Stewardship / Resistance Scan for Jan 13, 2020

Monoclonal antibodies for superbugs
;
ID consult and death, prescribing
;
C diff carriage and farm living

CARB-X awards $3.2 million for monoclonal antibody against superbugs

CARB-X today said it has awarded Trellis Bioscience of Redwood City, California, up to $3.2 million to develop an innovative monoclonal antibody designed to disrupt the protective biofilm that makes bacteria resistant to antibiotics.

The monoclonal antibody, called TRL1068, disrupts the bacterial biofilm by extracting a key protein, thereby rendering the bacteria more susceptible to attack by the immune system and to antibiotics. TRL1068 has been shown to enhance antibiotic activity in highly drug-resistant strains of gram-positive and gram-negative bacteria, the company said in a news release.

Erin Duffy, PhD, chief of research and development for CARB-X, which is based at Boston University, said in the release, "The Trellis project is in early development but if successful and approved for use in patients, its promise for tackling challenging, biofilm-mediated infections including joint implants could be transformational for the success of many modern medical procedures."

Stefan Ryser, PhD, CEO of Trellis, said TRL 1068 is a potential game-changer in treating a broad range of antibiotic-resistant bacteria. "CARB-X funding will support the manufacture of the drug for clinical development and, in a potential second tranche of funding, support an initial trial in patients with an infected implant, a type of infection that is particularly hard to treat due to biofilm formation on the surface of the implant."

Trellis could be awarded up to an additional $3.8 million if it meets certain project milestones.

Since it began in 2016, CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership, has announced 55 awards of more than $182.5 million total. It plans to invest $500 million for promising approaches to combat antibiotic resistance by the end of next year.
Jan 13 CARB-X news release

 

Lack of ID consult tied to higher death rates, inappropriate antibiotics

University of Minnesota researchers have discovered that having no infectious disease (ID) consultation is associated with more than a quadruple risk of death at 3 months, and a sixfold increased risk of death in the hospital among patients with bloodstream infections caused by methicillin-resistant Staphylococcus aureus (MRSA), Candida fungi, and Pseudomonas bacteria, according to their study in Open Forum Infectious Diseases.

ID consultation was also tied to a much higher rate of receiving appropriate antibiotics or antifungals.

The retrospective cohort study included 229 bloodstream infections in 2016 through 2018 (99 from MRSA, 69 Candida, and 61 Pseudomonas). All told, 181 patients had an ID consultation and 48 did not.

Overall 3-month mortality was 36%, but it was 4.5-fold higher in those who received no ID consult. Likewise, the risk of dying while still in the hospital was 5.9 times higher in those who had no ID consult. The investigators also determined that patients who received ID consultation were 9 times more likely to receive appropriate antibiotics or antifungals, 6 times more likely to have central lines removed, and 4 times more likely to have echocardiography to evaluate for endocarditis.

The authors conclude, "Automatic ID consultation may have the potential to improve patient survival; prospective evaluation of such an intervention is warranted."
Jan 11 Open Forum Infect Dis abstract

 

C difficile carriage tied to living near livestock farms

A single-center study published in JAMA Network Open found that living near a livestock farm is tied to a higher rate of Clostridioides difficile carriage at hospital admission, among other risk factors such as having been treated in a hematology-oncology unit and recent hospitalization in general.

Scientists examined data on 3,043 adults consecutively treated at Medical College of Wisconsin in Milwaukee from May 1, 2017, through Jun 30, 2018. All patients underwent C difficile screening using a nucleic acid amplification test at hospital admission. In addition to assessing typical C difficile risk factors, the investigators also noted the distance from patients' residence to the nearest livestock farm, meat processing plant, raw materials services, and sewage facilities.

Among the cohort, 318 (10.4%) tested positive for C difficile. Patients admitted to hematology-oncology units were 35% more likely to be colonized with C difficile, and the risk quadrupled among these patients if they had co-morbidities. The researchers also found that having been hospitalized in the preceding months raised the likelihood of colonization by 70%. Both these risk factors have been identified before.

The authors also found, however, that regardless of previous healthcare exposure, the probability of C difficile colonization more than doubled for those living 1 mile from a livestock farm compared with those living 50 miles from a livestock farm. They wrote, "Although we found an inverse association between C difficile colonization and the distance from a patient's residence to livestock farms, we did not find similar associations with water treatment plants, meat processing plants, or farm raw material plants."

They conclude, "Knowledge of the epidemiology of C difficile in the community surrounding the hospital is important, as it has potential implications for the incidence of hospital-onset C difficile infection."
Jan 10 JAMA Netw Open study

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