Stewardship / Resistance Scan for Apr 01, 2019

Rapid diagnostics partnership
Resistance genes in live poultry
Illegal antibiotic Rx in Sri Lanka

New rapid diagnostics partnership announced

A new public-private partnership to address inappropriate antibiotic use and antimicrobial resistance (AMR) through wider use of rapid diagnostics was launched today at an event in Madrid.

VALUE-Dx, a project of the Innovative Medicines Initiative, brings together six in vitro diagnostics companies with 20 non-industry partners to "generate evidence on the medical, economic, and public health value of diagnostics in tackling AMR," according to a news release from project partner, the University of Edinburgh. The project will focus on acute respiratory tract infections acquired in community care settings, one of the most frequent causes of inappropriate prescribing.

"This is an exciting and groundbreaking opportunity to address one of the greatest barriers to adoption of rapid diagnostics," Till Bachman, PhD, deputy head of infection medicine at the University Edinburgh, said in a statement. "It will shift the focus from the cost to the added value diagnostics provide in the fight against AMR."

Other partners include bioMerieux, Accelerate Diagnostics, the University of Antwerp, and the European Society of Clinical Microbiology and Infectious Diseases. The project is co-funded by the European Commission, Wellcome Trust, and private companies, with a budget of €14 million ($15.7 million) over 4 years.
Apr 1 University of Edinburgh news release


Chinese study finds many diverse resistance genes in live poultry

A new study in the Journal of Infection suggests that live poultry markets in China are a significant reservoir for antibiotic resistance genes (ARGs).

In the study, Chinese researchers used large-scale metagenomic sequencing to explore the diversity and abundance of ARGs in the gut microbiomes of poultry in live-poultry markets (LPMs). Because these markets are known to be a high-risk environment for the spread of avian flu to people, the researchers theorized they may also be a potential site for the dissemination of animal-origin ARGs. For their analysis, the authors collected 753 poultry fecal samples from 22 cities in 18 provinces, sequenced the genomes of 130 representative samples to create a catalogue of gut microbial genes, and compared the genes with genes from the pig gut and human gut microbiomes.

Overall, the analysis revealed the presence of 539 ARGs in live poultry that could be classified into 235 different ARG types. Both the number of ARGs and ARG types in live poultry were significantly higher than they were in humans and pigs, suggesting a greater diversity and enrichment of ARGs in live poultry. The overall abundance of ARGs was also highest in live poultry, followed by pigs and then humans. A total of 65 ARG types were shared among the three groups. Mapping of the ARG types to their corresponding antibiotics showed that tetracycline-resistance genes were the most abundant in all three groups.

Using polymerase chain reaction and Sanger sequencing, the researchers then investigated the distribution of the MCR-1 gene in all 753 live poultry fecal samples, finding it in 449 samples (59.6%). The MCR-1 gene was present in samples from all 18 provinces, and positive rates were similar in chickens, ducks, pigeons, and geese. The gene was also found in seven wild birds, and the researchers also identified MCR-3 and MCR-5 genes.

"The LPM is a special environment in China, where city dwellers have the opportunity to contact live animals and the viruses and bacteria carried by them," the authors of the study write. "We propose that LPMs represent a high-risk environment for the dissemination of animal-origin ARGs to public health."
Mar 29 J Infect study


Illegal antibiotic prescribing in Sri Lanka

An experimental study involving fake patients revealed a high level of illegal antibiotic prescribing in community pharmacies in Sri Lanka, according to a new study in Antimicrobial Resistance and Infection Control.

The cross-sectional study involved visits to 242 community pharmacies by 32 trained "pseudo-patients" (pharmacy school students or recent graduates) who pretended to have a relative with clinical symptoms of four randomly selected common infections. Three of the infections were viral (acute sore throat, common cold, acute diarrhea) and one was bacterial (uncomplicated urinary tract infection [UTI]). Each pseudo-patient requested an unspecified medicine for the condition, and a research assistant recorded the interaction. Sri Lankan law prohibits the supply of an antibiotic without a prescription.

In 41% (99/242) of visits, antibiotics were sold illegally without a prescription in response to the reported clinical symptoms, with two-thirds (65/99) being sold for underlying viral infections. Antibiotics were provided for 55% of uncomplicated UTIs, 50% of acute diarrhea cases, 42% acute sore throat cases, and 15% of common colds. Patient history was obtained in less than a quarter of interactions, and pharmacy staff recommended a visit to a physician in only 18% (44/242) of cases; yet in 25% (11/44) of those interactions, an antibiotic was still obtained. Roughly half of the pseudo-patients were advised on how and how often to take the antibiotics, and less than a quarter were advised on when to stop taking them. In nearly two thirds of instances, antibiotics were sold by a staff member other than a qualified pharmacist.

While the availability of a pharmacist reduced the likelihood of illegal antibiotic sales (odds ratio, 0.53; 95% confidence interval, 0.31 to 0.89, P = 0.016), it did not appear to reduce inappropriate prescribing.

"In addition to strict implementation of policies, awareness and educational interventions must be implemented to improve appropriate antibiotic dispensing practice among pharmacists and their staff," the authors of the study conclude.
Mar 29 Antimicrob Resist Infect Control study

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