Stewardship / Resistance Scan for Jan 07, 2020

News brief

CARB-X to fund novel immunotherapy for gram-negative bacteria

CARB-X today announced an award of up to $1.4 million to Centauri Therapeutics of Sandwich, UK, for the development of ABX01, a novel immunotherapy designed to treat infections caused by gram-negative pathogens.

ABX01 targets drug-resistant strains of Enterobacteriaceae, Pseudomonas aeruginosa, and Acinetobacter baumannii with a direct and immune-mediated mechanism that harnesses and re-directs naturally occurring effector antibodies in the body to kill the harmful bacteria. The company says the award will help advance the program, which is currently in the lead optimization phase of development.

"ABX01 is highly differentiated from other products targeting this area and this funding will help to accelerate its progression in an area of significant and growing unmet need," Centauri Therapeutics CEO Mike Westby, PhD, said in a press release from CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator).

ABX01 is the 53^rd antibacterial project funded by CARB-X since in launched in 2016
Jan 7 CARB-X press release

Antibiotics, asthma meds often co-prescribed for respiratory infections

An investigation of health records of patients in the United Kingdom diagnosed with acute lower respiratory tract infections (ALRTIs) has found that antibiotics for the condition are overprescribed irrespective of asthma status, and that clinicians frequently co-prescribe antibiotics and asthma medication, British researchers reported yesterday in Respiratory Research.

The retrospective study, conducted by researchers from the University of Bristol, analyzed electronic health records from 650 UK general practices, focusing on patients over 12 diagnosed with an ALRTI from January 2014 through December 2015. The aim of the study was to describe the frequency and variation of antibiotic and asthma medication prescribing following an ALRTI diagnosis, and investigate factors associated with prescribing among patients with and without asthma. Although British Thoracic Society guidelines state that acute asthma exacerbations should be treated with steroids and not antibiotics, guidance on ALRTI treatment in patients with asthma is unclear, the authors of the paper said.

Of the 110,418 patients diagnosed with an ALRTI, 17,952 (16%) had asthma; 81% and 79% of the patients with and without asthma received antibiotics, respectively, while 41% and 15% received asthma medication. For 90.5% of ALRTI episodes prescribed an asthma medication, patients were also given an antibiotic. There was variation in the frequency of antibiotic and asthma medication prescribing across practices.

Among the independent predictors of antibiotic prescribing among patients with asthma was the number of prior antibiotic prescriptions for any clinical indication. Patients who had received three or more prior antibiotic prescriptions, compared to those who had received one, were more likely to get an antibiotic prescription (odds ratio [OR], 1.28; 95% confidence interval [CI], 1.04 to 1.57). Higher practice ALRTI prescribing was also positively associated with antibiotic prescribing for asthma patients (OR, 1.47; 95% CI, 1.35 to 1.60).

"We have demonstrated high-use of antibiotics and asthma medication for the treatment of ALRTI in patients with and without asthma, respectively, with considerable between-practice variation," the authors concluded. "Further research is urgently needed to inform optimum use of both antibiotics and asthma medication for patients with ALRTI."
Jan 6 Respir Res study

News Scan for Jan 07, 2020

News brief

Ebola case count hits 3,391 in DRC

After some fluctuations, the World Health Organization's (WHO's) online Ebola dashboard shows a case count of 3,391 today, with a single newly confirmed case since yesterday. One new death was also recorded, bringing the toll to 2,234 in an outbreak that has now lasted 17 months in the eastern region of the Democratic Republic of the Congo (DRC).

The WHO said 568 suspected cases are currently under investigation. The DRC's Ebola technical committee (CMRE) said two cases confirmed yesterday were in Mambasa, a village that had gone more than 2 months without local Ebola transmission until this week.

"The new confirmed cases in Mambasa are of concern, since there had been no new confirmed cases in Ituri Province for 66 days. Resistance to response activities continues, particularly in North Kivu Province," the WHO African regional office said in its weekly report yesterday. The regional office said six health zones and 11 health areas reported confirmed cases in the past 21 days, and officials confirmed 13 new cases and one new death from Dec 29 to Jan 5.

Katwa, Kalunguta, Butembo, Mambasa, and Mabalako have all reported confirmed cases in the past week.

Vaccination efforts continue throughout the outbreak region. The CMRE said that, as of Jan 2, 4,802 people had been vaccinated with the Johnson & Johnson vaccine, and 261,596 people have been vaccinated with Merck's rVSV-ZEBOV vaccine.
WHO Ebola dashboard
Jan 6 CMRE report
Jan 5 WHO African regional office report

Serious bacterial infections rising in those with substance use disorders

A study today in Clinical Infectious Diseases says substance use disorders (SUDs) rose from 19.9% in 2012 to 39.4% in 2017 in US adults, and that increase is tied to rising rates of hospitalization for severe infections in those patients.

The study was conducted by researchers from the Centers for Disease Control and Prevention with data from the Premier Healthcare Database, which includes more than 800 American hospitals in both rural and urban settings.

The authors looked at adult patients with a hospital discharge diagnosis of bacterial infections and secondary SUD diagnoses. Most notably, they found that, among patients ages 18 to 44 with SUD, rates of infective endocarditis (IE) doubled during the 5-year study period.

In general, the rate of hospitalizations with SUD increased from 1.1 to 2.1 per 100,000 people for IE, 1.4 to 2.4 per 100,000 people for osteomyelitis, 0.5 to 0.9 per 100,000 people for central nervous system abscesses, and 24.4 to 32.9 per 100,000 people for skin and other soft-tissue infections (SSTIs). In the general population (without SUD), rates of IE, osteomyelitis, central nervous system abscesses, and SSTIs remained stable between 2012 and 2017.

The authors found the microbiology of infections among SUD patients was different from that in non-SUD patients, which is likely because of the rise of SUD patients who inject drugs. "The finding that S. aureus and viridans streptococci were the most common pathogens among IE-SUD patients suggests that additional emphasis on strategies to prevent infections caused by inadvertent injection of skin and mouth flora could be important for prevention of endocarditis," they said.
Jan 7 Clin Infect Dis study