Stewardship / Resistance Scan for Oct 31, 2017

News brief

CARB-X awards $4.55 million for Pseudomonas antibody treatment

CARB-X, an initiative to build a better pipeline of new antibiotics for treating resistant infections, announced today that it awarded Inhibrx $4.55 million to speed up the development of a new antibody to prevent and treat Pseudomonas, a hard-to-treat Gram-negative pathogen often found in health settings.

The award includes the possibility of $1.49 million more if Inhibrx, a biotherapy company based in La Jolla, Calif., meets certain development milestones with INBRX-111, which is currently in preclinical trials.

The Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) is a joint effort between the United States and the United Kingdom and is funded by the Biomedical Advanced Research and Development Authority (BARDA) and the Wellcome Trust, with additional support from the National Institute of Allergy and Infectious Diseases (NIAID).

Kevin Outterson, JD, executive director of CARB-X, said in a statement from the group that the Inhibrx project enriches the diversity of the CARB-X pipeline. He added that though projects in the CARB-X portfolio are in the early stages of research and come with a high risk of failure. " But if successful, these projects, including Inhibrx's antibody project, hold exciting potential in the fight against the deadliest antibiotic-resistant bacteria."

Mark Lappe, chief executive officer of Inhibrx, said company looks forward to advancing INBRX-111 rapidly though phase 1 trials.

The new award pushes CARB-X announced funding this year to $51.93 million covering 21 projects, with an additional $63.85 million if the groups meet their milestones. CARB-X said it expects to make further funding announcements later this year.
Oct 31 CARB-X press release

Study: California hospitals show progress on ASPs following new state law

The proportion of California hospitals with all of the Centers for Disease Control and Prevention's (CDC's) core elements for antibiotic stewardship rose from 59% to 69% following new state legislation requiring hospitals to implement additional stewardship practices, researchers with the California Department of Public Health reported yesterday in Infection Control and Hospital Epidemiology.

To assess implementation of antimicrobial stewardship programs (ASPs) before and after Senate Bill 1311 went into effect in 2015, the researchers analyzed the responses of California hospitals in 2014 and 2015 to an annual survey by the CDC's National Healthcare Safety Network (NHSN) that included questions about antibiotic stewardship practices. The law required hospitals to institute an antibiotic stewardship policy in accordance with guidelines established by the federal government and professional organizations, to develop a physician-supervised stewardship team with at least one physician or pharmacist who had received stewardship training, and to report all stewardship activities to appropriate hospital committees.

In total, 386 of 388 California hospitals completed the surveys in 2014 and 2015. Analysis of the survey answers showed that 267 hospitals (69.2%) had all seven of the CDC's core elements for hospital ASPs in 2015, compared with 229 (59.3%) in 2014. Nationally, only 48% of hospitals that reported to NHSN in 2015 had ASPs with all seven core elements.

The authors say the extent to which the legislation affected hospital ASPs is beyond the scope of the analysis. "However, in combination with recommendations from professional and government organizations, it is likely that this legislation had a catalyzing effect on California's ASP progress," they write.
Oct 30 Infect Control Hosp Epidemiol study

Welsh deaths from resistant, healthcare-related infections continue decline

In Wales, the number of deaths from the most common antibiotic-resistant and healthcare associated infections such as methicillin-resistant Staphylococcus aureus (MRSA) continued to decline in 2016, the BBC reported today, citing the latest statistics from the country's Office for National Statistics.

According to the results, MRSA deaths reflected a 22-year low; only 10 death certificates in 2016 noted MRSA, lower than the 14 recorded in 1994.

For Clostridium difficile, a common healthcare-associated infection that often affects older patients who are on antibiotics for other infections, Wales noted a rise in 2013, but the 79 deaths last year are the lowest since 2001, according to the report. For Staphylococcus aureus, the number of deaths in Wales last was the lowest since 1994.

The Welsh government released its Antimicrobial Resistance Delivery Plan in March. A government spokesperson told the BBC that the fall in deaths is a sign of overall progress National Health Service (NHS) Wales is making toward reducing healthcare-associated infections.
Oct 31 BBC report
C diff statistics
MRSA statistics

News Scan for Oct 31, 2017

News brief

H5N8 strikes poultry, zoo bird in South Africa

South Africa reported four more outbreaks involving highly pathogenic H5N8, two in poultry and two in other captive bird settings, according to two reports today from the World Organization for Animal Health (OIE).

The pair of farm-related outbreaks occurred near different cities in Western Cape Province in the southwest, one of them housing ostriches. The events started on Sep 26 and Oct 18, killing 200 of 28,623 susceptible birds. The surviving ones were slated for culling.

Officials also reported two other H5N8 detections, one involving a swan found dead on Oct 3 at a zoo in Gauteng Province in the north-central part of the country, and the other related to an outbreak that started on Oct 14 at a goose hobby farm in Cape Town in Western Cape Province. Between the two events, the virus killed 23 of 45 susceptible birds.

South Africa reported its first H5N8 outbreak in June, becoming the eighth African nation to detect the virus. Since then, the nation has reported several outbreaks involving poultry and other types of birds.
Oct 31 OIE report on H5N8 at South African farms
Oct 31 OIE report on H5N8 in other South African birds

**CDC: 12 more Campylobacter illnesses reported, 3 more states affected**

The Campylobacter outbreak related to puppies sold at Petland pet stores continues to grow this week. The Centers for Disease Control and Prevention (CDC) said yesterday that 12 more cases of the bacterial illness have been reported in 3 additional states since its last update on Oct 3. This brings the total number of cases to 67 in 15 states.

Of 62 ill people with available information, 17 (27%) have been hospitalized. No deaths have been reported. Patients have reported symptom onset between Sep 15 to Oct 14. Only five of the patients have not reported contact with a puppy at Petland.

Campylobacter bacteria isolated from 13 cases and 8 puppies has been resistant to first-line antibiotics, the CDC said. Resistance increases the risk for hospitalization and severe infections.

Campylobacter is spread through animal feces, and the CDC urges everyone to practice good hygiene before and after handling pets.
Oct 30 CDC update

New polio case discovered in Afghanistan

According to an advance update from the Global Polio Eradication Initiative (GPEI), a new case of wild poliovirus 1 (WPV 1) has been identified in the Shahwalikot district in Kandahar province, Afghanistan. This is the eighth wild poliovirus case detected this year in Afghanistan.

A new polio vaccination campaign is set to launch in the eastern provinces of Afghanistan in mid-November, the GPEI said.

In other news, three members of a polio eradication team were attacked with an improvised exploding device today in Pakistan. The attack took place in the Bajaur Agency's Khar district, near the federal tribal areas.

The workers were administering oral polio vaccine to local children. Polio is still endemic to Pakistan and neighboring Afghanistan, but insurgents have attacked workers on polio vaccination campaigns several times in the last decade, making widespread vaccine coverage challenging.
Oct 25 GPEI update
Oct 31 Dawn news story

Ebola studies tackle higher CFR in older people, deforestation threats

Greater participation in funerals may be one reason Ebola case-fatality rates are higher in elderly people, compared to their younger adult counterparts, researchers from Guinea reported yesterday in the American Journal of Tropical Medicine and Hygiene.

They looked at patterns in adults age 20 and older who were admitted to Ebola treatment centers in Guinea between Jan 2014 and Dec 2015. The group included 2,004 adults, which included 309 people who were elderly (age 60 and older).

Funeral participation, including washing and handling the dead body, was found to be a risk factor in West Africa's Ebola outbreak, and according to the authors, older people play a key role in funeral activities, including leading ceremonies and performing rituals and burial.

Their analysis found that the proportion of funeral participation was higher in the elderly group, compared to the younger adults. Also, duration between symptom onset and treatment center admission was significantly longer in the older group, which the team said could also play a role in the higher case-fatality rate, which was 80.6% in the elderly group, compared to 66.2% in the adult group.
Oct 30 Am J Trop Med Hyg abstract

In another Ebola research development, recent deforestation in Central and West Africa may increase the probability of an Ebola outbreak, an international research team reported yesterday in the latest issue of Scientific Reports. Deforestation is thought to increase contacts between humans and animals, a factor thought to increase the zoonotic disease threat.

They examined deforestation data between 2001 and 2014, focusing on 27 Ebola outbreak sites since 1976 where index cases were identified. With a modeling tool, they looked at variables to discriminate Ebola outbreak sites from 280 randomly selected control sites where humans lived but no Ebola outbreaks had occurred.

They found that outbreaks along the limits of the rainforest biome were associated with forest losses over the previous 2 years, a connection that was strongest for closed forests across a range of tree heights. Curbing forest losses could reduce the likelihood of future outbreaks, researchers concluded.
Oct 30 Sci Rep abstract

WHO marks progress in hepatitis C treatment

The World Health Organization (WHO) today announced progress in the global treatment of hepatitis C, stating that 3 million more people have had access to treatments in the last 2 years, and 2.8 million people received treatment for hepatitis B in 2016.

"We have seen a nearly 5-fold increase in the number of countries developing national plans to eliminate life-threatening viral hepatitis over the last 5 years," says Gottfried Hirnschall, MD, director of WHO's department of HIV and global hepatitis program. "These results bring hope that the elimination of hepatitis can and will become a reality."

The remarks come on the eve of the World Hepatitis Summit held in Brazil. Last year, 194 countries committed to eliminating hepatitis infections by 2030. Though progress has been swift, the WHO said the viral infection still causes more than 1.3 million deaths every year and affects more than 325 million people worldwide.

Detection will be key to eliminating hepatitis. As of 2015, only 10% of people infected with hepatitis B, and 1 in 5 people living with hepatitis C, were aware of their infections.
Oct 31 WHO news release