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

EU lawmakers urge action on antibiotic shortages, development

Originally published by CIDRAP News Oct 7

European lawmakers yesterday called for the European Union (EU) to address antibiotic shortages and antibiotic development as key components of its forthcoming Pharmaceutical Strategy for Europe.

In a letter to European Commission officials Margaritis Schinas and Stella Kyriakides, 30 European Parliament members said the EU should play a bigger role in multilateral discussions to address antibiotic shortages and should adopt an "end-to-end" approach to support development of models to fix the antibiotic development pipeline, while ensuring both sustainable use of antibiotics and equitable and affordable access.

"In this context, the EU should put forward new models that delink the R&I [research and innovation] cost from the prices of products through alternative mechanisms such as milestone prizes," the letter from the MEP Interest Group on Antimicrobial Resistance (AMR) said.

The letter also urged greater emphasis on prevention activities and more research into alternative therapies to reduce reliance on antibiotics, and recommended strengthening of antibiotic manufacturing requirements to reduce the release of antibiotic residues into the environment.

The Pharmaceutical Strategy for Europe aims to ensure Europe's supply of safe and affordable medicines and support the European pharmaceutical industry.

"AMR is a key area where European citizens rightly expect firm European action," they wrote.  "As it cannot be tackled efficiently at national level, we call for the Pharmaceutical Strategy to be a stepping stone to an ambitious regulation that would address human, animal, and environmental health in a 'One Health' approach and include non-pharmaceutical aspects such as monitoring and surveillance, infection prevention and control, and access to rapid and affordable diagnostic tools."
Oct 6 MEP Interest Group on AMR letter

Diagnostic stewardship tied to fewer urine culture orders, hospital UTIs

Originally published by CIDRAP News Oct 6

A diagnostic stewardship program at a large Los Angeles hospital was associated with significantly reduced inpatient urine culture orders and rates of hospital-acquired catheter-associated urinary tract infections (CAUTIs), researchers reported today in Clinical Infectious Diseases.

The stewardship program was implemented by clinicians at the Los Angeles County + University of Southern California (LAC + USC) Medical Center after they conducted a review of all CAUTI cases and found that almost half of the positive urine cultures that triggered mandatory national CAUTI reporting were obtained as part of routine hospital-onset fever workup, rather than because the patient had signs or symptoms of an infection. The intervention involved a hospital-wide memo that educated providers on the overuse of urine culture testing and described criteria for appropriate inpatient urine culture ordering, along with monthly audit and feedback of urine culture orders.

To assess the impact of the program, researchers at LAC + USC Medical Center compared inpatient urine culture orders and the CAUTI standardized infection ratio (SIR) in the baseline period (January 2018 to January 2019) and the period after implementation of the diagnostic stewardship intervention (March 2019 to January 2020).

The results showed that inpatient urine culture orders dropped from an average of 509 per month in the baseline period to 280 per month after implementation, and the corresponding CAUTI SIR fell dramatically. There were no significant changes in the hospital's observed mortality for all patients or those patients with urinary tract infections, indicating that the intervention was not associated with any detectable patient harm. In addition, the reduction in urine cultures led to a projected lab expenditure reduction of $920 to $3,910 per month.

"We plan to continue measuring and sharing our hospital CAUTI SIR monthly, educating providers in grand rounds yearly, and educating nurse champions at our monthly CAUTI committee meeting," the authors write.
Oct 6 Clin Infect Dis abstract

Peer comparison linked to reduced antibiotic prescribing at VA hospital

Originally published by CIDRAP News Oct 6

A peer comparison–based antibiotic stewardship intervention at a Veterans Affairs (VA) emergency department (ED) was associated with reductions in overall and unnecessary oral antibiotic prescribing, researchers reported yesterday in Antimicrobial Agents and Chemotherapy.

In a prospective, observational cohort study, researchers with the VA Pittsburgh Healthcare System and the University of Pittsburgh evaluated oral antibiotic prescribing by ED physicians at the VA Pittsburgh Healthcare System before and after implementation of a peer comparison stewardship intervention.

The intervention involved staff education and emails sent to each ED clinician that compared their antibiotic prescribing rate to that of their peers. The peer comparison intervention was conducted from January 2018 through June 2018, and the study compared oral antibiotic prescriptions during that period with prescriptions during the baseline period (June 2016 through December 2017).

During the intervention period, antibiotic prescriptions decreased monthly by 10.4 prescriptions per 1,000 ED visits (P = 0.07), and the relative decrease in the trend of antibiotic prescriptions during the intervention period compared to baseline was 9.9 prescriptions per 1,000 ED visits per month (P= 0.07). The intervention was associated with a significant decrease in monthly amoxicillin-clavulanate and increase in cephalexin prescriptions. Also, decreasing trends in ciprofloxacin prescriptions during the baseline period were maintained during the intervention.

Unnecessary antibiotic prescribing decreased from 55.6% to 38.7% (a 30.4% decrease, P = 0.003) during the intervention, while optimal prescribing increased from 21.6% to 29.3% (a 35.8% increase, P = 0.12).

The authors note that while the intervention was associated with decreased overall and unnecessary antibiotic prescribing, rates of unnecessary prescribing remained high, and increases in the optimal prescribing did not reach statistical significance.

"These findings suggest that additional interventions beyond education and peer comparison may be needed in EDs to decrease rates of inappropriate antibiotic prescribing," they wrote.
Oct 5 Antimicrob Agents Chemother abstract

CARB-X to fund development of novel antibacterial for pneumonia

Originally published by CIDRAP New Oct 5

CARB-X announced today that it is awarding up to $2.5 million to GangaGen Biotechnologies of Bangalore, India, to develop novel antibacterial proteins to treat hospital-acquired and ventilator-associated pneumonia caused by Klebsiella pneumoniae.

The money will fund preclinical development of klebicins, which are naturally occurring protein antibiotics that have shown potent activity against K pneumoniae in in vivo studies. Klebicins specifically target and kill K pneumoniae without harming beneficial bacteria in the microbiome.

"We are delighted to receive CARB-X's support to progress the klebicin programme," GangaGen president Tanjore Balganesh said in a press release from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator). "K. pneumoniae is a hard-to-treat pulmonary pathogen resistant to many of the current antibiotics. Additionally, hypervirulent strains of the pathogen are being isolated in many parts of the globe."

GangaGen will be eligible for an additional $8.1 million in funding from CARB-X if project milestones are met.

Since its launch in 2016, CARB-X has provided $252 million in funding to accelerate the development of 69 antibacterial products.
Oct 5 CARB-X press release