Stewardship / Resistance Scan for Jan 30, 2019

News brief

UN committee publishes AMR recommendations, seeks input

An ad hoc expert panel convened by the UN secretary-general in March 2017 yesterday published guidelines on antimicrobial resistance (AMR) and is seeking public input, the World Health Organization (WHO) announced.

The Interagency Coordination Group (IACG) on Antimicrobial Resistance has a mandate "to provide practical guidance for approaches needed to ensure sustained effective global action to address antimicrobial resistance," the WHO said. "The terms of reference for the IACG include to promote, plan and facilitate collaborative action, to align activities so gaps are closed, and resources are optimally utilized, to explore the feasibility of developing global goals and targets related to antimicrobial resistance." The report and IACG's recommendations will be submitted to the UN secretary-general in April.

The report is divided into five main areas, each with its own recommendations: (1) accelerate progress in countries, (2) innovate to secure the future, (3) collaborate for more effective action, (4) invest for a sustainable response, and (5) strengthen accountability and global governance.

The deadline for submitting feedback is Feb 19, and an email address is provided in the WHO announcement.
Jan 29 WHO announcement
Full IACG report

ECDC launches survey of healthcare workers and antibiotics

Earlier this week, Public Health England (PHE) and the European Centre for Disease Prevention and Control (ECDC) launched a Europe-wide survey to gauge health worker perceptions about antibiotic use and antibiotic resistance.

"ECDC and PHE are aiming for a return of at least 10,000 responses with representation from healthcare workers, including doctors, nurses, pharmacists and hospital managers, as well as clinical scientists, physiotherapists, nursing assistants, dental/pharmacy technicians, public health teams and health students," ECDC said in a news release yesterday.

The online survey takes 5 to 10 minutes to complete and is open until Feb 14.

ECDC said the results will be used to guide communication aimed at healthcare workers and to see what, if any, gaps exist in the current education around antibiotic use.
Jan 29 ECDC press release

Study: Half of UK residents long-term care residents receive antibiotics

Half of all residents in long-term care (LTC) facilities received at least one antibiotic in the previous year, according to a retrospective cohort study from the United Kingdom published yesterday in the Journal of Antimicrobial Chemotherapy.

To conduct the study, researchers extracted from a national pharmacy chain database antibiotic prescriptions written for LTC residents from November 2016 to October 2017. In total they analyzed 544,796 antibiotic prescriptions dispensed for 167,002 residents in England, Northern Ireland, Scotland, and Wales.

During the study period, 56.6% of LTC residents in Northern Ireland, 53.2% in Scotland, 48.5% in England, and 45.0% in Wales received at least one antibiotic prescription. Amoxicillin, trimethoprim, nitrofurantoin, and flucloxacillin accounted for 66.4% of all antibiotic prescribing. LTC residents were frequently rates for respiratory infections, urinary tract infections, and skin infections.

"Half of the residents (52.1%) were dispensed one antibiotic drug over the 12 month period, a quarter (27.5%) were dispensed two different antibiotics, 12.9% were dispensed three, and 5.1% were dispensed four (the remaining 2.4% were dispensed between 5 and 10 different antibiotics)," the study authors wrote.

This was the largest study to examine antibiotic prescribing among LTC residents in the UK, and the authors said the information can help both clinicians and pharmacists support antibiotic stewardship efforts.
Jan 29 J Antimicrob Chemother study

Novel antibiotic cadazolid underperforms in two phase 3 C difficile trials

Cadazolid, a novel quinoxolidinone antibiotic developed by Actelion Pharmaceuticals, was safe and well tolerated but was shown inferior to vancomycin for the clinical cure of Clostridioidis difficile infection (CDI) in one of two identical phase 3 trials, making its future uncertain, an international team reported yesterday in The Lancet Infectious Diseases.

The study highlights the results of IMPACT 1 and IMPACT 2, two identically designed multicenter, double-blind, placebo-controlled, randomized trials. IMPACT 1 was conducted in Australia, Brazil, Canada, France, Germany, Italy, the Netherlands, Peru, Poland, Romania, Spain, and the United States. IMPACT 2 was done in Argentina, Belgium, Brazil, Canada, Chile, Croatia, Czech Republic, Greece, Hungary, Israel, Romania, Slovakia, South Korea, the United Kingdom, and the United States. Adults with mild to severe CDI were randomized 1:1 to either the same daily dosage of oral cadazolid or oral vancomycin, with a placebo disguised as the other drug.

In the intention-to-treat arm of the study, cure rates for cadazolid were 84% in IMPACT 1 and 81% in IMPACT 2, versus 85% and 86% for vancomycin, respectively. In the per-protocol patients, cure rates were 88% and 87% for cadazolid, respectively, and 92% for vancomycin in both IMPACT 1 and 2. That means the data revealed non-inferiority for cadazolid in IMPACT 1 but not in IMPACT 2. Safety and tolerability was the same for both antibiotics in both trials.

The authors concluded, "Further commercial development of cadazolid for C difficile infection is unlikely." The study was funded by Actelion.

In an accompanying commentary, Benoit Guery, MD, PhD, with the University of Lausanne in Switzerland, wrote, "IMPACT 1 and 2 do not provide a strong basis for the implementation of cadazolid in treatment of C difficile infection, but they do underline the need for strong and uniform definitions and the development of new tools to assess the response to treatment."
Jan 29 Lancet Infect Dis study
Jan 29 Lancet Infect Dis commentary

News Scan for Jan 30, 2019

News brief

Camel contact linked to new Saudi MERS case

Saudi Arabia's Ministry of Health (MOH) reported another case of MERS-CoV today, this time in a man who had contact with camels.

In an update to its epidemiologic week 5 report, the MOH said the patient was a 65-year-old man from Buraydah. He is hospitalized for his MERS-CoV (Middle East respiratory syndrome coronavirus) infection.

In the World Health Organization's most recent MERS-CoV update, it said that, as of Dec 31, it had received reports of 2,279 MERS-CoV cases since 2012, at least 806 of them fatal.

Saudi officials have now reported 12 MERS cases this month.
Jan 30 MOH report

USDA: Only 14% of American home cooks use food thermometers

The US Department of Agriculture (USDA) surveyed Americans on home cooking practices and found only 14% used a food thermometer when preparing meals with meat, poultry, or seafood, and about 2% of cooks consumed raw milk in the past 7 days.

The information is gathered in a new report that aimed to assess how many Americans follow two standard USDA food recommendations: use a food thermometer when preparing meat and avoid consumption of raw milk. Responses were collected from 2014 to 2016 as part of the American Time Use Survey–Eating and Health Module.

The USDA found that 3.2 million people (1.3 % of US adults) consumed raw milk, and 19.5 million people (7.9% of adults) had used a food-grade thermometer in the last 7 days.

"At-home meal preparers whose occupation is related to food preparation were more likely to use a food thermometer, suggesting a potential link between mandatory on-the-job food safety training and food safety behavior at home," the USDA said.

Undercooked meat and poultry is tied to foodborne illnesses, including salmonellosis. Raw milk can contain serval pathogens, including Brucella.
Jan 29 USDA report

Groups launch new tool for jump starting new pandemic drugs

In a step designed to speed the development of new treatments for pandemic diseases, two groups have launched the Pandemic Response Box to provide researchers with free access to 400 compounds, according to an announcement yesterday. The groups include the Medicines for Malaria Venture (MMV) and the Drugs for Neglected Diseases initiative (DNDi).

The box is a collection of structurally diverse compounds that were selected by disease experts. It includes 201 antibacterials, 153 antivirals, and 46 antifungals. All are either already on the market or are in development. The compounds' biological activity hasn't been confirmed by the two groups, and their selection was based on information in the scientific literature.

According to a press release yesterday, in return for receiving the drug-like molecules free of charge, researchers agree to make their screening results public and to publish their findings in an open-access within 2 years of generating the data.

Timothy Wells, PhD, chief scientific officer of MMV, said in the statement, "Open innovation is one of the keys to unlocking new potential for drug discovery and tapping into existing expertise to kickstart new research efforts. The hope is that these efforts will contribute to the discovery and development of next generation therapies to manage a future pandemic as well as existing threats such as the Zika virus and Ebola."

The groups also said that the emergence and spread of drug-resistant pathogens further increases the frequency and seriousness of epidemics.

Graeme Bilbe, PhD, research and development director at DNDi, said a deeper understanding of disease pathogenesis and research into new effective treatments could help prevent the emergence and spread of drug-resistant pathogens. "The goal is to help shorten the time between the emergence of a new pandemic and the availability of new drugs to treat it. History has repeatedly shown that saving time, saves lives."
Jan 29 DNDi press release
MMV Pandemic Response Box link