The US Department of Health and Human Services (HHS) last week announced funding for a project that will use artificial intelligence (AI) to accelerate the discovery and development of new antibiotics.

To speed up the lengthy and laborious process of screening and testing molecular compounds for antibacterial activity, the Transforming Antibiotic R&D with Generative AI to stop Emerging Threats (TARGET) project will use generative AI to broaden the pool of candidate molecules for screening and deep learning to assess each candidate's effectiveness as an antibiotic. The aim of the project, which is being funded through the Advanced Research Projects Agency for Health (ARPA-H), is to identify 15 promising leads for new antibiotics.

"The rise of antibiotic resistance threatens to turn once-treatable infections into life-threatening ones, but with AI, we can accelerate the discovery of new antibiotics to address this threat like never before," ARPA-H Director Renee Wegrzyn, PhD, said in a press release. "With TARGET, ARPA-H is bringing together experts across antibiotic discovery, AI, and clinical testing to ensure we can refill the global pipeline of antibiotics and stop people from becoming seriously ill due to treatable infections."

The project will be led by Phare Bio, in collaboration with the Collins Lab at the Massachusetts Institute of Technology and Harvard University's Wyss Institute, with a budget of up to $27 million.

The use of fidaxomicin for Clostridioides difficile infection (CDI) has increased significantly since 2021 but it remains underutilized, researchers reported today in Clinical Infectious Diseases.

Using the PINC AI Healthcare database, researchers from Washington University School of Medicine and Merck examined records on adults who received CDI treatment before and after 2021, when updated guidelines from the Infectious Diseases Society of America (IDSA) recommended fidaxomicin as the only first-line agent for CDI, with vancomycin as an alternative option. Prior to 2021 vancomycin and metronidazole had been the recommended first-line agents for CDI, which is the most common healthcare-associated infection in adults and affects an estimated 460,000 US patients each year. Evidence on how CDI treatment patterns have changed since the 2021 guidelines has been limited.

Fidaxomicin use more than doubles

A total of 45,049 patients from 779 US hospitals were included in the study, with 29,520 in the pre-period (January 2020 to June 2021) and 15,529 in the post-period (October 2021 to September 2022). From the pre-period to the post-period, fidaxomicin use increased from 5.9% to 13.7%, while vancomycin used declined from 87.9% to 82.9% and metronidazole from 21.6% to 17.2%. Among census regions, increases in fidaxomicin use were smallest in the northeast, and greatest in the south.

In a secondary analysis that compared clinical and cost outcomes among patients treated exclusively with fidaxomicin versus vancomycin, fidaxomicin was associated with lower CDI recurrence (6.1% vs 10.2%) and higher sustained clinical response (91.7% vs 87.9%), while 90-day post-discharge costs were similar. The study authors note that these findings are consistent with prior research.

"While fidaxomicin use for CDI increased (and more than doubled) since the publication of the updated IDSA guidelines, it remained low relative to vancomycin and metronidazole use," the study authors wrote. "These novel findings imply that a substantial number of patients could have received the benefits of fidaxomicin if more hospitals had followed the ISDA 2021 guidelines."

• The Los Angeles Department of Public Health said it is investigating a fourth local dengue case, which involves a resident of Panorama City. It noted that the case isn't related to a local dengue cluster in Baldwin Park. Panorama City is about 40 miles west of Baldwin Park. Local dengue cases are extremely rare in Los Angeles County, and health officials urged area residents to take precautions such as wearing mosquito repellent and removing mosquito-breeding sites. 
• The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed three more H5N1 avian flu outbreaks in dairy herds, two in California and one in Idaho. The latest outbreaks push the national total to 242 across 14 states. Also, APHIS confirmed one more H5N1 outbreak in poultry, this time at a farm in Idaho’s Lincoln County that has 700 birds.
• The Minnesota Department of Health (MDH) announced that it is investigating a fatal rabies case involving a person older than 65 years who was exposed to a bat in July in the western part of the state. The latest case is Minnesota’s fourth since 2000. The patient's diagnosis was confirmed on September 20 based on testing at the Centers for Disease Control and Prevention (CDC). The MDH said it is working with the patient's family and healthcare facilities where the patient was treated to assess if any others were potentially exposed and may need treatment.