Stewardship / Resistance Scan for Dec 21, 2016

Antibiotics in food animals
Fungal disease tests

Pew releases recommendations for reduced antibiotic use in food animals

The Pew Charitable Trusts has released a set of recommendations for how to ensure more appropriate use of antibiotics in animal agriculture.

In 2017, two new policies from the Food and Drug Administration (FDA) that are intended to reduce the inappropriate use of antibiotics in food animals will go into effect. One is Guidance for Industry #213, which prohibits the use of medically important antibiotics to promote growth. The other is the Veterinary Feed Directive, which outlines the conditions under which veterinarians can authorize antibiotic use in animal feed.

While full implementation of both these new policies will help reduce antibiotic use in animal agriculture, Pew has laid out four other recommendations that it believes could enhance those policies and lead to further reductions. These recommendations include collecting and reporting better data to create a more comprehensive picture of antibiotic use in food animals and how it is linked to resistance; refining antibiotic labels to fully meet judicious use guidelines; minimizing the need for antibiotics through the increased use of alternative practices and interventions, such as vaccines and probiotics, that promote animal health; and buying meat that is raised according to responsible antibiotic use guidelines.

According to Pew, antibiotic sales data reported to the FDA showed that pharmaceutical companies sold more than 20 million pounds of medically important antibiotics for use in farm animals in 2014. That's 23% more than was sold in 2009, the first year that such data was made available. Overall, available data show that roughly 70% of the total volume of all medically important antibiotics sold in the United States is for use in food production.
Dec 19 Pew Charitable Trusts report

Experts: Antimicrobial stewardship must include better fungal testing

The underuse of nonculture fungal diagnostic tests is exacerbating the problem of antimicrobial resistance (AMR) and overprescribing, and addressing the issue is critical to mounting an effective broad-based stewardship program, experts from the Geneva-based Global Action Fund for Fungal Infections said yesterday in Emerging Infectious Diseases.

To underscore the problem, the authors detail four common clinical situations:

  • Inaccurate diagnosis of fungal sepsis in hospitals, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients who have invasive candidiasis
  • Failure to diagnose chronic pulmonary aspergillosis in patients who have smear-negative pulmonary tuberculosis
  • Misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients who have chronic obstructive pulmonary disease
  • Overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients

The authors conclude, "This lack and underuse of proper diagnostics squanders resources. The large scale of the problem, even in many of the world’s most advanced medical centers, compromises AMR control.

"In many countries, the government and private healthcare providers should be actively promoting diagnosis of fungal infections to minimize deaths and illness from fungal disease; such efforts will probably also have a positive benefit on inappropriate antibacterial drug usage and support stewardship programs."
Dec 20 Emerg Infect Dis commentary

In a related development, the European Centre for Disease Prevention and Control (ECDC) in a Rapid Risk Assessment yesterday warned about the threat that Candida auris poses to patients in healthcare facilities because of its propensity to cause outbreaks and its antifungal resistance. The agency said that difficulties with lab identification and a lack of awareness raise the risk of the pathogen, which has spread in recent years to hospitals on five continents.

The ECDC assessment outlines options to prevent C auris spread, including improved detection, infection control measures, and improved preparedness among European countries. Infection control measures include targeting high-risk patients, preventing transmission from carriers, recommendations for outbreaks settings, and antifungal stewardship.
Dec 20 ECDC risk assessment
Dec 20 ECDC
news release

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