Stewardship / Resistance Scan for Nov 13, 2019

News brief

Latest Scottish report shows drop in antibiotic use, stable resistance levels

In an annual report for 2018, public health officials in Scotland yesterday said total antibiotic use in humans has dropped by 6.2% since 2014, and resistance has stayed mainly stable.

The findings, from Health Protection Scotland, for the first time include data on animal antimicrobial use from small-animal veterinary practices and data on environmental antimicrobial resistance.

Among other key findings on antimicrobial use, the authors report that, since 2014, levels have declined by 10.2% in primary care but increased by 16.0% in acute care hospitals. For 2018, more than one in four people in Scotland (27.3%) received at least one antibiotic course in primary care settings. The new information from small animal veterinary practices found that at least one in five consultations resulted in a prescription for at least one antibiotic.

Regarding latest trends on antibiotic resistance in humans, infections involving carbapenemase-producing bacteria have increased significantly since 2014, but there was no change between 2017 and 2018. Resistance to vancomycin, a key antibiotic used to treat resistant infections, has increased to 43.2% in some infection types, and in 2018, nearly 10% of gonorrhea cases showed some resistance to azithromycin.

On a positive note, the level of resistance to antibiotics prescribed for Escherichia coli bacteremia and similar infections has been stable of the past 5 years, the authors found. And in 2018, two thirds of Salmonella infections in animals were fully susceptible to antibiotics tested, showing no change from 2017. The group said the level of antibiotic-resistant infections in animals has been relatively stable since 2014.
Nov 12 Health Protection Scotland report

Study: Antibiotic prescriptions rates high in Japan

A study today in the International Journal of Infectious Diseases surveyed Japanese antibiotic prescription rates from 2012 to 2015 via electronic health insurance claims and found that 56% of prescriptions were written for infections for which antibiotics are rarely indicated.

The national health insurance database claims showed 659 million infectious disease visits from April 2012 through March 2015 across the country, with antibiotics prescribed at 266 million visits (704 prescriptions per 1,000 population per year). Antibiotics were most commonly prescribed for upper respiratory infections, with bronchitis being the most frequently cited diagnosis for prescriptions (58.3% of prescriptions, or 184 prescriptions per 1,000 population per year). Other high rates were for viral upper respiratory infections (40.6%), pharyngitis (58.9%), and sinusitis (53.9%).

Gastrointestinal infections accounted for 26.1% of prescriptions. The vast majority (86%) of oral antibiotics prescribed were broad-spectrum (third-generation cephalosporins, macrolides, or quinolones), and antibiotics was prescribed approximately 6.6 times more frequently for infections that did not require antibiotics than infection for which antibiotics are usually indicated, the authors said.

"Prescriptions of oral antibiotics should be reduced at least 50% based on our data, showing that >50% of them (391 per 1000 population) were prescribed for conditions where antibiotics are generally not indicated," the authors concluded. "Broad-spectrum antibiotics were too frequently prescribed and most of them were prescribed for acute respiratory infections, which should be the main targets of antimicrobial stewardship intervention."
Nov 13 Int J Infect Dis study

News Scan for Nov 13, 2019

News brief

Saudi Arabia reports 9th MERS case of November

In the latest in a small but steady stream of cases, Saudi Arabia's Ministry of Health (MOH) today reported one more MERS-CoV infection, which involves a 75-year-old man from Jeddah.

The man's exposure to the virus is listed as primary, meaning he probably didn't contract MERS-CoV (Middle East respiratory syndrome coronavirus) from another patient. His contact with camels isn't known. His illness marks the ninth case this month.
Nov 13 MOH report

Meanwhile, the World Health Organization Eastern Mediterranean regional office (WHO EMRO) today posted an overview of 14 MERS-CoV cases reported in October, 3 of them fatal. Thirteen were from Saudi Arabia and one from the United Arab Emirates (UAE). The 14 cases for October were up sharply from 4 cases reported in September.

One of the cases involved a healthcare worker who was infected while caring for a patient, but there were no other clusters. Two patients had symptom onsets in September, and the three people who died were in the 70- to 79-year-old age-group.

As of the end of October, the WHO since 2012 has received reports of 2,482 lab-confirmed MERS-CoV cases, at least 854 of them fatal. The vast majority have been in Saudi Arabia.
Nov 13 WHO EMRO situation update

Dengue cases in Americas region hit record high

As of the middle of October, the WHO Americas region has experienced the most dengue cases in its history, topping the number reported in the 2015 epidemic year by 13%, the WHO's Pan American Health Organization (PAHO) said in a Nov 11 update.

So far this year, more than 2.7 million cases (44.5% of them lab confirmed) have been reported, along with 1,206 deaths. The proportion of severe dengue infections (0.8%) has exceeded that seen in the previous 4 years.

All four dengue serotypes are present in the region, and cocirculation of all four have been detected this year in Brazil, Guatemala, and Mexico. A combination of three serotypes are circulating in seven nations. Of five countries with the highest incidence, four are in Central America: Belize, El Salvador, Honduras, and Nicaragua. Brazil has the fifth highest incidence.
Nov 11 PAHO dengue update

Department of Defense funds new Marburg virus vaccine candidate

IAIV, the non-profit research organization, announced yesterday it received a $35.7 million award from the US Department of Defense's Defense Threat Reduction Agency to develop a recombinant vesicular stomatitis virus (VSV) vector Marburg vaccine candidate.

IAIV has previously used VSV technology to develop HIV and Lassa fever vaccine candidates, both in preclinical development. The Marburg vaccine candidate has shown strong protection from the virus in non-human primate studies.

"IAVI looks forward to applying more than a decade of our experience in viral vector vaccines to hasten the development of this viral hemorrhagic fever vaccine candidate," said Mark Feinberg, MD, PhD, president and CEO of IAVI.

The vaccine is based on the same VSV platform as Merck’s Ebola Zaire virus vaccine, which yesterday was given prequalification for licensing by the WHO. Marburg virus, like Ebola, is often deadly and could be used as a bioweapon. Both Marburg and Ebola are filoviruses.
Nov 12 IAIV press release