Stewardship / Resistance Scan for Mar 04, 2019

News brief

Report: Antibiotic resistance, sustainable development are intertwined

A new report from ReAct and the Dag Hammerskjold Foundation calls for antibiotic resistance to be integrated into the sustainable development agenda.

The report, titled "When the Drugs Don't Work: Antibiotic Resistance as a Global Development Problem," argues that if antibiotics continues to lose their effectiveness, efforts to achieve the United Nation's 2030 Agenda for Sustainable Development could be in jeopardy. Using data from the World Health Organization, World Bank, and other sources, the report focuses on how antibiotic resistance could hinder efforts to eradicate poverty, promote economic growth, reduce inequality, fight hunger, improve public health, and protect the environment.

The report also illustrates how antibiotic resistance is intertwined with many of these issues. For example, the authors note, poor people in low- and middle-income countries are more vulnerable to infection, and lack of access to affordable and effective medical care to treat drug-resistant infections may push them deeper into poverty because they have to pay out of pocket for more expensive second-line drugs or for hospitalization. It could also lead people to self-medicate and use antibiotics inappropriately, thereby promoting more resistance. Conversely, efforts to eradicate poverty could help reduce vulnerability to resistant infections.

The report concludes that antibiotic resistance should be included in national or regional target-setting to reach the Sustainable Development Goals, and that stakeholders in sectors beyond health and agriculture need to get involved in efforts to combat resistance.

"The Sustainable Development Goals are deeply interconnected and many goals and targets rely on one another to achieve the envisioned state of wellbeing and sustainability," the authors write. "Antibiotic resistance knows no sectorial limits, country borders or other divisions and therefore requires a level of cooperation that other challenges have not demanded before."
Feb 28 ReAct/Dag Hammerskjold Foundation report
Feb 28 ReAct news release

CARB-X provides funding for Contrafect's amurin platform

CARB-X announced today that it will award up to $1.75 million in funding to Contrafect Corporation, of Yonkers, New York, to develop a new approach to treating serious infections caused by gram-negative ESKAPE pathogens (Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species).

The funding will support Contrafect's work on amurins, a class of phage-encoded lytic agents that have demonstrated broad-spectrum activity in vitro against all ESKAPE pathogens and Salmonella Typhimurium, and have also show the ability to clear biofilms and act synergistically with a range of antibiotics. The company could receive an additional $5.9 million if certain project milestones are met.

"Amurins are highly differentiated from conventional antibiotics through their novel mechanism of action and potent spectrum of activity against the most threatening Gram-negative pathogens," Contrafect chief medical officer Cara Cassino, MD, said in a CARB-X press release. "We look forward to advancing development of this promising new class of antimicrobial agents with the support of CARB-X."

CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) is supporting the development of amurins to treat acute exacerbations of cystic fibrosis caused by multidrug-resistant gram-negative pathogens and potentially hospital-acquired bacterial pneumonia.

This is the second award that Contrafect has received from CARB-X, which to date has awarded more than $110 million for pre-clinical development of new antibiotics, diagnostics, and alternative therapies for drug-resistant infections.
Mar 4 CARB-X press release

Study compares prediction methods for multidrug-resistant infections

A study today in Infection Control and Hospital Epidemiology found that two methods for predicting multidrug-resistant infections performed similarly in a head-to-head comparison.

The single-center study by investigators from Johns Hopkins Bloomberg School of Public Health and the University of Maryland School of Medicine compared two statistical models for identifying multidrug-resistant gram-negative infections: logistic regression–derived risk scores and machine learning–derived decision trees. They compared the performance of the two models using a dataset of 1,288 patients hospitalized at Johns Hopkins Hospital with E coli or Klebsiella bloodstream infections to determine which one was better at identifying patients with an extended-spectrum beta-lactamase (ESBL) producer. They also reviewed the practical and methodologic attributes of the two approaches.

A total of 194 patients (15%) in the cohort were ESBL-positive, based on previous microbiologic test results. The results of the comparison showed that in practice the 14-variable risk score and the 5-variable decision tree performed similarly in identifying these patients, with positive predictive values of 94.6% and 90.8% and negative predictive values of 91.8% and 91.9%, respectively. While the C-statistic of the risk score was higher (0.87 vs. 0.77), suggesting better predictive value, the investigators also determined that the decision tree was more intuitive and user friendly.

"Statistical models for predicting drug resistance can provide important information in settings when laboratory diagnostics are challenging to implement," the authors of the study conclude. "These methodologies offer different strengths and limitations, and we hope that their continued utilization in infectious disease research will assist with improving patient outcomes."
Mar 4 Infect Control Hosp Epidemiol abstract

News Scan for Mar 04, 2019

News brief

US measles total climbs to 206 cases

The US Centers for Disease Control and Prevention (CDC) today reported 47 more measles cases, raising the total since the first to the year to 206 cases in 11 states. For comparison, the CDC reported 372 cases for all of 2018, the most since 2014.

Affected states are California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New Jersey, New York, Oregon, Texas, and Washington.

Meanwhile, the number of outbreaks remained at six, which includes a large outbreak centered in Clark County in the area around Vancouver, Washington. In that outbreak, county officials reported 5 more cases, raising its total since early January to 70. No more suspected cases or possible exposure locations have been reported, and all but 2 patients are known to have been vaccinated.

In New York, Rockland County officials reported 2 more cases, raising the total since September to 140, and an outbreak in an Orthodox Jewish community in Brooklyn has 121 cases as of Feb 26. In Illinois, a measles outbreak near Champaign-Urbana area involves 1 more case, raising the total to 5.
Mar 4 CDC update

With 9 new acute flaccid myelitis cases, CDC will switch to monthly reports

In a separate update, the CDC today confirmed 8 more 2018 acute flaccid myelitis (AFM) cases in the past 2 weeks, raising 2018's total number of cases to 223 reported in 41 states, and 1 more for 2019, raising this year's cases to 2.

The 223 cases—which are by a large margin the most US cases in 1 year—were confirmed from 374 reports of patients under investigation (PUIs). The CDC said no deaths have been attributed to AFM in 2018 or 2019.

The 2019 AFM cases have been diagnosed in patients from North Carolina and Utah, with the latter being a new case since the CDC's previous update on Feb 15.

Texas has reported the most AFM cases in 2018, with 29. Colorado has 16 cases, Ohio and California have 14 each, and Washington state and New Jersey both have 11. Minnesota and Pennsylvania have each recorded 10.

As of today, the CDC said it will update AFM counts monthly instead of biweekly because of a reduction in the number of PUIs.

AFM affects the spinal cord, leaving patients—almost always children—with partial or total limb paralysis or muscle weakness. The cause of the disease is unknown, but 90% of patients report upper respiratory virus symptoms in the weeks prior to limb weakness. In previous years the syndrome has been tied to enterovirus infections.
Mar 4 CDC report

Bangladesh confirms Nipah case in suspected family cluster

Lab tests in the investigation into the early February deaths of five family members in Bangladesh revealed that one was infected with Nipah virus, according to a report from the Daily Star, Bangladesh's largest English-language newspaper, which cited a statement from the country's Institute of Epidemiology, Disease Control and Research (IEDCR).

The family members are from Baliadangi upazila in Rangpur division in the far northwest of the country. IEDCR committees have conducted investigations at hospitals and other locations, collecting samples from health workers, as well as other family members, neighbors, and villagers. None of other family member tested positive.

The IEDCR said it's not known if the patient whose sample was positive had a history of drinking raw date palm sap, a known risk factor for the disease because of virus contamination through bat droppings. The agency said the four others may have been infected by the individual whose samples were positive.

Nipah virus is harbored by bats, which can transmit the disease to people and other animals. It is one of three priority areas targeted by the Coalition for Epidemic Preparedness and Innovations (CEPI). In 2018, a Nipah virus outbreak in India's Kerala state was linked to 17 deaths. In 2018, Bangladesh recorded three Nipah virus cases, one of them fatal, according to a list from the IEDCR.
Mar 4 Daily Star story
IEDCR yearly distribution of Nipah virus cases

Novel H5N2 detected at Egyptian farm; Denmark reports low-path H5

Egypt's agriculture ministry yesterday reported a novel H5N2 avian flu virus on a duck farm, according to a brief agriculture ministry statement and Arabic media report translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The reports didn't say if it was a highly pathogenic virus or where the farm was located.

Another Egyptian media report translated and posted by FluTrackers, an infectious disease news message board, quoted a veterinary official as saying the virus is a reassortant between H5N1 and H9N2, both of which are known to circulate in Egyptian poultry.
Mar 4 AFD post
Mar 3 FluTrackers thread

In other avian flu developments, Denmark reported a low-pathogenic H5 outbreak at an organic layer farm in Terndrup in North Jutland County, according to a Mar 1 report to the World Organization for Animal Health (OIE).

The outbreak began on Feb 26, and the birds had subclinical infection. The holding has 7,000 hens, and all will be destroyed to curb the spread of the virus. So far, the source isn't known.
Mar 1 OIE report on low path H5 in Denmark

WHO agrees to extend public health emergency for polio

The 20th meeting of the Emergency Committee under the International Health Regulations of the World Health Organization (WHO) nanimously agreed late last week that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC).

During the meeting, which convened in Geneva on Feb 19, the group considered several developments, including a rising number of wild poliovirus type 1 cases, the international spread of circulating vaccine-derived polio in several African countries, and population movement, before deciding the PHEIC status needed to stay in place.

"The current situation calls for unabated efforts and use of every tool available, to achieve the goal in these most challenging countries," the WHO said. "Particularly in the three remaining endemic countries, further engagement with senior levels of government and other key stakeholders is needed to advocate for polio eradication, and ensure all levels of government maintain a strong commitment until the job is done."

Polio is endemic in Afghanistan, Pakistan, and Nigeria. Several countries, including Indonesia, Papua New Guinea, and Somalia, have also reported recent cases.
Mar 1 WHO statement