News Scan for May 15, 2019

News brief

British veterinarian group updates policy on antimicrobials in food-animals

The British Veterinary Association (BVA) has issued an updated policy position on responsible antimicrobial use in food-producing animals.

Citing a need for a collaborative One Health approach to the issue of antimicrobial resistance, the updated policy proposes 15 overarching recommendations for veterinarians, farmers, and policy makers on antimicrobial stewardship in food-animal production. It recommends that veterinarians carefully consider their use of antimicrobials in food animals, pay attention to the risk of resistance, and restrict the use of critically important antibiotics (as defined by the European Medicines Agency) to last-resort scenarios, while also urging that critically important antimicrobials be kept as a treatment option, in the interest of animal welfare.

The updated policy also calls for prioritizing development of effective diagnostic tools for animal illness, including rapid diagnostic tests; government incentives to improve husbandry and biosecurity measures on farms; farm assurance schemes that require commitment to responsible antimicrobial use; empowering farmers to work with vets to ensure the responsible use of antimicrobial on farms; and collaboration between government, veterinarians, and farmers on rational targets for reducing antimicrobial usage.

In addition, the policy reiterates that veterinarians should be guided by the BVA's seven principles on responsible antimicrobial use, which include avoiding inappropriate use and working with farmers to avoid the need for antimicrobials.

"Antimicrobial resistance is a shared problem that must be addressed by medical, veterinary, and environmental professionals collaboratively and not subject to a culture of blame," BVA president Simon Doherty said in a press release. "BVA is committed to providing continued leadership on the issue."

Doherty noted that ongoing efforts by veterinarians, farmers, and industry have already contributed to a 40% reduction in the sales of antibiotics for use in food-producing animals in the United Kingdom over the past 5 years.
May 10 BVA policy position
May 10 BVA press release


Inappropriate prescribing linked to adverse outcomes for seniors

A new study in the Annals of Family Medicine highlights the increased risks associated with inappropriate antibiotic prescribing in older primary care patients.

In the systematic review and meta-analysis, researchers in Singapore looked at more than 2,800 articles to find studies relating to "older persons," "primary care," and "inappropriate prescribing." After reviewing the articles, the researchers included eight studies with a total of 77,624 participants in the final analysis, pooling the adverse outcomes of potentially inappropriate prescribing (PIP) reported in the literature.

The results of the meta-analysis showed that while PIP did not affect mortality (risk ratio [RR], 0.98; 95% confidence interval [CI], 0.93 to 1.05), it was associated with increased risk of emergency room visits (RR, 1.63; 95% CI, 1.32 to 2.00), adverse drug events (RR, 1.34; 95% CI, 1.09 to 1.66), functional decline (RR, 1.53; 95% CI, 1.08 to 2.18), hospitalizations (RR, 1.25; 95% CI, 1.09 to 1.44), and health-related quality of life (standardized mean difference – 0.26; 95% CI, – 0.36 to – 0.16).

"This study demonstrated the associations between PIP and a wide range of adverse outcomes and highlighted the relevance of PIP among older persons in primary care," the authors of the study write, adding that the findings warrant further research into PIP interventions in primary care.

A previous systematic review found that one in five older patients attending primary care receive a potentially inappropriate antibiotic.
May/June Ann Fam Med study


Expanded resistance testing tied to more diagnoses of resistant TB

Chinese and Dutch researchers report today in Emerging Infectious Diseases that expanding rapid testing for drug-resistance in tuberculosis (TB) patients in two provinces was associated with a tripling of the number of patients diagnosed as having rifampin-resistant TB.

In the before-and-after study, researchers evaluated the introduction of rapid resistance testing of sputum samples by line-probe assay (LPA) for all patients given a primary diagnosis of smear-positive TB (rather than just those suspected of having rifampin-resistant TB) in two prefectures in eastern and middle China. They also evaluated LPA-based testing of cultures in smear-negative patients.

The study was part of an effort by the Chinese Ministry of Health, supported by the Bill and Melinda Gates Foundation, to expand access to diagnosis and treatment of rifampin-resistant TB. A total of 13,069 cases of rifampin-resistant TB were reported in China in 2017, but because only 14% of Chinese TB patients were tested for drug resistance, the vast majority of rifampin-resistant cases go undetected.

Analyzing data on 5,222 pulmonary TB patients in the 12-month baseline period and 4,364 in the 12-month intervention period, the researchers found that the number of smear-positive patients with rifampin-resistant TB rose from 30 in the baseline period to 97 in the intervention period, while the number of smear-negative patients with rifampin-resistant TB rose from 0 to 13, reflecting a low proportion of positive cultures. Of the 110 patients give a diagnosis of rifampin-resistant TB during the intervention period, 94 (85.5%) started second-line drug treatment, compared with 20 of 33 (60.6%) during the baseline period.

The authors of the study note that even though the intervention increased the number of patients receiving second-line treatment, 14% of patients with rifampin-resistant TB did not start second-line treatment, and treatment success remained low (50%). "This finding clearly calls for improvement of linkage into care and retention in treatment," they write.
May 15 Emerg Infect Dis study


Civica and Xellia partner to ease antibiotic shortages

Civica Rx, a nonprofit group formed in 2018 to reduce chronic shortages of generic drugs in the United States, today announced that it and Danish company Xellia Pharmaceuticals have signed an agreement for Xellia to make essential antibiotics—including vancomycin and daptomycin—for its member health systems. It added that shortages of the two drugs are affecting patient care in hospitals across the country.

In a news release, Civica said today marks its first generic drug production announcement since it was formed to tackle chronic drug shortages. It said it will partner with suppliers to deliver 14 essential generic drugs this year.

Xellia is expanding its manufacturing and sales capacity in the United States and produces its own active pharmaceutical ingredients and injectable drugs for serious and often life-threatening bacterial and fungal infections, Civica said. It said Xellia will make medications for Civica under Xellia's abbreviated new drug application and Civica labeling and new drug code.

Martin VanTrieste, president and chief executive office of Civica, thanked Xellia for its efforts to ease shortages, including those to treat infections caused by resistant bacteria. "By helping to stabilize the supply of Vancomycin and Daptomycin, we will have a direct impact on patient safety and public health by providing consistent access to antibiotics that are important treatment options in the management of difficult-to-treat and life-threatening infections," he added.

Vancomycin is an intravenous (IV) antibiotic used to treat serious infections, including those caused by methicillin resistant Staphylococcus aureus (MRSA) that are resistant to certain other medications. Daptomycin, also administered as an IV antibiotic, is used to treat complicated skin and skin-structure infections caused by susceptible gram-positive bacteria, including MRSA. Clinicians also use it to treat bloodstream infections and infective endocarditis caused by MRSA and methicillin-susceptible S aureus.
May 15 Civica press release


MCR-1 resistance genes found in Vietnamese chickens, Tunisian camels

Two new studies to assess the presence of the resistance gene MCR-1 in food animals found high levels in chicken farms from Vietnam and that the gene is present in both tourist and meat-producing camels in Tunisia.

Both studies were published yesterday in the Journal of Global Antimicrobial Resistance. MCR-1 confers resistance to the last-resort antibiotic colistin.

In the study on chickens, researchers from Canada and Senegal examined isolates from chicken feces from Canada (Quebec), Senegal, and Vietnam for Escherichia coli resistance to colistin and for MCR-1 and MCR-2 genes in extended-spectrum beta-lactamase (ESBL)- or AmpC-producing E coli. They also looked at susceptibility patterns of the colistin-resistant E coli isolates to other clinically important antimicrobials. They tested 327 possible ESBL/AmpC-producing E coli isolates.

None of the 108 isolates from 7 farms in Canada were resistant to colistin or had the MCR-1 or MCR-2 gene. Of samples from 15 farms in Senegal, the researchers found a low prevalence (2.2% of 93 samples) of colistin resistance, with no MCR-1 or MCR-2. However, the 126 samples from 2 of 4 farms in Vietnam had a higher prevalence (8.7%) of colistin resistance, and the team found MCR-1 genes in 85% of 13 colistin-resistant isolates. Also, all of the colistin-resistant samples showed evidence of multidrug resistance.

The team concluded that the coexistence of MCR-1 and ESBL/AmpC genes and very high levels of multidrug resistance in all colistin-resistant E coli isolates from the chicken farms in Vietnam is a major concern.

In the camel study, a research team from Tunisia and France set out to examine the role of camels as reservoirs of resistant genes by analyzing fecal swabs collected from 232 camels—from tourist-riding attractions and meat-producing facilities—in Tunisia from April 2016 to July 2018. They found E coli in 70.3% of the samples and Klebsiella pneumoniae in 6.9%. One K pneumoniae and one E coli from a tourist farm had the blaCTX-M-15 gene on an IncY plasmid, and two E coli samples from a camel butchery had the blaCTX-M-15gene on an IncIl plasmid and co-location of blaCTX-M-1 and MCR-1 genes on an INcHI2 plasmid.

The authors note that the study documents ESBL-producing Enterobacteriaceae in Tunisian camels, from both the tourist and meat-producing sectors, and the first detection of MCR-1 in a meat-producing camel. "Though not alarming, this context needs specific attention to avoid that camels become a bigger reservoir of multidrug-resistant Enterobacteriaceae," they wrote.
May 14 J Glob Antimicrob Resist abstract on chickens
May 14 J Glob Antimicrob Resist abstract on camel

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