Stewardship / Resistance Scan for Sep 30, 2020

News brief

Review shows stewardship apps increase guideline accessibility

A review of studies analyzing use of antimicrobial stewardship (AMS) apps found they may increase adherence to antibiotic prescribing guidelines, European researchers reported yesterday in PLOS One.

The review, led by researchers from Erasmus Medical Center in the Netherlands, included 13 studies published from 2008 to 2019 focusing on the use of AMS smartphone or tablet app use by physicians treating in-hospital patients. The aim of the study was to review the apps and evaluate their impact on antibiotic prescribing for in-hospital patients. The primary study outcomes included average monthly use, guidelines assessed, adherence to guidelines, and user experience.

In general, the studies measured different outcomes, applied different designs, and varied in quality. None of them were randomized controlled trials. In four studies, guideline-adherent antibiotic prescribing increased significantly (6.5% to 74%) after app implementation, and in one study, this resulted in significantly less resistance to some antibiotics and a decrease in total drug costs.

Most users considered the apps easy to use (77.4% to >90.0%) and useful (71.0% to >90.0%) in three studies, and preferred guideline access via app to desktop or booklet in two studies. In three studies, some physicians reported that use of apps in front of patients or colleagues felt unprofessional.

The authors of the review say that while the studies indicate that apps may increase guideline accessibility, because of the small number of studies and the limited quality of the data, they can't draw any conclusions on the advantages of AMS app use in hospital settings.

"High quality, randomized, multi-centre studies including robust clearly defined clinical, microbiological and process outcomes are needed to evaluate the impact of AMS apps on antimicrobial prescribing and its role within healthcare," they wrote.
Sep 29 PLOS One study

BARDA to fund two new antibacterial drug candidates

The Biomedical Advanced Research and Development Authority (BARDA) today announced advanced funding for two new drug candidates that target bacterial infections.

The two drug candidates are VE303, a live biotherapeutic product developed by Vedanta Biosciences that focuses on restoring the normal balance of beneficial bacteria in the digestive tract to prevent recurrence of Clostridioides difficile, a bacterial infection associated with antibiotic use. The other is Locus Biosciences' LBP-EC01, which uses CRISPR-Cas3 technology and bacteriophages to treat urinary tract infections caused by Escherichia coli, including those that are antibiotic resistant.

BARDA, part of the Department of Health and Human Services (HHS) Office of the Assistant Secretary for Preparedness and Response, will provide an initial $7.36 million and up to $76.9 million over 9.5 years to Vedanta to support development of VE303 and an initial $11 million and up to $77 million to Locust for LBP-EC01. The funding will support phase 2 and phase 3 trials of the drugs.

The Centers for Disease Control and Prevention has identified C difficile and antibiotic-resistant E coli as serious and urgent health threats.

"Healthcare providers need tools at-the-ready to prevent or combat secondary bacterial infections, particularly those that impact a patient's successful recovery following antibiotic usage in a public health emergency," BARDA Acting Director Gary Disbrow, PhD, said in a press release. "Infections associated with long-term antibiotic use are a growing concern and are often costly to treat which makes developing novel drugs and technologies for prevention and treatment all the more urgent for U.S. health security."
Sep 30 HHS press release

News Scan for Sep 30, 2020

News brief

Cats and dogs susceptible to COVID-19 infection, study finds

Domestic cats and dogs are susceptible to infection with SARS-CoV-2, the virus that causes COVID-19, according to a study yesterday in Proceedings of the National Academy of Sciences (PNAS). While both types of animals showed an immune response to the virus, only cats demonstrated viral shedding, and neither animal model showed evidence for a significant role in human infection, the study found.

In the first published study involving cat experimental infections, researchers inoculated dogs and cats with SARS-CoV-2 and monitored for symptoms, viral shedding, seroconversion (production of antibodies against the virus in the blood), pathology, and transmission. Both dogs and cats showed an immune response in the form of neutralizing antibodies.

Infected dogs and cats did not develop signs of clinical disease, and the study confirmed earlier publications showing that dogs do not replicate the virus in the upper respiratory tract. But cats were highly susceptible to infection and capable of shedding virus for up to 5 days after initial infection.

Cats were also capable of direct transmission to other cats, potentially via aerosols, and mounted an immune response that was protective against reinfection after a second viral challenge. "This is the first report of protective immunity against SARS-CoV-2 in cats following repeated exposure," study authors note.

The study authors wrote, "While animals, including domestic animals and pets, are frequently implicated as the source of emerging pathogens, reverse zoonosis [transmission from people to animals] of SARS-CoV-2 is more probable, as human cases are far more prevalent than domestic animals and there is no evidence to date of infected cats or dogs transmitting SARS-CoV-2 to humans."

Cat and human cells, unlike those of mice or rats, contain angiotensin-converting enzyme 2 (ACE2) cell receptors, which are implicated in SARS-CoV-2 infection. The presence of feline ACE2 receptors, a robust antibody response, and protective immunity to SAR-CoV-2 reinfection lead the study authors to conclude that domestic cats may be a useful animal model for COVID research.
Sep 29 PNAS study

Ebola infects 1 more in DRC as WHO probes sexual abuse reports

In new Ebola developments in the Democratic Republic of the Congo (DRC), tests confirmed one more case in the Equateur province outbreak and a media investigation says 51 women have reported incidents of sexual abuse by Ebola response workers in the country over the past 2 years.

The new case is the first reported since Sep 19 and involves a patient whose samples were collected at that time, but delivery of samples was delayed due to communications problems. The patient is from Lusengo health zone, marking the first case detected in that area. The infection raises the outbreak total to 125 cases. No new deaths were reported, keeping the total at 50.

Meanwhile, a joint investigation by The New Humanitarian and Reuters published yesterday, based on interviews with 51 women, detailed reports of abuse by men who said they were working for international aid organizations, including the World Health Organization (WHO), from 2018 to 2020. Many of the women described a pattern of men propositioning or forcing them to have sex in exchange for jobs, which typically paid twice the region's normal wage. Others said they were terminated from their jobs when they refused.

In a statement, the WHO said its leadership and staff are outraged by the reports, and they said the actions of perpetrators who said they were working with the WHO are unacceptable and will be aggressively investigated.

"The betrayal of people in the communities we serve is reprehensible. We do not tolerate such behaviour in any of our staff, contractors or partners," the statement said. "Anyone identified as being involved will be held to account and face serious consequences, including immediate dismissal." Other aid groups issued similar statements, such as the United Nations International Organization for Migration (IOM), which said there was a serious allegation against one of its workers.
Sep 30 UN OCHA update
Sep 29 New Humanitarian/Reuters story
Sep 29 WHO statement
Sep 30 IOM statement