ASP Scan (Weekly) for Nov 03, 2017

Livestock-related MRSA
Antimicrobial stewardship recognition
IV antibiotics for UTIs
MRSA vaccine candidate
MCR-1 in pigs
MRSA and patient-sharing
Pneumonia overprescribing
New CARB-X funding
Hospital ASPs
Wales superbug deaths decline
Antibiotics in nursing homes

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Survey details spread of livestock-associate MRSA in Europe

Results from a survey published yesterday in Eurosurveillance indicate more frequent detection and greater geographical dispersion of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in Europe.

The survey and questionnaire from the European Centre for Disease Prevention and Control (ECDC) collected data on LA-MRSA subtypes identified among MRSA isolates by national or regional reference laboratories in European Union/European Economic Area (EU/EEA) countries in 2013. The samples included both clinical and screening isolates. Overall, 28 reference labs (26 national and 2 regional) from 27 of 30 EU/EEA countries responded.

The respondents reported receiving MRSA isolates from 14,291 patients in 2013, of which 13,756 (96.3%) were molecularly typed. LA-MRSA was identified by 17 of 19 countries (89%) with MRSA typing data. The Netherlands, Denmark, and Spain reported the most LA-MRSA isolates (164, 157, and 52, respectively). The overall percentage of typed MRSA isolates that were LA-MRSA was 3.9% (535 of 13,756).

Almost all LA-MRSA isolates belonged clonal complex (CC) 398, which is commonly associated with swine and is the most widespread MRSA lineage in Europe. The only non-CC398 subtype considered to be LA-MRSA came from Italy.

This was the first survey conducted on LA-MRSA in the EU/EEA since 2007, when only eight countries reported LA-MRSA isolates from human; in that survey, the proportion of MRSA that were LA-MRSA was above 2% in four countries and one region of Germany. The authors of the current study say the 2013 survey results, along with more recent data suggesting that LA-MRSA is spreading in the Nordic countries, the Netherlands, Germany, and the UK, indicate an apparent upward trend and more widespread dispersion of LA-MRSA across Europe. They're also concerned that labs in seven of the responding countries did not report any MRSA typing.

The ECDC is recommending that EU/EEA countries repeat the survey periodically to monitor for changes and map potential reservoirs and transmission pathways.
Nov 2 Eurosurveill report 
Nov 3 ECDC news release


IDSA announces first antibiotic stewardship excellence designations

Originally published by CIDRAP News Nov 2

The Infectious Diseases Society of America (IDSA) today announced the first two recipients to receive its Antimicrobial Stewardship Centers of Excellence (COE) designation: Saint John's Health Center in Santa Monica, Calif., and Summa Health, based in Akron, Ohio.

IDSA unveiled the Antimicrobial Stewardship COE program this month to recognize institutions that meet standards established by the Centers for Disease Control and Prevention (CDC) for antimicrobial stewardship programs that are led by infectious disease physicians and ID-trained pharmacists.

IDSA President Paul Auwaerter, MD, MBA, said in the statement that IDSA is committed to stewardship programs as a key component in the battle against antimicrobial resistance, which leads to 23,000 deaths each year and costing $20 billion in unnecessary healthcare costs. He added that the COE program is a way to recognize groups that take the lead in establishing highly effective antimicrobial stewardship programs that help clinicians provide optimal anti-infective therapies.

The criteria for the IDSA's Antimicrobial Stewardship COE were developed by a workgroup and builds on guidelines in the CDC's Core Elements of Hospital Antibiotic Stewardship Programs. The IDSA says the COE program emphasizes a facility's ability to implement stewardship protocols using the electronic health record system and providing ongoing education to staff.

Health systems can learn more about and apply for the COE designation on the IDSA's web site. The application deadline is Dec 15, 2017.
Nov 2 IDSA statement
IDSA Antimicrobial Stewardship Center of Excellence information


Rate of longer-term IV antibiotics for UTIs in kids drops dramatically

Originally published by CIDRAP News Nov 2

A study involving hospitalized US children published today in Pediatrics determined that the proportion of infants who receive longer-term intravenous (IV) antibiotic treatment for urinary tract infections (UTIs) decreased markedly from 2005 to 2015 without an increase in hospital readmissions.

US researchers analyzed data from the Pediatric Health Information System database, looking for readmission within 30 days for a UTI. They found that the proportion of infants 60 days old and younger at 46 US children's hospitals who received IV antibiotics for 4 or more days for UTIs decreased from 50% in 2005 to 19% in 2015. They also found that the drop did not correlate with an increased rate of readmission to the hospital.

The authors conclude, "These findings support the safety of short-course IV antibiotic therapy for appropriately selected neonates."
Nov 2 Pediatrics abstract


CARB-X awards $168,000 for development of novel MRSA vaccine

Originally published by CIDRAP News Nov 1

CARB-X announced today that it's awarding $168,000 to Integrated Biotherapeutics to develop a vaccine for the prevention of infections caused by MRSA.

According to a statement from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), IBT-V02 is the first multivalent S aureus vaccine entirely based on rationally designed toxoids, including seven attenuated toxoids protective against three large families of toxins secreted by S aureus. The project has completed the discovery stage and proof of concept efficacy in animal models of MRSA.

M. Javad Aman, PhD, president and chief scientific officer of Maryland-based Integrated Biotherapeutics, said in the statement that the award will help the company complete the preclinical studies and the phase 1 clinical trial for IBT-V02. The company could receive up to $8.3 million from CARB-X based on achievement of milestones.

IBT-V02 is the first vaccine candidate in the CARB-X portfolio, which now includes 22 projects in the early stages of research and development. A public-private partnership funded by the Biomedical Advanced Research and Development Authority (BARDA), UK-based charity the Wellcome Trust, and the National Institute of Allergy and Infectious Diseases (NIAID), CARB-X was launched in 2016 to address gaps in development and funding of new antibiotics, diagnostics, and vaccines to treat the most serious gram-negative bacterial infections.

With today's announcement, the group has now awarded more than $52 million to fund the 22 projects, plus an additional $72 million if project milestones are met.
Nov 1 CARB-X press release


Study finds high-rate of MCR-1-producing bacteria in Portuguese pigs

Originally published by CIDRAP News Nov 1

Prospective screening of pigs in Portugal revealed an extremely high rate of Enterobacteriaceae harboring the colistin-resistance gene MCR-1, European researchers reported yesterday in Emerging Infectious Diseases.

In June 2016, the researchers collected a total of 100 rectal swab samples from two pig farms in Portugal, 30 kilometers apart. Of the 108 colistin-resistant isolates recovered, 90 were Escherichia coli, 17 were Klebsiella pneumoniae, and 1 was Proteus mirabilis. Molecular analysis identified the MCR-1 gene in 98 of the isolates and showed that all MCR-1 producing isolates also harbored the blaTEM-1 gene, with 10 showing an extended-spectrum beta-lactamase phenotype. Pulsed-field gel electrophoresis identified 15 different sequence types (STs) among the non-clonally related E coliisolates, and 2 different K pneumoniae STs.

Further analysis showed that the MCR-1 gene was carried on three different plasmids—IncHI2 (54%), IncP (38%), and IncX4 (8%). IncHI2 and IncP carried other resistance determinants associated with MCR-1, but IncX4 carried only MCR-1.

Because the pigs received colistin in their feed in the 6 weeks before sampling, the authors of the study suspect that use of the drug created selective pressure for MCR-1 acquisition. They believe that their data, along with a recent study in Germany that identified pig farms as a potential source of environmental contamination for MCR-1 producing E coli, indicate the need for screening farm environments in Portugal.  
Oct 31 Emerg Infect Dis study


Patient sharing spreads MRSA between UK hospitals

Originally published by CIDRAP News Nov 1

Though hospital transmission of MRSA has declined in UK hospitals that have implemented infection control measures, there is still little known about existing transmission paths. A study yesterday in Clinical Infectious Diseases, however, shows that frequent patient admissions to multiple hospitals is behind many MRSA cases recorded in London.

Study authors conducted a cross-sectional observational study of 610 hospitalized MRSA patients in southeast London. A large proportion (40.7%) of the cases was linked to 90 transmission clusters, 27 of which spanned multiple hospitals. Analysis of one 32-patient cluster showed that 26 (81.6%) of the patients were linked by hospital stay, suggesting inter-ward transmission.

"This is significant because it indicates that current endemic levels are explained by recent transmission on hospital wards that may be missed by a single hospital centric view, and not elsewhere as has been implied by other studies," the authors wrote.

The authors suggest inter-hospital sharing of MRSA data as a way to halt transmission among patients who are frequently hospitalized.
Oct 31 Clin Infect Dis study


Empiric pneumonia treatment with MRSA drugs more common in the US

Originally published by CIDRAP News Nov 1

Empiric treatment of MRSA-related community-acquired pneumonia (CAP) is most common in the United States and is rarely prescribed in other countries, an international research group based at South Texas Veterans Health Care and University of Texas Health in San Antonio reported yesterday at the annual meeting of the American College of Chest Physicians annual meeting in Toronto.

The scientists based their findings on a review of adult patients hospitalized with CAP over 4 nonconsecutive days at 222 facilities from 54 countries, according to the study abstract published yesterday in a Chest supplement. The study group included patients who had submitted respiratory or blood samples, and the authors considered anti-MRSA therapy as treatment administered according to clinical guidelines when it included vancomycin or linezolid within the first 24 hours of admission.

Of 3,193 patients hospitalized with CAP, 12% (436) were treated for MRSA, with the United States accounting for 52% of all prescriptions. Vancomycin was the most commonly prescribed MRSA therapy (12%), followed by linezolid (2%). Five or more MRSA-therapy prescriptions were reported by 10 countries, while 40 countries had three or fewer during the study period.

Of all the patients prescribed anti-MRSA treatment, only 12% actually had MRSA pneumonia.

The researchers concluded that non-US countries rarely use empiric anti-MRSA therapies for CAP and that more efforts are needed to prevent the empiric overuse of antibiotics, especially regarding anti-MRSA therapy. They added that clinicians should rely more on specific MRSA risk factors before exposing patients to unneeded treatments.
Oct 31 Chest abstract


CARB-X awards $4.55 million for Pseudomonas antibody treatment

Originally published by CIDRAP News Oct 31

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 

Originally published by CIDRAP News Oct 31

The proportion of California hospitals with all of the 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

Originally published by CIDRAP News Oct 31

In Wales, the number of deaths from the most common antibiotic-resistant and healthcare associated infections such as 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 S 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


Poor antimicrobial prescribing noted in Australian nursing homes

Originally published by CIDRAP News Oct 30

Nursing homes in Australia continue to be a substantial source of inappropriate antimicrobial prescribing, with about one third of antimicrobials prescribed for residents with no indications, according to the second annual Aged Care National Antimicrobial Prescribing Survey Report (acNAPS).

The 2016 acNAPS report, published Oct 26, is produced as a collaboration between Australia's National Centre for Antimicrobial Stewardship (NCAS), the Guidance group based at Melbourne Health, and the Victorian Healthcare-Associated Infection Surveillance System (VICNISS) Co-ordinating Centre. Data were collected from 251 aged care home from Jun 27 through Sep 9, 2016. In 2015, only 186 aged care facilities had participated in the survey.

This year's report found that 32.4% of antimicrobials were prescribed for residents who showed no signs or symptoms of infection in the previous week, up a bit from the previous report (31.6%). In addition, the new report found that 67.2% of prescriptions did not meet the criteria for infection, similar to the 66.4% rate found in the 2015 survey. And 23.0% of prescriptions were administered for longer than 6 months, which was down from 31.4% in the 2015 acNAPS report.

The 2016 acNAPS report also noted poor documentation, with no stop date recorded in 49.9% of prescriptions, no indication recorded for 22.1%, and no started date documented for 3.2% of the antimicrobials.

Respiratory tract (34.5% of the total), skin or other soft-tissue (29.3%), and urinary tract (14.8%) infections were the most common indications for prescribing antimicrobials. Cefalexin (21.7%) was the most commonly prescribed antimicrobial, followed by topical clotrimazole (13.3%).

The authors of the report concluded, "The 2016 acNAPS has confirmed the 2015 pilot acNAPS results, which identified the need for improvement in practice regarding infections and antimicrobial use in Australian aged care homes."
Oct 26 acNAPS report
Oct 26 NCAS 
news release
2015 acNAPS report

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