonly used in primary and secondary care. Antibiotics used in England but not included in the WHO AWaRe index were then added to an appropriate category following a workshop consensus exercise with national experts, and the methodology was tested using national antibiotic prescribing data.

In 2016, 46 of 108 antibiotics included within the WHO AWaRe index were routinely used in England, along with an additional 25 antibiotics that were not included in the WHO AWaRe index. WHO AWaRe-excluded and -included antibiotics were reviewed and reclassified according to the England-adapted AWaRE index, with justification by experts for each addition or alteration.

Applying the England-adapted AWaRe index, Access antibiotics accounted for the majority (60.9%) of prescribing in primary care, followed by Watch (37.9%) and Reserve (0.8%). In acute secondary care, Access antibiotics still accounted for most of the antibiotics used (49.7%), but Watch (46.9%) and Reserve (3.3%) antibiotics were used more frequently. There was an unexplained twofold variation in prescribing between hospitals within each AWaRe category, highlighting the potential for quality improvement.

"We recommend that countries should review the AWaRe categorizations in their country, potentially using similar methodology, and consider which antibiotics from each category should be moved into the relevant category based on resistance profiles and antibiotic use," the authors of the paper write. "Quality improvement methodology can then be applied to organizations to improve antimicrobial stewardship and, in particular, preserve antibiotics in the Watch and Reserve categories."
Jul 30 J Antimicrob Chemother article

News Scan for Aug 02, 2019

News brief

Six countries report more polio cases

In the latest polio developments, Afghanistan and Pakistan reported more wild poliovirus type 1 (WPV1) cases, and three African nations and Malaysia reported circulating vaccine-derived poliovirus in cases, contacts, or the community, according to a weekly update from the Global Polio Eradication Initiative (GPEI).

In Afghanistan, a patient from Garmser district in Hilmand province had a paralysis onset of May 26, bringing the country's WPV1 total for the year to 12. Pakistan reported two cases, one from Balochistan province and the other from Khyber Pakhtunkhwa province with Jun 6 and Jun 11 paralysis onsets, respectively. The country has now reported 47 WPV1 cases in 2019, already far outpacing the 12 reported for 2018.

In Africa, Nigeria reported one more cVDPV2 case involving a patient from Borno state who had a Jun 20 paralysis onset, pushing the country's total to 13 so far this year. Democratic Republic of Congo (DRC) reported cVDPV2 in a close contact from Sankuru state on Jun 23 and one sample from a community isolate, also in Sankuru state, on Jun 22. Central African Republic reported 10 samples from community isolates in RS1 state and three such samples from RS4 state.

And finally, Myanmar reported one more cVDPV1 case in a patient from Kayin province who had a May 23 paralysis onset, putting the country's total at three so far for the year.
Aug 2 GPEI weekly update

Earlier this week the World Health Organization (WHO) summarized all the cVDPV2 developments in Africa this year, where cases or environmental positives reported in eight countries, with some reporting separate outbreaks.

The WHO said the risk of international spread or emergence of cVDPV2 across Africa is high due to suboptimal population immunity, ongoing population movements, and increasing mucosal immunity gaps to type 2 poliovirus. It added that the events underscore the risk posed by any low-level transmission of the virus and that a robust response is needed to rapidly stop circulation and ensure sufficient vaccination coverage in affected areas.
Jul 31 WHO update

 

New York man dies from Powassan virus infection

Yesterday the Ulster County Department of Health in New York confirmed the death of a man with Powassan virus. The man, who lived in Gardiner, was the first known case of Powassan virus in New York this year and had underlying health conditions.

Powassan virus is transmitted by the bite of an infected deer tick, and infections—though serious— are rare. According to Ulster County, only one to six New York state residents are diagnosed with the virus each year.

"It is imperative that all residents take every precaution necessary against tick-borne illnesses, especially during outdoor activities.  Residents should vigilantly check themselves and their pets for ticks and tick bites," said Carol M. Smith, MD, Ulster County’s commissioner of health and mental health.

There is no treatment for Powassan virus, and symptoms can range from headache, fever, to encephalitis.
Aug 1 Ulster County press release

 

Study: Easy access to prenatal flu vaccination boosts uptake

Free flu vaccination during prenatal visits at maternity hospitals can significantly increase vaccine coverage, according to a study that took place at three Paris-area hospitals. French researchers reported their findings yesterday in PLOS One.

Though seasonal influenza vaccination is recommended for pregnant women to protect them and their babies, coverage is well-below recommended levels. According to the study, vaccination coverage in pregnant women in France is 2016 was estimated to be 7%.

The study, which took place during the 2016-2017 flu season, included data from maternity wards at three hospitals. At one hospital, women at their prenatal appointments were offered the vaccine without charge. The team compared vaccination at that hospital with women who had prenatal appointments at the other two hospitals.

Data from a questionnaire answered by 248 women who gave birth during 10 days in January 2017 found an overall flu vaccine coverage of 19.4%. It was much higher at 35.4% in women from the hospital where free flu vaccine was offered and much lower at 2.7% and 0% in the women at the other two hospitals.

Other factors significantly linked to higher vaccine coverage were the mother's French birth and previous flu vaccination.

Vaccinated women generally reported that they had received enough information about flu vaccination, mainly from their prenatal care provider. The team found that women who weren't vaccinated said they didn't because it wasn't offered (81.5%), they feared fetal side effects (59.5%), or had inadequate information (51.4%).

The team concluded that the streamlined vaccination approach at the intervention hospital probably led to higher uptake levels by limiting the number of missed opportunities.
Aug 1 PLOS One abstract

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