APUA Highlights: November 2012
APUA Headquarters in Action
New APUA Webinar on antimicrobial stewardship to be released Nov. 14 for CDC's Get Smart about Antibiotics Week
On Wednesday November 14, 1pm-2pm EST, APUA will present a one-hour webinar entitled "Containing Health Care Associated Infections through Antibiotic Stewardship" in conjunction with the Tufts Medical Center. This webinar will describe the nature of antimicrobial resistance, identify trends of major resistant infections, and delineate the important components of successful antimicrobial stewardship. The targeted audience is infectious disease pharmacists, physicians, and laboratory personnel. This webinar is free to attend. Please register to attend the live event on the APUA website. The archived version will be available after November 14th.
CDC's Get Smart about Antibiotics Week November 12-18
"Get Smart About Antibiotics Week" is the CDC's annual national campaign for appropriate antibiotic use in the community, and in health care facilities. Since 2010, APUA has been a strategic partner in this initiative. This year the campaign runs November 12-18 and coincides with European Antibiotic Awareness Day, Australia's Antibiotic Awareness Week and Canada's Antibiotic Awareness Week. The CDC has made available six fact sheets
along with public service announcements and other extensive opportunities for building antibiotic resistance awareness.
Activities you can participate in for CDC's Get Smart About Antibiotics Week include:
Tuesday, November 13
1 p.m. ET – Twitter Chat with ABC’s Dr. Richard Besser about using antibiotics wisely in outpatient settings and tips for symptom relief when antibiotics aren’t needed; #SaveAbx; #abcDrBchat
2 p.m. ET – Twitter Chat with CDC experts about what doctors, clinicians, and healthcare providers can do to ensure that antibiotics are used wisely in healthcare settings and nursing homes; #SaveAbx.
APUA joins partner health care organizations in advocating stewardship
On Tuesday, November 13 at 10:00 a.m. EST, the Centers for Disease Control and Prevention (CDC), the Center for Disease Dynamics, Economics & Policy (CDDEP) and the Robert Wood Johnson Foundation (RWJF), in collaboration with APUA and more than twenty other leading health care organizations [including Infectious Disease Society of America (IDSA), The Society for Healthcare Epidemiology of America (SHEA), The Society of Infectious Disease Pharmacists (SIDP) and The Pew Charitable Trusts], will unveil the details of an unprecedented joint partnership to fight against antibiotic resistance. The telephone-only briefing coincides with CDC’s “Get Smart About Antibiotics Week.”
Telebriefing participants will discuss alarming patterns of antibiotic use and resistance in the United States. Participants will also share plans for working together to preserve antibiotic effectiveness and slow antibiotic resistance.
Arjun Srinivasan, Centers for Disease Control and Prevention
Ramanan Laxminarayan, Center for Disease Dynamics, Economics & Policy
Question & answer session to include representatives from signatory organizations
Register for this event on the CDDEP website. For more information on antibiotic stewardship, register for APUA's upcoming webinar.
APUA President Dr. Stuart B. Levy in the AARP Bulletin article "Battling Bacteria 'Superbugs'"
The article by Katharine Greider appears in the October issue of the AARP and can be viewed online on the AARP website. The author elaborates on how the misuse of antibiotics in humans leads to resistance and Dr Levy's advice is quoted, "You don't want to take antibiotics without a physician's advice. Don't stockpile them. Don't beg for them. You don't take antibiotics for the common cold." The article also points out the problems associated with overuse of antibiotics in food production. Dr Levy is quoted once more, "Resistance is produced and amplified by the misuse of antibiotics. There are lives being lost. And the solution is to get... antibiotics out of the environment as best we can."
APUA advocates for consumer involvement in US FDA meetings on antibiotic use in livestock
The U.S. Food and Drug Administration (FDA)’s Draft Guidance #213 asks drug makers to voluntarily end the sale of antibiotics for livestock growth promotion and feed efficiency. Proposed changes to the Veterinary Feed Directive (VFD)—currently published in the form of draft pre-regulatory text—would partner with the guidance to require greater veterinary oversight of over-the-counter drugs. Along with the U.S. Department of Agriculture (USDA), the FDA has planned a series of public stakeholder meetings across the country to discuss increased veterinary oversight of judicious antibiotic use in food animal production. Large animal veterinarians and producers are expected to attend. While the attendance of these groups is critical, it is equally important that the public health community and consumers be represented at these meetings as well. APUA has signed on to a joint letter to the FDA Commissioner urging the agency to actively involve public health and consumer stakeholders in the upcoming meetings, to finalize Guidance #213 and to issue a formal proposed rule regarding VFD changes by the end of 2012. You too can write to the FDA to advocate about this issue using a template on the Pew Charitable Trusts website.
Recently, Representative Waxman of California has proposed a bill called the “Delivering Antibiotic Transparency in Animals (DATA) Act.” It could provide the FDA with important information about the types, purposes, and quantities of antibiotics being fed to livestock. Information would be gathered from drug manufacturers as well as feed mills. “We need reliable information about the use of antibiotics in agricultural operations,” said Rep. Waxman. “The more we learn, the graver the threat becomes from overuse of antibiotics by industrial-scale farms. We need this information so scientists and Congress can stop the spread of drug-resistant infections from farm animals to humans.”
APUA attends The Joint Commission's National Summit on Overuse of Medical Treatments
The Joint Commission invited APUA to the National Summit on Overuse where participants considered the evidence surrounding appropriate use of the following five treatments: antibiotics for the common cold, heart vessel stents, blood transfusions, ear tubes for brief periods of fluid behind the ear drums, and early scheduled births without medical need. Representing APUA at this invitation-only event, APUA VP Dr. Thomas F. O’Brien shared his extensive expertise concerning the appropriate use of antibiotics. The Summit resulted in the development of recommendations for raising awareness among health care professionals and patients to reduce overuse of these treatments such as creation of educational tools, dissemination of leading practices, standardization of data reporting, and alignment of existing guidelines. The podcasts highlighting the day’s events are available on The Joint Commission website.
News and Publications of Note
US FDA creates Antibacterial Drug Development Task Force; White House Advisory Board issues Report
As committed in the recent GAIN Act, the US FDA has created a new Antibacterial Drug Development Task Force, a multi-disciplinary group of 19 FDA scientists and clinicians. The goals of the task force are to explore novel scientific approaches to facilitate antibacterial drug development, to identify issues related to unmet medical needs for antibacterial drugs, to evaluate existing FDA guidances related to antibacterial drug development, and to use existing collaborative agreements to work with think tanks and other thought leaders to explore new approaches.
Following the FDA’s announcement, the President’s Council of Advisors on Science and Technology issued a report on Sept. 25 detailing a plan to double the yearly production of new drugs over the next decade. The report makes specific recommendations to improve drug development and evaluation, and effectively monitor benefits and risks. Find more information about the GAIN Act in APUA's recent Newsletter Vol. 30. No 1.
ReAct evaluates programs to develop new antibiotics
The two different approaches taken by the US GAIN Act and the European NewDrugs4BadBugs (ND4BB) are compared on the ReAct website . The article points out that the GAIN act fails to address the scientific bottlenecks in the antibiotic R&D pipeline and suggests ways to strengthen the US approach. ReAct reports that the European Union has developed a plan that will bring 223.7 million Euros (US$280 million) to support the creation of a European public-private partnership for the development of novel antibiotics. This program will be funded by the Innovative Medicines Initiative with a matching in-kind contribution from the pharmaceutical industry. Currently, it does not address regulating rational use of antibiotics developed, but there is hope that future calls with address this issue.
New research findings: C. difficile and ESBLs undergo shift in epidemiology
According to new research presented at the American College of Gastroenterology’s (ACG) 77th Annual Scientific meeting last month, Clostridium difficile-Associated Diarrhea has shifted from primarily being a traditional hospital-acquired infection to a community and long-term-care facility-based infection. Researchers from Sinai Hospital in Baltimore retrospectively analyzed data from patients admitted to an acute care hospital between January 2005 and December 20120. The results of their analysis were presented with the title “Changing Epidemiology of Clostridium difficile-Associated Diarrhea (CDAD) Among Long-Term Care Facility Patients.”
Similar trends were noted by researchers studying transmission rates of extended-spectrum beta-lactamase (ESBL) producers at the University Hospital in Bern, Switzerland. A prospective longitudinal study was conducted of patients admitted with a newly recognized infection or colonization with ESBL-producing E. coli or ESBL-producing K. pneumoniae isolates, and their hospital and household contacts. The study published in the October issue of Clinical Infectious Diseases found that household transmission of ESBLs outweighs hospital transmission in a non-outbreak setting.
Hilty et al. Transmission Dynamics of Extended-Spectrum Beta-lactamase-Producing Enterobacteriaceae in the Tertiary Care Hospital and the Household Setting. CID 55(7): 967-75.
Selected notes from IDWeek 2012: UV disinfection, and Stewardship
Researchers at Duke University Medical Center and the University of North Carolina Hospital System used short-wave ultraviolet radiation (UV-C) to nearly eliminateAcinetobacter, Clostridium difficile and vancomycin-resistant enterococci (VRE) in more than 50 patient rooms at the two medical facilities. Given previous findings by the University of North Carolina team that UV-C is effective at decreasing methicillin-resistant Staphylococcus aureus(MRSA) in hospital rooms the new study lays critical groundwork for expanding a new technology for broad elimination of major hospital-acquired pathogens.
A study involving one of the nation's largest networks of pediatric practices was able to nearly halve the inappropriate use of antibiotics through quarterly monitoring and feedback of its physicians' prescribing patterns. Initially, about 28 percent of all children inappropriately received a broad-spectrum antibiotic for a targeted condition. After the antibiotic primer session and a year of regular prescribing evaluations, clinicians in the intervention group reduced off-guideline use to 14 percent. The control group rate also declined, but only to 23 percent. More information about cutting edge research from IDWeek can be found in this press release.
New "European Manual of Clinical Microbiology" available
President of the APUA-Italy chapter, Dr. Giuseppe Cornaglia is co-editor of the newly released "European Manual of Clinical Microbiology" which is mainly intended for those involved in medical microbiology, but suitable for clinicians, residents and students as well. Dr. Cornaglia also authored the chapter on Antimicrobial Resistance Surveillance.