ASP Scan (Weekly) for Dec 03, 2021

Antibiotic resistance legislation
Swine farm antimicrobial use, resistance
Contact precautions for MRSA, VRE
Malaria control and kids' antibiotics
Fast food antibiotics
EU veterinary antimicrobial sales
Extensively resistant Klebsiella
Veterinary antibiotic stewardship app

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

Bill aims to boost federal response to antibiotic resistance

US Sen. Sherrod Brown, D-Ohio, announced this week that he has reintroduced legislation to strengthen the federal response to antibiotic resistance.

The Strategies to Address Antibiotic Resistance (STAAR) Act, which was originally introduced in 2019, aims to strengthen the federal response by improving data collection on antibiotic use and resistance, expanding the capacity of the Center for Disease Control and Prevention's (CDC's) Antimicrobial Resistance Surveillance and Laboratory Network, and boosting the development and implementation of antimicrobial stewardship programs in healthcare facilities.

The bill would also reauthorize the Interagency Task Force for Combating Antibiotic-Resistant Bacteria, which was created in 1999 to coordinate federal action, through 2028, and would authorize the CDC to work directly with health departments nationwide to implement prevention collaboratives.

"We've seen over the past two years how critical it is that we prepare for possible health threats, and work to prevent or mitigate them before they become full-blown crises," Brown said in a press release. "We have to be proactive if we want to prevent another public health crisis, and stop the spread of these superbugs before they erase many of the health gains we’ve made over the past century."
Dec 1 STAAR Act press release


USDA to study antimicrobial use, resistance on swine farms

Originally published by CIDRAP News Dec 2

The US Department of Agriculture's (USDA's) Animal and Plant Health Inspection Service (APHIS) announced this week that it has begun an effort to study antimicrobial use and resistance on commercial swine farms in the Midwest.

The collaborative effort, which also includes Minnesota-based Pipestone Veterinary Services and South Dakota State University, involves collecting, isolating, and analyzing samples of selected pig- and food safety-related pathogens for resistance.

Pipestone has been collecting data on antimicrobial use on its client farms for several years and recently began sampling for resistance. Researchers with APHIS's National Animal Health Monitoring System will provide more analysis and interpretation of the data in the context of factors related to animal management and disease pressure.

The USDA says the collaborative effort is the first of its kind, with funding provided by public, private, and industry sources.

"This collaboration could serve as a model for future studies to monitor antimicrobial use and resistance," the agency said in a press release.
Nov 30 USDA press release


Study suggests contact precautions for MRSA, VRE can be safely removed

Originally published by CIDRAP News Dec 1

A study conducted in 15 hospitals found that discontinuing contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) did not result in increased healthcare-associated infection (HAI) rates, researchers reported today in Infection Control & Hospital Epidemiology.

To determine the impact of removing contact precautions for MRSA and VRE, which are recommended by the CDC to reduce transmission but are controversial because of associations with patient harms, the researchers performed a retrospective, quasi-observational study at 15 acute care hospitals in a Pennsylvania healthcare system. Twelve of the hospitals (the intervention hospitals) had removed MRSA and VRE contact precautions after a policy change recommended doing so, and 3 (non-intervention hospitals) continued them.

The researchers compared HAI rates at the hospitals during the 12 months before and after discontinuation. To predict conditions where contact precautions may safely be removed, they correlated selected baseline hospital characteristics and infection prevention practices with HAI rate changes.

Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between the intervention and non-intervention hospitals.

All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. No correlations were found between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, although there was an increase in MRSA HAIs in hospitals with a higher proportion of semiprivate rooms (P = .04).

"Our results suggest that contact precautions for endemic MRSA and VRE can be safely removed under the right conditions without increasing HAI in a large, diverse health system, which would lead to significant cost savings on isolation gowns," the study authors write. "The exact conditions necessary require further investigation, but this study supports the importance of high rates of hand hygiene and low rates of HAI with MRSA and VRE."
Dec 1 Infect Control Hosp Epidemiol abstract


Intensive malaria control measures linked to reduced antibiotics in kids

Originally published by CIDRAP News Dec 1

Implementation of intensive malaria control efforts in Uganda was associated with a 70% reduction in antibiotic use in children, researchers reported yesterday in BMC Medicine.

In the study, Ugandan, US, and UK researchers analyzed the medical records of two cohorts of children (ages 6 months to 10 years) in a high-transmission area of Uganda where distribution of long-lasting insecticidal nets (in 2013 and 2017) and sustained indoor residual spraying (IRS) of insecticides (in 2014, with repeated rounds through 2019) were initiated. They then compared the incidence of antimalarial and antimicrobial treatments—which are frequently used for the acute bacterial and viral infections that are common in malaria-endemic settings—before and after the vector control measures were implemented.

Comparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4 to 5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR], 0.02; 95% confidence interval [CI], 0.01 to 0.03; P < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR, 0.30; 95% CI, 0.27 to 0.34; P < 0.001).

The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics.

The study authors say the high number of antibiotic treatments averted (mostly amoxicillin) could help reduce selection pressure and help slow the spread of antimicrobial resistance in Uganda and other countries where malaria is endemic.

"We found that investments in malaria control may have broader health benefits for children beyond malaria," they wrote. "Future studies should investigate the association between malaria control and antibiotic prescribing practices in other settings to further explore the impact on health systems and to inform strategies to mitigate the overuse of antibiotics and the threat of antimicrobial resistance in malaria-endemic settings."
Nov 30 BMC Med study


Groups urge McDonald's to follow through on antibiotics commitments

Originally published by CIDRAP News Nov 30

A coalition of food, health, and consumer groups last week sent a letter to McDonald's urging the company to follow through on its pledges to reduce antibiotic use in beef.

The letter, signed by members of US PIRG (Public Interest Research Groups) Education Fund, the Natural Resources Defense Council, the Antibiotic Resistance Action Center, Center for Food Safety, and several others, called out McDonald's for missing its 2020 deadline for setting meaningful reduction targets for use of medically important antibiotics in its global beef and dairy supply chains. The widespread use of medically important antibiotics to prevent and treat disease in beef and dairy cattle has become a major target of antibiotic stewardship advocates.

The company set the deadline in December 2018, when it announced that it would measure medically important antibiotic use and establish reduction targets among beef suppliers in the 10 countries (including the United States) that make up 85% of its beef supply chain by the end of 2020. The company also said it would begin reporting progress on meeting those targets in 2022.

The 2018 announcement was widely praised by antibiotic stewardship advocates at the time, given that McDonald's is the world's largest fast food chain and one of the world's biggest buyers of beef. There was hope that the move could spur a shift toward antibiotic-free beef that would replicate what's been seen in the poultry industry.

The groups are now calling on McDonald's to fulfill its commitments by setting aggressive antibiotic reduction targets in its beef supply, particularly in the United States; publicly reporting on their progress in meeting those targets; and using third-party auditors to verify antibiotic use practices among its beef suppliers.

"As a leader in the fast food sector and the beef production industry, McDonald's is poised to lead the way in producing meat ethically and without the overuse of antibiotics," the groups wrote. "Fulfilling your commitment to reduce antibiotic use in beef will also set an important example for other fast food companies who have made similar commitments to do so, and help spark change."
Nov 24 letter to McDonald's


Veterinary antimicrobial sales show significant decline in Europe

Originally published by CIDRAP News Nov 29

A new report from the European Medicines Agency (EMA) shows sales of veterinary antimicrobials have fallen by more than 40% since 2011.

In the 25 European Union/European Economic Activity (EU/EEA) countries that provided sales data for all years, overall sales of veterinary antimicrobial drugs fell from 161.4. milligrams per population correction unit (mg/PCU) in 2011 to 91.6 mg/PCU in 2021—a decline of 43.2%. During the period, 19 of the 25 countries saw declines ranging from 11.7% to 60.4%, while 5 countries saw veterinary antimicrobial use increase.

The decline was fostered by lower sales of antimicrobials considered critical for human medicine. Sales of third- and fourth-generation cephalosporins fell by 32.8%, polymyxins by 76.8%, fluoroquinolones by 12.8%, and other quinolones by 85.4%.

EMA officials said the decline indicates that establishing reduction targets, restricting the use of certain antimicrobials in food-producing animals, initiating awareness-raising campaigns, and other measures taken at the national and EU/EEA level are having a significant impact.

"The decrease in sales of antimicrobials for use in animals over ten years shows that EU policy initiatives combined with guidance and national campaigns promoting prudent use of antimicrobials in animals are having a positive effect," Ivo Claassen, PhD, head of the EMA's Veterinary Medicines Division, said in an agency press release.

The report also found that sales of veterinary antimicrobials in 2020 rose by 5.8% from 2019. But the authors say that finding could be the result of a combination of factors and should be interpreted with caution. 
Nov 23 EMA report
Nov 23 EMA press release


Study warns of extensively drug-resistant strain of Klebsiella pneumoniae

Originally published by CIDRAP News Nov 29

A new paper published in the Proceedings of the National Academy of Sciences describes the spread of an extensively drug-resistant strain of Klebsiella pneumoniae in Tuscany, Italy.

To understand the regional emergence and transmission dynamics of the protracted outbreak of New Delhi metallo-beta-lactamase (NDM)-producing carbapenemase-resistant K pneumoniae, which was first identified at a hospital in Tuscany in 2018 and continued in 2020 and 2021, a team of Italian, US, and German scientists collected and sequenced the genomes of 117 isolates from 76 patients at several healthcare facilities in southeast Tuscany.

All isolates belonged to the high-risk clone ST-147, showed high genetic relatedness, and were predominantly non-susceptible to all tested penicillins, cephalosporins, carbapenems, and aminoglycosides.

Phylogenetic analysis of the isolates revealed the existence of two clades that emerged in mid-2018 and early 2019. Clade A comprised isolates from 23 patients in three healthcare facilities in southeast Tuscany, and clade B included isolates from 57 patients at a single hospital in Siena. Rapid nosocomial spread of clade B was observed at the hospital from July to December 2019.

When compared with international ST-147 genomes, the outbreak clone from Italy most closely resembled NDM-producing multidrug-resistant K pneumoniae (MDR-Kp) isolates collected from the Middle East in 2016 and 2017. The comparisons further revealed that, since divergence from the ancestor shared with the Middle East lineage, the ST-147 clone from Italy had acquired eight other antimicrobial resistance genes in addition to the NDM-1 gene and genes previously linked to hypervirulence. The plasmids were similar to those found in ST-147 isolates reported in UK hospitals in 2018 and 2019.

"Further studies are needed to fully characterize the role of these plasmids and the drivers of their emergence in distinct lineages of MDR-Kp around the globe," the study authors wrote. "Close monitoring of global K. pneumoniae populations, as well as ongoing, local efforts to contain the dissemination of such high-risk clones, is critical to impede the emergence of this troublesome pathogen."

The authors note that recent surveillance data suggest the outbreak in Italy is ongoing.
Nov 24 Proc Natl Acad Sci USA study


Smartphone app aims to optimize veterinary antimicrobial use

Originally published by CIDRAP News Nov 29

A team of Canadian veterinary and infectious diseases specialists has developed a smartphone app to help promote prudent use of antimicrobials in animals.

The algorithmic app, developed by researchers with the University of Calgary, the Canadian Veterinary Medical Association (CVMA), and the Stewardship of Antimicrobials by Veterinarians Initiative, offers point-of-care treatment recommendations and other reference material for infections in a wide range of animal species. The developers say it will be an ideal tool for veterinarians who treat both companion and food-producing animals.

"This app gives veterinarians guidelines for prescribing antibiotics for species-specific conditions," Dr. John Conly, MD, infectious disease specialist at the University of Calgary's Cumming School of Medicine, said in a university press release. "This is a novel tool which we hope will help promote the optimal use of antibiotics with the aim of reducing antimicrobial resistance."

The app is available to veterinarians, veterinary technicians, and veterinary students across Canada who are members of the CVMA, but Conly says he hopes the platform will be emulated by other countries.
Nov 24 University of Calgary press release

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