Stewardship / Resistance Scan for Mar 27, 2017

Diagnostic test competition
MDR-TB in African migrants
Stewardship in Aruba

NIH announces semifinalists in bacterial diagnostic competition

The National Institutes of Health (NIH) today said it has selected 10 semifinalists in the first phase of a federal prize competition that will award up to $20 million for innovative tests that can rapidly diagnose bacterial infections and identify antibiotic resistant bacteria.

The 74 concept submissions for the Antimicrobial Resistance Diagnostic Challenge were evaluated by an independent panel of scientific and clinical experts, based on several criteria. In particular, the judges considered whether the submissions demonstrated novel and innovative technology, whether implementation would improve clinical decision-making and reduce antibiotic resistance, and whether the concepts would produce actionable results relevant to their intended use. The likelihood of success as a commercial diagnostic system was also considered.

The contest is sponsored by the NIH and the Biomedical Advanced Research and Development Authority (BARDA) in support of the National Action Plan for Combating Antibiotic-Resistant Bacteria. The hope is that new rapid, point-of-care diagnostic tests will be able to distinguish between viral and bacterial infections and detect and characterize antibiotic-resistant bacteria within hours rather than days, thereby cutting down on the unnecessary and inappropriate antibiotic use that causes resistance.

"Diagnostics that are fast, accurate, and easy-to-use are critical to address antibiotic resistance that could imperil not only each person's health but also our nation's security from natural and intentional threats," BARDA Director Rick Bright, PhD, said in an NIH press release. "The exciting technology envisioned by our challenge's semifinalists may help us put better tools at the patient's side."

Semifinalists will each receive $50,000 to develop their concepts into prototypes. Submissions of prototypes and analytical data for the second phase of the competition are due Sep 4. NIH is expected to announce up to three winners on Jul 31, 2020. The winners will share up to $20 million, subject to the availability of funds.
Mar 27 NIH press release


ECDC says MDR-TB cases in African migrants have risen to 25

European health officials report that 25 cases of multidrug-resistant tuberculosis (MDR-TB) among migrants from the Horn of Africa appear to be part of a chain of recent transmission.

In a rapid risk assessment issued today, the European Centre for Disease Prevention and Control (ECDC) reports that whole-genome sequencing (WGS) analysis indicates that all 25 cases belong to a single cluster and differ by only one single nucleotide polymorphism, an indication of recent transmission from a common source of infection. According to the ECDC report, available data suggest the origin of the cluster strain stems from the Horn of Africa. All cases have a recent history of migration from Somalia (22), Eritrea (2), and Ethiopia (1).

The cluster was initially reported by the ECDC in December 2016, when it involved 16 cases, with the first infections identified between February and August 2016. As of Mar 14, isolates from the cluster have been reported from Germany (13), Switzerland (8), Austria (2), Finland (1), and Sweden (1). In addition, Germany has reported a culture-negative and a culture-positive case with epidemiologic links, and a likely case that's awaiting WGS. France is reporting two cases under investigation.

Although it's unclear whether transmission took place in the patients' countries of origin, along the migration route, or in the destination country, the ECDC says preliminary analysis of the cases in Switzerland suggests most patients reported symptoms at arrival or before. Migrants from war-torn or impoverished countries may be at increased risk of TB or MDR-TB because of inadequate healthcare in their country of origin and exposure to destitution and poor social conditions along the migration route.

The ECDC says the clearest risk of transmission is within the affected migrant population, and that the risk to the European Union/European Free Trade Association population is low. But the agency is urging rapid investigation of exposure risk factors, including the travel history and itineraries of patients and their contacts.
Mar 27 ECDC rapid risk assessment


Checklist helps increase appropriate use of antibiotics in Aruba

Introduction of an antibiotic checklist increased appropriate use of antibiotics at a hospital in Aruba, according to a new study in the International Journal of Infectious Diseases.

For the study, investigators conducted a prospective cohort trial from August 2015 through January 2016 at Aruba's only hospital. The aim of the study was to compare the periods before and after the implementation of an antibiotic checklist consisting of seven quality indicators (QIs) that define appropriate antibiotic treatment of bacterial infections in the hospital. Among the checklist items are taking at least two blood cultures from a patient before starting antibiotic therapy, adjusting dosing based on renal function, documenting in the patient's file the indication for antibiotic treatment, and adjusting therapy when culture results are available.

Recent research by the team indicated that implementation of the checklist had resulted in more appropriate antibiotic use in the Netherlands. Aruba, a constituent country of the Netherlands that struggles with high antimicrobial resistance rates, seemed like a good test case to see if the checklist could provide similar results in a different setting.

Eligible patients at the 288-bed hospital included adults who had a suspected bacterial infection and were treated with intravenous antibiotics. For all patients, data were collected on adherence to the QIs. There were 150 patients in the baseline group and 173 in the intervention group. The primary end point was the QI sum score, calculated by the patient's sum of performed checklist items divided by the total number of QIs that applied to each patient.

Overall, the checklist was used in 63.3% of the patients, which was high compared with the 23.2% in the Dutch study. The percentage of patients with a QI sum score of 50% or greater was more than three times higher in the intervention group compared with the baseline group (odds ratio, 3.67). But performance did not improve on each individual QI; the largest increase was seen in the collection of blood cultures, adjustment to renal function, and documentation of the indication for antibiotic treatment.

"Further initiatives are necessary for further improvement, especially to improve antibiotic guideline adherence," the authors write. "Completion of the antibiotic checklist was high, suggesting that the implementation of the checklist is possible outside the Netherlands."
Mar 24 Int J Infect Dis abstract

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