Stewardship / Resistance Scan for Mar 01, 2018

News brief

Two groups laud Senate bill to combat antimicrobial resistance

Two major infectious disease groups voiced strong support of a bill introduced yesterday to strengthen the US government's response to the growing threat of antimicrobial resistance (AMR).

The Infectious Diseases Society of American (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) applaud the Strategies to Address Antimicrobial Resistance (STAAR) Act, introduced by Senator Sherrod Brown, D-Ohio.

The STAAR Act would reauthorize the Interagency Antimicrobial Resistance Task Force and codify sections of the National Action Plan for Combating Antibiotic-Resistant Bacteria to promote prevention and tracking, enact Centers for Disease Control and Prevention (CDC) recommendations to bolster federal AMR efforts, provide research grants to healthcare facilities, and foster partnerships between the CDC and state health departments, among other steps, according to a news release from Brown's office.

"Senator Brown's important bill builds upon bipartisan investments in addressing AMR by reinforcing our public health capacity for prevention, detection, and tracking antibiotic resistance threats," the IDSA said in a news release. "The STAAR Act would also drive the implementation of antimicrobial stewardship programs in health care facilities that have proven to improve patient outcomes while lowering inappropriate antibiotic use that causes the development of resistance. The legislation would also strengthen research on AMR to help ensure the availability of evidence-based techniques and innovative tools to combat AMR."

In a SHEA press release, SHEA President Keith Kaye, MD, MPH, said, "Currently, health care systems in the United States face significant challenges in addressing antibiotic resistant bacteria, which threaten the lives and well-being of millions of people each year." He added that the act "addresses this complex public health issue head-on by providing much needed resources support for developing innovative approaches towards infection surveillance, antimicrobial stewardship, and research that can have a meaningful impact on prevention of antimicrobial resistance and patient safety."
Feb 28 IDSA news release
Mar 1 SHEA press release
Feb 28 Sen. Brown news release

CARB-X awards $2.4 million for antibiotic candidate to treat serious UTIs

CARB-X, a public-private initiative that supports companies in early-stage antibiotic discovery and development, today announced its latest grant: $2.44 million to Macrolide Pharmaceuticals of Watertown, Mass., to support the development of a novel fully synthetic macrolide antibiotic with gram-negative activity, according to a CARB-X news release. The drug is geared toward treating serious infections, including drug-resistant complicated urinary tract infections (cUTIs).

As an antibiotic class, macrolides are known to be effective against various gram-positive but not gram-negative pathogens. Macrolide is using its proprietary chemistry platform to re-engineer the macrolide scaffold with the aim of developing a fully synthetic macrolide to treat drug-resistant cUTI infections that can be administered intravenously and orally, CARB-X said.

If certain milestones are met, the Macrolide award could grow to $6.81 million, according to the release.

Kevin Outterson, JD, Executive Director of CARB-X, said, "The world urgently needs new antibiotics, rapid diagnostics, vaccines, and entirely new approaches to protect us against drug-resistant bacteria. The projects in the Powered by CARB-X portfolio are in the early stages of development, and there is always a risk of failure. But if successful, these innovative projects, like the Macrolide project, hold great potential to treat life-threatening infections and fight against drug-resistant bacteria."

Since the beginning of last year, CARB-X has announced awards totaling $64.64 million, plus an additional $81.42 million if project milestones are met.
Mar 1 CARB-X news release

Clinical pathways tied to lower antibiotic use in Italian pediatric hospital

The introduction of multidisciplinary patient management plans called clinical pathways (CPs) for pneumonia in an Italian pediatric emergency department was associated with impressive reductions in antibiotic prescribing, according to a study yesterday in PLoS One.

Italian pediatric antimicrobial prescription rates are among the highest in Europe, the authors of the study said. As a first step in an antimicrobial stewardship program, on Oct 1, 2015, they implemented a CP for community-acquired pneumonia (CAP) to lower overall prescribing of antibiotics, especially broad-spectrum options.

The researchers analyzed outcomes data on children 3 months to 15 years old who had CAP from Oct 15, 2014, to Apr 15, 2015 (pre-CP) or from Oct 15, 2015, to Apr 15, 2016 (post-CP). They assessed antibiotic prescribing during the two periods, including rates, breadth of spectrum, and duration of therapy. They also compared length of hospital stay.

Based on data from 120 pre-CP and 86 post-CP visits, the investigators determined that broad spectrum regimens for particular macrolides decreased from 50.0% to 26.8% after CP, with an associated increase in amoxicillin prescriptions. Median doses of antibiotics dropped from 10 to 8, and duration of therapy declined from 10 to 8 days.

Among inpatients they found a decrease in broad-spectrum regimens (100% pre-CP vs 66.7% post-CP) and the introduction of narrow-spectrum regimens (0% vs 33.3%). Hospitalized patients received antibiotics for 10 days post-CP compared with 18.5 days pre-CP, but inpatients had no statistical difference in length of therapy after the intervention.

In addition, the researchers reported no difference in treatment failure between the two periods.
Feb 28 PLoS One study

News Scan for Mar 01, 2018

News brief

European nations report low mid-season flu vaccine effectiveness

This season's flu vaccine was from 25% to 52% effective against influenza in Europe, according to interim results published today in Eurosurveillance, based on data from five surveillance systems from groups that looked at mid-season vaccine effectiveness (VE) across Europe.

Studies were conducted at primary care clinics in Spain, the United Kingdom, and Denmark, and in Croatia, France, Germany, Ireland, Italy, the Netherlands, Portugal, Spain, and Sweden. The Danish study also included VE among hospitalized patients, as did a hospital-based study conducted in France, Italy, the Netherlands, Portugal and Spain.

The UK study showed that the live attenuated influenza vaccine was 53% effective in children, outperforming the injected vaccine, which had a VE of 18%. VE against any hospitalized influenza in patients aged 65 years and older was 35% in France, Italy, the Netherlands, Portugal, and Spain. Among targeted groups in Spain, the VE was 40%.

VE was strongest against influenza A H1N1, ranging from 55% to 63% for those under 65, and 37% for those over 65 (Denmark). The vaccine was not protective against H3N2. Among all ages, VE against H3N2 ranged from −42% (95% confidence interval [CI], −116% to 7%) in Denmark to 7% (95% CI, −74% to 51%) in Spain, with all findings not statistically significant.

Among all ages, VE against influenza B ranged between 36% (95% CI, 27% to 44%) in the Danish study and 54% (95% CI, 24% to 72%) in the UK study.

"VE was moderate to good against influenza A(H1N1) pdm09 among all ages (55 to 68%), poor against influenza A(H3N2) with all point estimates below 8% for all ages, and moderate against influenza B, with point estimates between 39 and 52% for all ages, " the authors concluded.
Mar 1 Eurosurveill study

Novavax reports promising findings for recombinant adjuvanted flu vaccine

Novavax, a pharmaceutical company based in Gaitherburg, Md., yesterday announced that a phase 1/2 trial of its nanoparticle recombinant adjuvanted flu vaccine (NanoFlu) showed improved immune response in people age 60 and older when compared to an egg-based high-dose flu vaccine.

The study tested two NanoFlu trivalent formulations and was tested against the egg-based high dose vaccine in healthy adults age 60 and older, according to a statement from the company. Researchers measured immunogenicity by looking at hemagglutination inhibition (HAI) and neutralization antibody responses against a panel of vaccine-homologous, historical, and forward-drifted flu viruses.

Initial findings suggest the vaccine, which contains a proprietary Matrix-M adjuvant, showed significantly higher HAI antibody response against H1N1 and H3N2 seasonal flu viruses and had comparable response to the influenza B Brisbane strain, when compared to the egg-based counterpart. Also, researchers found higher HAI response against historic and forward-drifted H3N2 strains and strong neutralizing antibody responses that correlated with HAI results against H3N2 strains.

In a statement, the company said it will submit more detailed results to a peer-reviewed medical journal. Nanovax added that it expects a phase 2 trial of the vaccine to launch in the third quarter of 2018.
Feb 28 Novavax statement

Avian flu outbreaks hit Saudi Arabia, South Africa, India, Netherlands

In the latest highly pathogenic avian flu outbreak developments, Saudi Arabia and South Africa reported more H5N8 outbreaks, India detected H5N1 in crows, and the Netherlands confirmed that a recent H5 outbreak in poultry involved the new H5N6 reassorant, according to separate reports from the World Organization for Animal Health (OIE).

In Saudi Arabia, officials reported seven more H5N8 outbreaks on farms with start dates from Jan 6 to Feb 16, all in Riyadh province and most of them near the city of Al Kharj. Taken together the virus killed 37,700 of 497,810 susceptible birds, and the remaining ones were destroyed to curb the spread of the virus.

Meanwhile, South Africa reported another H5N8 outbreak in backyard poultry, which began on Feb 11 in Limpopo province in the north of the country, killing 8 of 130 birds. The rest were slated for culling. South Africa also reported more H5N8 detections in seabirds found sick or dead between Feb 2 and Feb 15 in Western Cape province. Of 35 birds, four were jackass penguins, one was a swift tern, and 30 were Cape gannets, a large type of seabird.
Mar 1 OIE report on H5N8 in Saudi Arabia
Mar 1 OIE report on H5N8 in South African poultry
Mar 1 OIE report on H5N8 in South African seabirds

In developments involving other strains, tests in India detected H5N1 in house crows found dead in the city of Paradeep in Orissa state in the eastern part of the country. The event began on Feb 11 and led to the deaths of 173 crows. So far the source of the virus isn't known.

Meanwhile, an H5 outbreak at a poultry near the city of Oldekerk, announced by Dutch agriculture officials earlier this week, has been confirmed as reassorant H5N6, according to a report from the OIE. The virus killed 230 of 27,866 susceptible birds, and the survivors were culled to control the spread of the virus. In a separate report, officials reported H5N6 in a wild duck found dead in North Holland province.
Mar 1 OIE report on H5N1 in India
Feb 27 OIE report on H5N6 in Dutch poultry
Feb 27 OIE report on H5N6 in Dutch waterfowl

Report: Core public health funding cut by one-third since 2002

A new report from Trust for America's Health (TFAH), a nonprofit health advocacy group based in Washington, DC, shows that state public health spending has drastically dwindled in the United States since 2002, and has been "flat" for the last decade.

"A healthy United States is a strong United States. A prepared nation is a safe nation. But persistent underfunding of the country's public health system has left the nation vulnerable," said John Auerbach, president and chief executive officer of TFAH.

In 2002, the federal Public Health Emergency Preparedness (PHEP) Cooperative Agreement Program budget, which allows states to prepare for and respond to emergencies, was $940 million. Last year, the budget was $667 million.

The analysis, which adjusted for inflation, found that state public health spending in 2016 to 2017 was lower than in 2008 to 2009, meaning funding cuts that occurred after the Great Recession have not yet been retired or resumed. Since 2008, local health departments have lost 55,590 staff due to layoffs.

Moreover, shrinking state budgets and staff can't compensate for federal cuts to public health funds, TFAH said. TFAH said since 2002, only 19 states and Washington, DC maintained or increased their budgets.

TFAH's analysis includes eight recommendations, the first of which is to increase public health spending at the local and federal level.
Mar 1 TFAH press release
Mar 1 TFAH report

New bipartisan caucus to focus on biosecurity

Earlier this week, Congress celebrated the launch of a new biodefense caucus, a bipartisan group of 27 members who will work together to protect the country from chemical, biological, radiological, and nuclear (CBRN) threats and pandemic outbreaks.

The caucus is an informal group chaired by Rep. Susan Brooks (R-Ind.) and Rep. Anna G. Eshoo (D-Calif.), which plans to have regular briefings.

"This is an issue that too many of us take for granted," Brooks said in a statement. "There is an assumption that we have stockpiles of vaccines readily available to combat the next Anthrax attack."

The Alliance for Biosecurity today applauded this development, stating the caucus will be able to "identify and fill gaps in preparedness and response capabilities."
Mar 1 Alliance for Biosecurity press release