ASP Scan (Weekly) for May 11, 2018

Rapid diagnostic test for STDs
Free stewardship e-book
Drug maker stewardship program
Med students' antibiotic prescribing
E-learning and prescribing
UK guidance on UTIs
New CARB-X funding
Antibiotic prescribing in primary care

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

CARB-X to fund rapid diagnostic test for chlamydia, gonorrhea

CARB-X yesterday announced funding for the development of a rapid test to speed up diagnosis and treatment of chlamydia and gonorrhea, including drug-resistant strains.

The award of up to $4.4 million to Talis Biomedical Corporation, of Menlo Park, Calif., will help support development of the company's molecular pathogen identification system, which would diagnose chlamydia and gonorrhea from a patient sample in less than 20 minutes. The system would also test for antibiotic susceptibility in positive gonorrhea samples to determine the most effective antibiotic. 

"The support of CARB-X offers Talis an extraordinary opportunity to bring rapid pathogen identification and phenotypic anti-microbial susceptibility testing to the point-of-care," Talis CEO Brian Coe, MBA, said in a CARB-X news release.  

Talis could get an additional $4.2 million from CARB-X based on achievement of project milestones.

This is the fifth diagnostic project supported by CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership that to date has awarded more than $86 million for projects targeting the most serious drug-resistant pathogens.
May 10 CARB-X press release


Australian Commission publishes free e-book on antimicrobial stewardship

The Australian Commission on Safety and Quality in Health Care (ACSQHC) today published a free e-book titled Antimicrobial Stewardship in Australian Health Care 2018, which focuses on strategies for implementing and sustaining stewardship and outlines the roles of various clinicians.

"This publication," the authors write, "is designed to provide clinicians and managers working in all healthcare sectors with the evidence, expert guidance and tools they need to initiate and sustain AMS [antimicrobial stewardship] activities in a diverse range of practice settings—hospitals (public and private, metropolitan and rural), primary care and aged care homes. It describes the roles of those responsible for establishing and implementing AMS programs, as well as how prescribers, pharmacists, infection control practitioners, nurses and midwives can contribute to program success by incorporating AMS principles within their clinical practice."

The book covers the structure and governance of AMS, detailing how to establish a multidisciplinary team, ensure ongoing education and training, and provide other components. It also discusses essential strategies, such as implementing clinical guidelines, establishing formulary restrictions and approval systems, reviewing prescribing patterns, and setting up point-of-care interventions.

"The publication will continue to evolve with additional chapters over time that address AMS in specific settings such as primary care," the ACSQHC says on the book landing page.
May 10 ACSQHC free e-book


Melinta launches antimicrobial stewardship program

Antibiotics maker Melinta Therapeutics today announced the launch of a new antimicrobial stewardship program, according to a company press release.

As part of the program, which is designed to promote the responsible and sustainable use of Melinta's current and future antibiotic portfolio, the company says it will be conducting antimicrobial resistance surveillance efforts, including post-marketing susceptibility testing and real-world use registries, and implementing stewardship-focused promotional standards. Other steps will include evaluating economic models to support the reasonable and sustainable use of Melinta products and collaborating with healthcare providers on educational programming.

Melinta, of New Haven, Conn., also said it will continue to work with its manufacturing partners to implement strategies to minimize the environmental impact of antibiotic discharge.

"The launch of our Antimicrobial Stewardship Program is an important tenet of our mission, vision and culture, as we focus on providing new and targeted therapies that are used when they are the right choice for the right pathogen and the right patient," Melinta President and CEO Dan Wechsler said in the press release.

Melinta officially introduced the program at the 21st annual MAD-ID meeting in Orlando, Fla.
May 11 Melinta Therapeutics press release 


Survey: European medical students want more education on antibiotic use

Originally published by CIDRAP News May 9

A survey of final-year medical students in Europe has found that most feel they still need more education on antibiotic use, a team of European researchers report today in the Journal of Antimicrobial Chemotherapy. 

The cross-sectional web-based survey, developed by the ESCMID Study Group for Antimicrobial Stewardship (ESGAP), sought to assess how prepared final-year medical students felt to prescribe antibiotics according to commonly accepted principles of prudent use, with the intention of providing data to support targeted national and international improvement efforts. The 47-item questionnaire included questions on demographics, self-reported preparedness on 27 curriculum topics on prudent antibiotic use, and perceived need for further education.  

A preparedness score was calculated for each student, and mean scores were compared at medical schools and country levels. In addition, comparisons were made with national-level data on resistance among four common bacterial pathogens.

Overall, 7,328 responses from 179 medical schools in 29 European countries were included in the analysis. Country global preparedness scores, representing the proportion of curriculum topics that students felt at least sufficiently prepared on, ranged from 54.8% in Portugal to 84.8% in Latvia, with a mean of 71.2%. The proportion of students wanting more education on prudent antibiotic use or general antibiotic use ranged from 20.3% (Sweden) to 94.3% (Slovakia), with a mean of 66.1%, and was strongly inversely correlated with global preparedness scores (Spearman's rho = −0.72, n=29, P<0.001). Higher prevalence rates of antibiotic-non-susceptible bacteria were associated with lower preparedness scores and higher self-reported needs for further education (P < 0.01).

"In conclusion, many final-year European medical students do not feel sufficiently prepared to prescribe antibiotics responsibly and we have identified areas for improvement," the authors write. "Further research is needed to understand how students' self-reported preparedness reflects observed preparedness and how this in turn translates into clinical practice."
May 9 J Antimicrob Chemother study


E-learning intervention helps improve medical students' prescribing

Originally published by CIDRAP News May 9

In another study today in the Journal of Antimicrobial Chemotherapy, Dutch researchers report that an e-learning module significantly improved medical students' performance during a simulated antimicrobial therapeutic consultation.

The e-learning module on antimicrobial prescribing was introduced to medical students in their fourth year at VU University Medical Centre in Amsterdam from September 2011 through August 2012, and was temporarily implemented as a non-compulsory course over a 6-week period. The module was based on the World Health Organization's guide to good prescribing. Six months later, students who took the course underwent an infectious disease-based objective structured clinical examination (OSCE) aimed at simulating postgraduate prescribing. Their results were compared against a control group of students from a period before the e-learning module was implemented.

The results showed that the OSCE pass percentage among the 71 students in the intervention group was 97%, compared with 86% for the 285 students in the control group (+11 percentage points, odds ratio, 5.9). OSCE overall, knowledge, and drug choice grades were also significantly higher in the intervention group (differences +0.31, +0.31, and +0.51, respectively). When questioned on their confidence in prescribing antimicrobial therapy in clinical practice prior to and subsequent to the e-learning module, the percentage of students indicating insecurity or severe insecurity decreased from 74% to 37%.

"In order to shape future antimicrobial prescriber behaviour, it is very important to identify resource-effective tools that can improve undergraduates' prescribing competence, rather than at a later stage when physicians have already begun clinical practice," the authors write. "Our results suggest that e-learning may be just that."
May 9 J Antimicrob Chemother study


UK health officials issue draft guidance for UTI treatment

Originally published by CIDRAP News May 8

The United Kingdom's National Institute for Health and Care Excellence (NICE) today issued draft guidance for the treatment of urinary tract infections (UTIs).

The draft guidelines set out recommendations for preventing and managing lower UTIs, pyelonephritis, catheter-associated UTIs, and recurrent UTIs. While the recommendations vary by condition, they all aim to optimize antibiotic use in UTI treatment and reduce antibiotic resistance. They encourage clinicians to ask patients about the severity and regularity of symptoms, provide advice about managing symptoms with self-care, and obtain urine culture and susceptibility results before prescribing an antibiotic.

The guidelines also recommend that when antibiotics are indicated, clinicians should review the susceptibility test results to choose the most appropriate antibiotic, use narrow-spectrum antibiotics when possible, take into account the severity of symptoms and previous antibiotic use, advise patients on possible adverse effects, and reassess treatment if symptoms worsen rapidly.

"We recognise that the majority of UTIs will require antibiotic treatment, but we need to be smarter with our use of these medicines," Mark Baker MD, director of the Centre for Clinical Practice at NICE, said in a press release. "Our new guidance will help healthcare professionals to optimise their use of antibiotics."

Public consultation on the draft guidelines ends on Jun 5, and final publication is expected in early 2019.
May 8 NICE press release


CARB-X to fund development of new class of antibiotics

Originally published by CIDRAP News May 7

CARB-X announced today that it's awarding more than $2 million to Melinta Therapeutics to help the company advance a new class of antibiotics into clinical development.

According to a CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) press release, Melinta's novel pyrrolocytosine compounds have been designed de novo, from the ground up, in a site not previously exploited by other successful classes of antibiotics that target the ribosome. They are being developed to optimize properties that allow then to get in and stay in bacterial cells. In preclinical studies, pyrrolocytosines have shown activity against all ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter).

"Our structure-based design efforts to create and optimize the pyrrolocytosine class of antibiotics have shown exciting promise, with several compounds demonstrating comprehensive activity and preclinical effect across the full set of bacterial 'superbugs,' " Melinta Chief Scientific Officer Erin Duffy, PhD, said in the press release. "We believe this new class of antibiotics could be transformational in the fight against these urgent threats." 

Under the terms of the agreement, Melinta will receive an initial award of up to $2.3 million from CARB-X, with the possibility of an additional $3.9 million based on achievement of certain project milestones.

Since it was established in 2016, CARB-X has awarded more than $82 million to 32 projects in seven countries. 
May 7 CARB-X press release


German GP survey finds strong awareness of antimicrobial resistance

Originally published by CIDRAP News May 7

A survey of general practitioners (GPs) in Germany found a strong awareness of antimicrobial resistance but also identified barriers to rational antibiotic use in primary care, according to a study in BMC Infectious Diseases.

The survey, designed by a multidisciplinary team as part of a broader intervention study promoting rational antibiotic use, comprised 32 questions grouped around four issues: awareness of antimicrobial resistance, use of antibiotics, guidelines/sources of information, and socio-demographic factors. The questionnaire was mailed to 987 GPs with registered practices in eastern Germany in May 2015.

Overall, 34% (340/987) of the GPs responded to the survey. Most of the participants assumed that multidrug-resistant infections were a result  of multiple factors, with 80.9% (275/34) identifying infection control in hospitals, 80.3% (273/340) the use of antibiotics by GPs, and 79.1% (261/340) the use of antibiotics in livestock as the main drivers for drug resistance. In addition, 70.2% (239/340) believed that their own prescribing behavior influenced the drug-resistance situation in their area. GPs with longer work experience (more than 25 years) assumed less individual influence on drug resistance than colleagues with less than 7 years of experience as practicing physicians.

However, only 39.1% (133/340) of the GPs indicated they frequently use guidelines for antibiotic therapy, and only 21.8% (74/340) answered that they "often" or "very often" apply a delayed prescribing strategy for dealing with uncomplicated respiratory tract infection, even though 99.1% (337/340) were familiar with the strategy. Also, 36.2% (123/340) responded that an acute infection with yellow or green sputum is an indication for an antibiotic prescription, a belief the authors argue has questionable diagnostic value in the case of an acute respiratory infection.

"This survey shows clear targets for further approaches to reduce the prevalence of drug-resistant organisms," the authors conclude.
May 4 BMC Infect Dis study

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