APUA Highlights: February/March 2014
Supporting Chapters APUA Project Partnerships
APUA - Abu Dhabi The Bill and Melinda Gates Foundation National Biodefense Analysis and Countermeasures Center
APUA - Australia (Australian Society for Antimicrobials) The Pew Charitable Trusts
APUA - South Korea U.S. National Institutes of Health (NIH) Centers for Disease Control and Prevention (CDC)
APUA - United Kingdom (British Society for Antimicrobial Chemotherapy) Pan American Health Organization (PAHO) U.S. Food and Drug Administration (FDA)
U.S. Office of Homeland Security World Health Organization (WHO)
U.S. Agency for International Development (USAID) World Bank
U.S. Department of Agriculture (USDA) Ministries of Health
APUA gratefully acknowledges unrestricted grants from corporate sponsors:
APUA Headquarters in Action
APUA names Honor Roll companies that responsibly limit antibiotic use in food products
In its first annual Honor Roll, APUA named Applegate, Bell & Evans, Chipotle, Coleman Natural, Heritage Acres Foods, Niman Ranch, Panera Bread, sweetgreen, and Whole Foods. APUA applauds these Honor Roll companies that are taking the initiative to commit to more stringent controls on antibiotic use in food production. "Through their leadership and best practices, these companies strive for healthful quality and assert pressure on the food animal industry to stop overusing antibiotics for non-therapeutic purposes and growth promotion," said APUA President Dr. Stuart Levy.
Dr. Levy participates in Harvard forum on addressing antibiotic resistance
On February 5th, APUA President Dr. Stuart Levy participated in the Forum at Harvard School of Public Health, which featured "Battling Drug-Resistant Superbugs: Can We Win?" Also on the panel: Marc Lipsitch of the Harvard School of Public Health, Aaron Kesselheim of Brigham and Women’s Hospital, and Beth Bell of CDC. The event, was moderated by David Baron, health and science editor of “The World.”
Dr. Levy and colleagues addressed a wide range of issues—from how we talk about and address antibiotic resistance, to the genetic evolution of resistance, preventive hygiene, antibiotic use in animals, hospital stewardship programs and the antibiotic pipeline. Dr. Levy stressed that antibiotics are “societal drugs”, due to the effects that individual use has on resistance in the community.
Read more about the event here, or watch a recording here.
APUA presents third antibiotic stewardship webinar, hosted by Robert Gaynes, M.D.
Through an unrestricted educational grant from Alere, APUA has engaged multiple experts from around the world to contribute to a diverse collection of educational materials dedicated to antimicrobial stewardship. These materials include three educational webinars presented between July 2013 and January 2014. The final webinar, titled, Antibiotics: Managing a Medical Treasure, was presented by Dr. Robert Gaynes, Chair of the Antimicrobial Stewardship Committee and Infection Control Committee at Emory University School of Medicine. The webinar:
- Analyzes the relationship between antibiotic use and resistance,
- Discusses the need for stewardship and the dearth of new antimicrobials, and
- Describes the methods for optimizing antibiotic use, including the use of biomarkers, diagnostic tools, and approaches to de-escalating antibiotics.
APUA welcomes new corporate sponsor, BacterioScan
APUA welcomes its newest corporate sponsor, BacterioScan. Founded by a diverse product-development team, BacterioScan promises to revolutionize the treatment of infection by more accurately targeting the right therapy at the right time with its advanced research and clinical diagnostics. BacterioScan developed and patented a unique electro-optic technology and instrumentation platform for rapidly detecting and quantifying bacteria in fluids. Learn more about BacterioScan here.
Sound Medicine interviews Dr. Stuart Levy on recent FDA Veterinary Feed Directive
On February 2nd, the radio program Sound Medicine interviewed APUA President, Stuart B. Levy, MD on the topic of regulating antibiotics in food animals. The interview focused on the recent FDA guidelines that ask for a voluntarily reduction in the use of antibiotics for growth promotion in food animals. Although some groups are disappointed that the FDA guidance is too limited and does not ban feeding growth-promoting antibiotics altogether, Dr. Levy said that, after waiting 30 years for some kind of regulation, he is pleased with the FDA action as a step in the right direction. “This policy at least sets a mark. We are asking, not only the farmers, but the veterinarians and others to look at this practice critically,” he said.
While growth-promotional antibiotic use in Europe has been banned, it is still permitted in the U.S. Dr. Levy cited evidence for the spread of resistant bacteria from farm animals to humans, commented on the potential impacts of antibiotic restriction, and suggested ways in which we, as individuals, can reduce antibiotic-resistant infections.
Pew Teleconference: Addressing the FDA Veterinary Feed Directive
On Tuesday, January 28th, APUA participated in a teleconference organized by The Pew Charitable Trusts. Serious concerns were expressed regarding the recent FDA Veterinary Feed Directive asking for voluntary reductions in antibiotics for growth enhancement in feed animals. Discussion revolved around the following issues:
- Disappointment with the limited action and “voluntary” aspects of the directive
- Reduced record keeping requirements
- Changes in definition of feed “distributors” and “mixers” – If a farmer mixes his own feed, does this need to be reported?
- Vagueness regarding when/if a veterinarian must visit farms (e.g., if a producer has 5 farms, must a veterinarian visit all, or just one? How many animals should be examined?
- Will prescribed antibiotics have limits on the number of renewals?
- How will data be collected and how can it be verified?
A subcommittee was formed to write a letter to the FDA expressing these concerns.
APUA Chapter News
APUA-Lebanon sponsors antibiotic resistance workshop
The APUA-Lebanon chapter planned a "Workshop on Phenotypic Detection of Bacterial Resistance," hosted at the University of Balamand on February 28, 2014. The event included lectures on “Resistance in the North of Lebanon,” “Mechanisms of Antimicrobial Resistance,” and “Phenotypic Detection of Bacterial Resistance,” followed by a practical session with hands-on application performing phenotypic tests, reading, interpreting, and reporting results. The forty-five attendees included lab directors and microbiologists. Click here for more information.
News and Publications of Note
European collaboration targets novel antibiotics
Thirty-two European universities and companies are joining together to develop antibiotics that fight Gram-negative pathogens such as E. coli. The six-year project, called ENABLE (European Gram Negative Antibacterial Engine), is led by GlaxoSmithKline and Uppsala University, and funded by Innovative Medicines Initiative (IMI). The ENABLE project is part of a new joint response to the lack of new antibiotics in development. Together, the European Commission and the European Federation of Pharmaceutical Industries and Associations have launched a series of projects under the banner New Drugs for Bad Bugs (ND4BB). This kind of public private partnership represents a promising step forward in the fight against dangerous drug-resistant bacteria.
Chick-fil-A, Delta Airlines declare they will use antibiotic-free meat
Georgia-based fast food company Chick-fil-A announced plans to stop serving chicken raised on antibiotics within the next five years. The restaurant states, “We are collaborating with national and regional poultry suppliers to build a supply chain based on chickens raised with no antibiotics. We are asking suppliers to work with the USDA to verify that antibiotics are never administered from the hatchery to the processing plant.” With over 1,700 locations in 39 states and Washington, DC, this company has the influence to significantly reduce antibiotic use in poultry production.
Delta Airlines also announced that it has introduced a new line of healthy, antibiotic-free meal options. The meals, available to Delta’s economy class passengers on transcontinental flights, feature hormone and antibiotic-free proteins. Meanwhile, Panera Bread celebrates its 10-year anniversary of serving antibiotic-free meat. Beginning with a single item in 2004, the company now offers 23 menu items that meet the stricter criteria.
APUA is encouraged to see companies choosing to stop serving meat raised on antibiotics.
Partnership formed to combat antibiotic resistance as bioterrorism threat
The recent “Worldwide Threat Assessment,” as laid out by the Director of U.S. National Intelligence, lists “drug-resistant pathogens” as one of the foremost health risks. “Infectious diseases, whether naturally caused, intentionally produced, or accidentally released, are still among the foremost health security risks,” Director of National Intelligence James Clapper wrote. “Antibiotic drug resistance is an increasing threat to global health security. Seventy percent of known bacteria have now acquired resistance to at least one antibiotic, threatening a return to the pre-antibiotic era.”
The U.S. Department of Health and Human Services (HHS) announced a new public-private partnership to develop a new drug (Carbavance) to protect the public against two bioterrorism threats: melioidosis and glanders. This drug, if approved by the FDA, could potentially be used to fight antibiotic-resistant infections, including complicated urinary tract infections, hospital-acquired pneumonia, ventilator-acquired pneumonia, and carbapenem-resistantEnterobacteriaceae (CRE).
HHS’s Biomedical Advanced Research and Development Authority will partner with Rempex Pharmaceuticals Inc. under a five-year cost-sharing agreement.
Decline in antibiotic prescriptions for children may have plateaued
Antibiotic use in children has declined markedly over the past 20 years. However, a Pediatrics study that examined the claims of three U.S. health plans from 2000-2010 (in New England, the Mountain West, and the Midwest), found that the downward trend in outpatient antibiotic prescriptions has slowed. In contrast, third-generation cephalosporin use for otitis media increased from 1.6 to 5.5-fold. The authors recommend identifying and implementing best practices in low-prescribing areas, and emphasized that intervention efforts should focus on decreasing broad-spectrum antibiotics for common conditions such as otitis media.
President Obama notes drug resistance research in State of the Union Address
In his 2014 State of the Union address, President Obama mentioned the important work being done to combat drug-resistance. “Congress should undo the damage done by last year’s cuts to basic research so we can unleash the next great American discovery,” he said. “There are entire industries to be built based on vaccines that stay ahead of drug-resistant bacteria or paper-thin material that is stronger than steel.” He was referring to NIH research that is exploring the use of tiny nanosponges to trap and bind MRSA’s toxin. The researchers, based at the University of California, San Diego, suggest that this same technology may be used to create vaccines against other toxins, such as those produced by E. coli.
Residents near factory farms have elevated risk of MRSA carriage
Methicillin-resistant Staphylococcus aureus (MRSA) frequently colonizes livestock and their caretakers. A recent study published in Infection Control & Hospital Epidemiology (January 2014) found that residential proximity to a large swine farm also increases the risk of MRSA colonization. The research team from the University of Iowa, Iowa City Veterans Affairs, and Kent State University surveyed 1,036 VA patients at hospital admission. 6.8 percent of these carried MRSA in their nostrils; however subjects were 2.76 times more likely to be colonized by MRSA if they lived within one mile of a CAFO (confined or concentrated animal-feeding operation) housing over 2,500 swine.
New dress code recommended to prevent HAI
The Society for Healthcare Epidemiology of America released a new guideline for healthcare personnel attire in non-operating-room settings. The report published by SHEA says that “Recommendations for healthcare personnel (HCP) attire should attempt to balance professional appearance, comfort, and practicality with the potential role of apparel in the cross-transmission of pathogens.”
The guideline recommends that hospitals adopt the following policies to limit transmission of hospital acquired infections:
Bare below the elbow, meaning wearing short sleeves and no wristwatch, jewelry, or necktie during clinical practice;
HCP that interact directly with patients should have two white coats, and the hospital should provide hooks where coats can be hung prior to interaction with patients;
If neckties are worn, they should be secured;
Clothing that comes in contact with patients should be laundered daily;
White coats should be laundered at least once a week and whenever visibly soiled
Narrow-spectrum antibiotics provide effective empiric therapy in pediatric pneumonia
A study in Pediatrics found that narrow-spectrum antibiotics are as effective as broad-spectrum ones when treating children hospitalized with community-acquired pneumonia (CAP). These findings confirm the 2011 guidelines for treating children with CAP published in the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA).
APUA supports the use of narrow-spectrum antibiotics over broad-spectrum ones whenever possible, as this treatment targets the specific problem and minimizes the potential for antibiotic resistance development.
New diagnostic test differentiates C. diff strains
While most types of HAIs (hospital-acquired infections) are declining, those caused by C. difficile remain at historically high levels and are linked to 14,000 deaths in the U.S. each year (CDC). The emergence of a hypervirulent C. diff strain (NAP1/027/Bl) has created an urgent need for more sensitive and rapid strain detection and typing. Researchers at Rhode Island Hospital in Providence have developed an assay to quickly and accurately differentiate between subtypes of Clostridium difficile utilizing three genes associated with C. difficilehypervirulence. The platform has potential as a point-of-care test in hospitals and other health-care settings.
March 20, 2014: British Society for Antimicrobial Chemotherapy's Spring Meeting 2014, London, UK
BSAC will convene at the Royal College of Physicians in London, with a focus on antimicrobial stewardship in human and animal health. Coordinated stewardship efforts can reduce the cost of healthcare for infections and limit the spread of antimicrobial resistance. This meeting draws over 200 delegates each year, ranging from microbiologists to infectious disease physicians, pharmacists, scientists, infection control specialists, colleagues in industry and professional allies to the field of infection and antimicrobial therapy.
May 5, 2014: WHO call to action: Celebration of hand hygiene and AMR activity
This call to action is part of the WHO Save Lives: Clean Your Hands initiative. Their slogan says “No action today; no cure tomorrow – make the WHO 5 Moments for Hand Hygiene part of protecting your patients from resistant germs.” Two of the proposed May 5, 2014 activities will be international surveys—one surveying the prevalence of multi-drug-resistant organisms, the second surveying the use of surgical antibiotic prophylaxis. Both global surveys ask laboratories in healthcare facilities around the world to submit their own data. The comprehensive list of activities is available here.
May 10-13, 2014: European Congress on Clinical Microbiology and Infectious Diseases (ECCMID 2014), Barcelona, Spain
The 24th European Congress of Clinical Microbiology and Infectious Diseases will convene at Barcelona’s International Convention Center, the largest in Southern Europe. The program will include a series of keynote addresses, educational workshops, symposia and meet-the-expert sessions, covering the entire field of infectious disease and clinical microbiology.
May 17-20, 2014: American Society for Microbiology's Annual Meeting (ASM 2014), Boston, MA, USA
ASM’s 114th general meeting will cover today’s cutting edge science in diverse areas of microbiology through a series of interactive workshops, scientific sessions, and networking events. The event will bring together thousands of microbiologists.
Coming Soon: Resistance the film
The documentary film, Resistance, produced by Ernie Park and Michael Graziano is planned for release this year. The film includes Dr. Levy and promises to address the many sides of antibiotic resistance, from farm to hospital, community, and personal use. It features interviews with experts and individuals who have been impacted by the problem of antibiotic resistance. Screenings will be hosted across the US and will also be available for streaming online and on DVD.