ASP Scan (Weekly) for Mar 27, 2020

News brief

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

Malaria group urges action on antimicrobial resistance

The Malaria Consortium yesterday published a paper outlining the steps that the global community needs to take to address antimicrobial resistance (AMR).

As a leading organization in the fight against malaria and other communicable diseases, the organization says it's "gravely concerned" about the impact that AMR will have on public health, including ongoing malaria control and elimination efforts.

"AMR threatens to reverse decades of progress across the health and environment sectors, and it is crucial that we come together as a community to find solutions to this global problem," the group said in a press release.

The Malaria Consortium's recommendations to global stakeholders, based on objectives laid out in the World Health Organization's (WHO's) Global Action Plan on AMR, include supporting low- and middle-income countries in developing and implementing national AMR action plans, investing in increased surveillance of antibiotic use and resistance patterns, supporting the regulation of antibiotic quality and use, supporting the development of diagnostic tests; investing in community-based primary healthcare programs, investing and implementing programs to increase awareness of AMR, and funding the development and rollout of new vaccines.
Mar 26 Malaria Consortium AMR paper
Mar 25 Malaria Consortium press release

Guidelines aim to reduce surgical-site infections in lower-resource nations

Originally published by CIDRAP News Mar 26

An international team of surgeons this week released a set of recommendations for preventing surgical-site infections (SSIs) that aim to improve patient outcomes, reduce unnecessary antibiotic exposure, and curb antibiotic resistance in low- and middle-income countries (LMICs).

Published in the British Journal of Surgery, the guidelines identify nine essential recommendations for reducing SSIs that focus on patients undergoing abdominal surgery and can be feasibly implemented in low-resource settings. The recommendations include selecting antibiotic prophylaxis according to published local, regional, or national guidelines and taking into account local resistance patterns; administering antibiotic prophylaxis for all patients undergoing clean-contaminated, contaminated, or dirty surgery; administering antibiotic prophylaxis within 1 hour before surgery; and not routinely continuing prophylactic antibiotics beyond 24 hours after surgery.

SSIs are among the most common post-operative complications from abdominal surgery, particularly in LMICs, where an estimated 14.7 million patients develop an infection after gastrointestinal surgery. In addition, LMICs have significantly higher rates of antibiotic resistance.

"High rates of SSI and antimicrobial resistance are a real worry for surgeons, particularly in LMICs. Although guidelines for prevention of SSI have previously been published, they were developed in high income countries with little thought for the specific needs of LMIC patients," co-lead author Adewale Adisa, MBChB, of Obafemi Awolowo University in Nigeria said in a press release from the University of Birmingham, which led the collaboration. "This is the first guideline to have been led by LMIC surgeons and I believe our recommendations can be implemented immediately to benefit all patients across the world."

The collaboration was commissioned by the UK National Institute for Health Research.
Mar 24 Br J Surg paper
Mar 25 University of Birmingham press release

Canadian study links fewer early antibiotics to reduced childhood asthma

Originally published by CIDRAP News Mar 26

A new study by Canadian scientists provides further support for the link between early antibiotic use and childhood asthma.

The study, led by researchers from the University of British Columbia and published in The Lancet Respiratory Medicine, included both a population-level analyses of children born in British Columbia from 2000 to 2014 and an individual-level analysis of a cohort of children enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) study, which includes children recruited prenatally in four Canadian cities from 2008 to 2012.

The researchers also analyzed 16S rRNA gene sequencing data from fecal samples of children in the CHILD study to assess how composition of the gut microbiota relates to antibiotic exposure and asthma incidence.

The researchers found that, at the population level, a 26% decrease in asthma incidence in children ages 1 to 4 from 2000 to 2014 (from 27.3 diagnoses per 1,000 children to 20.2 per 1,000 children) was correlated with a 61% decrease in antibiotic use in children under the age of 1 during the same period (from 1,253 prescriptions per 1,000 infants to 489.1 per 1,000 infants). Further analysis revealed that asthma incidence increased 24% with each 10% increase in antibiotic prescribing (adjusted incidence rate ratio, 1.24; 95% confidence interval [CI], 1.20 to 1.28, P < 0.0001).

Analysis of 2,644 children in the CHILD study, after excluding children who received antibiotics for respiratory symptoms, found that outpatient antibiotic use in the first year of life was significantly associated with asthma diagnosis by age 5 (adjusted odds ratio [aOR], 2.15; 95% CI, 1.37 to 3.39, P = 0.0009), with a significant dose response; the aOR for diagnosis of asthma rose from 1.93 in children exposed to one course of antibiotics to 3.25 in children exposed to three or more courses.

Examination of 16s rRNA gene sequences from children in the CHILD cohort found that the gut microbiota of children who received antibiotics showed reductions in six key bacterial taxa, with two of the bacterial species having mechanistic links to asthma, a finding that suggests that gut bacteria may play a mediating role in asthma development.

The authors conclude, "Our findings suggest that the reduction in the incidence of paediatric asthma observed in recent years might be an unexpected benefit of prudent antibiotic use during infancy, acting via preservation of the gut microbial community."
Mar 24 Lancet Respir Med abstract

Forge, Hoffman-La Roche partner on antibiotic for lung infections

Originally published by CIDRAP News Mar 25

Forge Therapeutics announced today that it will partner with Hoffman-La Roche to develop and commercialize a novel antibiotic for treating serious lung infections caused by antibiotic-resistant gram-negative bacteria.

The antibiotic, developed by Forge through its Fg-LpxC LUNG program, targets and inhibits LpxC, a zinc metalloenzyme found in gram-negative bacteria, using a proprietary chemistry platform.

Forge, which received funding for the program from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) in 2019, says its LpxC inhibitors have been found safe and effective in animal models and are being optimized for lung infections, including those caused by Pseudomonas aeruginosa.

Under the terms of the agreement, Forge will retain control of the Fg-LpxC LUNG program until Hoffman-La Roche exercises its exclusive option to license the program. Forge is eligible to receive up to $190.5 million in total payments.

"We look forward to combining our novel approach and innovative chemistry with Roche’s proven drug development and commercialization expertise to provide a truly new class of antibiotic for people suffering from serious antibiotic-resistant infections," Forge CEO Zachary Zimmerman, PhD, said in a company press release.
Mar 25 Forge Therapeutics press release

WHO to fund AMR research projects in 7 countries

Originally published by CIDRAP News Mar 24

The WHO's Special Programme for Research and Training in Tropical Diseases (TDR) announced late last week that 13 projects from 7 countries have been awarded funding for research on AMR.

Countries that received the funding, awarded under the Small Grants Scheme for Implementation Research on AMR, include Colombia, Ecuador, Ghana, Myanmar, Nepal, Sierra Leone, and Uganda. The projects emphasize a One Health approach to AMR, looking at the human, animal, and environmental drivers of drug-resistant infections.

"As the drivers of antimicrobial resistance lie in human, animal and plant health; food and feed production; and the environment, there is a need for robust evidence to guide the implementation of effective interventions across the One Health spectrum," Haileyesus Getahun, MD, PhD, MPH, director of WHO’s Department of Global Coordination and Partnership on Antimicrobial Resistance, said in a TDR press release.

Among the funded projects are an investigation of resistance patterns in poultry production in Nepal, surveillance of healthcare-associated infections and resistance in hospitals in Sierra Leone, and a study of drug-resistant gonorrhea in Colombia.
Mar 20 WHO TDR press release

News Scan for Mar 27, 2020

News brief

As COVID-19 rages, CDC reports spike in US visits for flulike illness

While laboratory-confirmed flu cases continue to decline in the United States, the number of people visiting healthcare providers for influenza-like illness (ILI) rose sharply again last week, according to the Centers for Disease Control and Prevention's (CDC's) latest FluView report today.

The CDC says the increase in ILI activity, which rose from 5.6% to 6.4% for the week ending Mar 21, is likely linked to the COVID-19 pandemic, as more people seek care for respiratory illnesses.

High ILI activity was reported in 37 jurisdictions, down from 40 the previous week. On a regional level, outpatient visits for ILI ranged from 4.7% to 11.8%, with all regions above the national baseline of 2.4%. The number of jurisdictions reporting regional or widespread flu activity fell from 50 to 49. The percentage of respiratory specimens testing positive for influenza at clinical laboratories dropped from 14.9% to 6.9%.

The hospitalization rate for flu also climbed again, rising to 67.3 per 100,000 population from 65.1 per 100,000 population the previous week, a rate that's higher than all recent flu seasons for this time of year except for the 2017-18 season. In addition, hospitalization rates for children 0 to 4 years old and adults 18 to 49 years old are now the highest the CDC has recorded for these groups. The percentage of deaths attributed to pneumonia and influenza is 7.4%, above the epidemic threshold of 7.3%.

The CDC also said that 6 more pediatric deaths were reported, bringing the total for the season to 155. Aside from the 2009 pandemic flu season, that number is higher for this time of year than any season since the CDC began reporting flu statistics in 2004-05.

Testing by public health laboratories shows that 56.7% of the circulating viruses tested since Sep 29, 2019, are influenza A, and 43.3% are influenza B. The most common influenza A virus is 2009 H1N1, which accounts for 92.5% of positive specimens, and the most common influenza B virus is the Victoria lineage (98.4%).

The CDC estimates there have been 39 million flu illnesses so far this season, 400,000 hospitalizations, and 24,000 deaths.
Mar 27 CDC FluView report

Stretch with no new Ebola cases continues for DRC

In its latest weekly update yesterday, the World Health Organization (WHO) marked another week with no new Ebola cases in the Democratic Republic of the Congo (DR Congo). The last new case reported was on Feb 17.

Still, the WHO warned that, with continued insecurity and population displacement in previous Ebola hot spots, limited access to affected communities, and potential shortages of resources, a high risk of re-emergence remains and surveillance and response operations must be maintained. The WHO also repeated its call for an urgent injection of US $20 million to ensure that response teams, who are continuing to investigate suspected cases and provide support for survivors, can keep operating through the beginning of May.

"If no new resources are received, WHO risks running out of funds for the Ebola response before the end of the outbreak," the agency said.

After validating 9 historic probable cases last week, the WHO says a total of 3,453 Ebola cases have been reported in 29 health zones since the outbreak began in August 2018, with 2,273 deaths (overall case-fatality rate, 66%).
Mar 26 WHO update

Pakistan, 4 African countries report more polio cases

According to the latest weekly report from the Global Polio Eradication Initiative (GPEI), five countries reported new cases: Pakistan and four African nations.

Pakistan reported 2 more wild poliovirus type 1 (WPV1) cases, both in Sindh province. So far this year the country has reported 32 WPV1 cases.

In addition, Angola, Cameroon, Chad, and Ethiopia reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. Angola's two cases were in Moxico province and are included with the 2019 total, which is now 129. Cameroon has one case, its first of the year, which involves a patient with a Jan 30 paralysis onset.

Chad reported five cases, two in Batha province and one each in Guera, Tandjile, and Barh el Gazel provinces. They are the first cases of 2020, part of activity involving two different outbreaks, one linked to Jigwa province in Nigeria. Ethiopia has three more cVDPV2 cases, bringing its total for the year to five. The paralysis onset of the most recent case was Feb 12.
Mar 26 GPEI weekly report

Malaria group urges action on antimicrobial resistance

The Malaria Consortium yesterday published a paper outlining the steps that the global community needs to take to address antimicrobial resistance (AMR).

The Malaria Consortium's recommendations to global stakeholders, based on objectives laid out in the WHO's Global Action Plan on AMR, include supporting low- and middle-income countries in developing and implementing national AMR action plans, investing in increased surveillance of antibiotic use and resistance patterns, supporting the regulation of antibiotic quality and use, supporting the development of diagnostic tests; investing in community-based primary healthcare programs, investing and implementing programs to increase awareness of AMR, and funding the development and rollout of new vaccines.
Mar 26 Malaria Consortium AMR paper
Mar 25 Malaria Consortium press release