Stewardship / Resistance Scan for Jun 22, 2020

News brief

CARB-X to fund topical antibiotic for surgical, wound infections

CARB-X today announced $4.6 million in funding to expand development of two topical antimicrobial products that target serious surgical and traumatic wound infections.

The money, awarded to Amicrobe, Inc. of Carlsbad, California, will help accelerate development of Amicidin-β Solution, a bioengineered topical antimicrobial designed for direct application to contaminated and infected tissues in surgical and emergency settings.

CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) previously awarded the company $6.2 million to support the development of Amicidin-β Solution through a phase 1 clinical trial.

Amicrobe will use $1.84 million of the award to develop Amicidin-β/EF (extended formulation), a version of the product that could be used in developing countries where cold storage systems aren't always available for healthcare products. Company officials say the solution could be used to help prevent infections that develop after caesarean delivery, which represents more than 50% of surgical procedures in sub-Saharan Africa.

"The threat of antimicrobial resistance challenges all of us to bring forward new technologies and innovative products to prevent and treat life-threatening infections," Amicrobe CEO and CSO Michael Bevilacqua, MD, PhD, said in a CARB-X press release. "Amicrobe is grateful to CARB-X and its funding partners for enabling the advancement of our Amicidin-β programs, which we believe have the potential to save lives and curb the spread of drug-resistant bacteria in our own communities and around the world," he said.

Funding for Amicidin-β/EF is made possible by the UK Department of Health and Social Care's Global Antimicrobial Resistance Innovation Fund, a CARB-X partner.
Jun 22 CARB-X press release

Survey: Primary care physicians worry about antibiotic use, but not in their practice

A survey of internal, family, and pediatric medicine physicians in the United States revealed that while most agree that antibiotic resistance and inappropriate antibiotic prescribing are problems in US outpatient settings, far fewer see it as a problem in their practice, researchers reported last week in Open Forum Infectious Diseases.

The 20-minute online survey, which was developed by researchers from the Pew Charitable Trusts, asked about respondents' knowledge, attitudes, and perceptions around antibiotic resistance and prescribing, as well as their support for antibiotic stewardship implementation in their practices. The idea was to identify strategies for tailoring effective interventions and barriers to stewardship uptake. From August 2018 through October 2018, nearly 13,000 primary care physicians received invitations to participate in the survey, and 1,500 responded.

Nearly all respondents (94%) agreed that antibiotic resistance is a problem in the United States, and 73% ranked it within their top three public health issues behind obesity and vaccine hesitancy.

Also, 65% of respondents said they had seen an increase in resistant infections among their patients. But only 55% agreed that antibiotic resistance was a problem in their practice. When it came to antibiotic prescribing, 91% said that inappropriate prescribing was a problem, but only 37% said it was a problem in their practice, and 60% agreed that they prescribed antibiotics more appropriately than their peers.

On the issue of stewardship, 91% of respondents indicated they believed that stewardship programs were appropriate for office-based medical practices, with many respondents saying patients and families should be the primary focus of stewardship efforts. Slightly less than half (47%) said they would need a lot of help to implement stewardship efforts within their practices, and 50% said tracking antibiotic use would be difficult to accomplish.

The activities with the strongest likelihood of spurring stewardship adoption included state departments of health publishing reports on local antibiotic resistance patterns and a public or private payer creating a stand-alone quality incentive program on antibiotic stewardship.

The authors of the study said the results are consistent with previous studies that have found high levels of awareness among clinicians of antibiotic resistance and less recognition of it as a problem in their own practice.

"This lack of recognition of physicians' own contributions to inappropriate prescribing presents a barrier to encouraging widespread stewardship uptake," they wrote.
Jun 20 Open Forum Infect Dis abstract

News Scan for Jun 22, 2020

News brief

NIH stops 2 hydroxychloroquine COVID-19 trials

The National Institutes of Health (NIH) announced over the weekend that it has stopped two randomized clinical trials exploring the use of the antimalaria drug hydroxychloroquine for treating and preventing COVID-19.

The NIH halted the ORCHID study, which was evaluating the safety and effectiveness of hydroxychloroquine in adults hospitalized with COVID-19, after a data safety and monitoring board met late Friday and determined that while the drug had caused no harm, it was unlikely to benefit hospitalized patients. More than 470 patients were enrolled in the blinded, placebo-controlled trial when it was stopped. All patients will continue to receive standard care.

The other trial, conducted by the National Institute of Allergy and Infectious Diseases (NIAID), was exploring whether a short course of hydroxychloroquine and azithromycin could safely and effectively prevent hospitalization and death among patients with mild-to-moderate COVID-19.

The study had enrolled only 20 patients out of a planned 2,000, however, and after the Food and Drug Administration revoked the emergency use authorization that allowed hydroxychloroquine to be used in COVID-19 patients on Jun 15, NIAID determined that the trial would be unable to enroll to completion and meet its intended objectives.

The two trials are the latest involving hydroxychloroquine to be stopped. On Jun 5, UK investigators announced that they had stopped the hydroxychloroquine arm of the RECOVERY trial after a review of data found no benefit in hospitalized patients. Then, on Jun 17, the World Health Organization announced it was dropping the hydroxychloroquine arm from its SOLIDARITY trial after reviewing data from the RECOVERY trial and other randomized clinical trials.
Jun 20 NIH press release
Jun 20 NIH press release

Pregnant, new moms report more depression, anxiety during COVID-19

The COVID-19 pandemic is exacerbating depression and anxiety in pregnant women and new mothers, according to a Canadian study published late last week in Frontiers in Global Women's Health.

The authors used social media postings to recruit 520 pregnant women and 380 women in the first year of motherhood to take an online survey that included the Edinburgh Postnatal Depression Survey (EPDS), the State-Trait Anxiety Inventory (STAI-State), and questions on physical activity levels from Apr 14 to May 8.

Of the 900 women, 64% reported less physical activity after lockdown measures were implemented, while 15% said they exercised more, and 21% reported no change. An EPDS score of 13 or higher, indicating depression, was reported by 41% of respondents during the pandemic, versus 15% before.

During the pandemic, 72% of women had a STAI-State score of 40 or higher, indicating moderate to high anxiety, compared with 29% before. Women who said they engaged in at least 150 minutes of moderate physical activity per week, meeting current guidelines, during the pandemic had significantly lower scores for both depression and anxiety than those who didn't.

The authors noted that one in seven women report depression and anxiety during the perinatal period, increasing their risk of preterm delivery, reduced mother-infant bonding, and delayed cognitive and emotional development of the infant. They also said that the pandemic was likely to increase social isolation and stress, while decreasing access to gyms and to diagnosis and treatment of mental illnesses.

"This highlights the strong need for heightened assessment and treatment of maternal mental health," the researchers wrote. "However, these data also suggest that physical activity, which has previously been shown to reduce depression and depressive symptoms in pregnancy, may be associated with better mental health during the pandemic."

In a press release, lead author Margie Davenport, PhD, of the University of Alberta, said that the findings are important for maternal mental health at any time. "Even when we are not in a global pandemic, many pregnant and postpartum women frequently feel isolated whether due to being hospitalized, not having family or friends around or other reasons," she said.
Jun 19 Front Glob Womens Health study and press release

Ebola sickens 5 more in recent Democratic Republic of Congo

Five more cases have been confirmed in a recent Ebola outbreak in the Democratic Republic of the Congo's (DRC's) Equateur province, the World Health Organization (WHO) African regional office said today on Twitter.

The cases push the outbreak total to 23, which includes 20 confirmed and 3 probable cases. One more death was reported, raising the fatality count to 13. No details were available about the latest case-patients. Located in the northwestern part of the DRC, the outbreak—detected in early June—is spread across five health zones and includes areas that are insecure and difficult to reach.

The country's larger outbreak in the eastern part of the country has recorded no new cases, keeping the total at 3,463, including 2,280 deaths, and will be declared over on Jun 25 if no new cases are reported.
Jun 22 WHO African regional office tweet

Cyclospora outbreak tied to bagged salad sickens dozens in Midwest

At least 76 people in six Midwestern states have becomes sickened with the parasite Cyclospora after eating bagged salad sold at Aldi, Jewel-Osco, and Hy-Vee grocery stores.

So far there have been no deaths report, and six patients have required hospitalization, the Centers for Disease Control and Prevention (CDC) said in a Jun 19 notice. Illness-onset dates range from May 11 to Jun 14. Iowa has the most cases, with 28, followed by Illinois (23), and Minnesota (13). Missouri, Nebraska, and Kansas also report a handful of cases. Patients range in age from 16 to 92 years, with a median age of 62.

Of 20 case-patients who shopped at Aldi, 16 (80%) bought the bagged salad, as well as 16 (43% of 37 Hy-Vee customers and 5 (80%) of 6 who shopped at Jewel-Osco. Bagged salad from the three grocery stores, however, do not explain all the illnesses, the CDC said.

Though there has been no recalls, the CDC recommends consumers do not eat and retailers do not sell the following products: All Jewel-Osco Signature Farms Garden Salad sold in Illinois;all Hy-Vee Brand Garden Salad sold in Iowa, Illinois, Kansas, Missouri, Minnesota, and Nebraska; and all Aldi Little Salad Bar Brand Garden Salad sold in Iowa, Illinois, Missouri, and Minnesota.

Cyclospora is a parasite that can be found in uncooked produce, and infection results in watery diarrhea that can last weeks if untreated.
Jun 19 CDC update