APUA Highlights: February 2013
APUA Headquarters in Action
APUA President Dr. Stuart B. Levy lectures on agricultural antibiotics and human health
On February 6, Dr. Levy presented “Agricultural Antibiotics and Human Health” to the Tufts University Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy. Dr. Levy expounded on the scientific evidence linking the rise of antibiotic-resistant pathogens in livestock and their transmission to people and described the current US policy initiatives aimed at addressing this risk. An audio recording of this lecture can be downloaded from the Friedman School’s ITunesU page.
Additional information on legislation restricting the use of antibiotics in animal feed from the American Society for Microbiology can be found here.
Major developments in US Policy on antibiotic use in food animals can be found here on the APUA website.
APUA attends WHO meeting on strategies for surveillance of antimicrobial resistance
On December 18, Dr. Thomas O’Brien and Lisa Tapert represented APUA at the World Health Organization’s Technical consultation: Strategies for global surveillance of antimicrobial resistance in Geneva, Switzerland. The group of global experts was assigned the task of reviewing and identifying the objectives, needs and gaps, priorities and action steps for improving global surveillance of antibacterial resistance and exploring opportunities for collaboration. As a first step, WHO resolved to identify resources in order to produce and release a global report on antimicrobial resistance surveillance using existing data. Of note, the group expressed interest in non-governmental sector involvement and the need to identify “champions”. Recommendations included making data accessible to clinicians, developing further collaboration, and a roadmap/timeline for implementing strategies.
APUA article on C. difficile receives wide distribution in Massachusetts
A published interview with CDC’s Arjun Srinivasan on C. difficile has recently been disseminated to 17 hospitals and 70 long-term care facilities by The Massachusetts Coalition for the Prevention of Medical Errors, a public-private partnership whose mission is to improve patient safety and eliminate medical errors in Massachusetts. The article highlights the risks of excessive antibiotic exposure and focuses on the roles of patients and healthcare workers in stemming the spread of this severely incapacitating infection.
APUA signs joint letter supporting new provisions to ADUFA
Keep Antibiotics Working (KAW) and Pew Trusts have drafted a joint letter urging the reauthorization of the Animal Drug User Fee Act (ADUFA) to include provisions that will help preserve the efficacy of antibiotics vital to protecting public health.
The recommendations include: (1) improving existing requirements in ADUFA on the collection and reporting of information on the sales of antibiotics for use in food-producing animals, and (2) requiring the FDA to track and publicly report on implementation of its voluntary plan to address antibiotic misuse and overuse in food-producing animals.
“In the face of the antibiotic resistance crisis, we cannot afford to be standing still. We need strong action to combat the overuse of antibiotics in animal agriculture,” said Steven Roach, Public Health Program Director at Food Animal Concerns Trust (FACT) and a member of KAW. “The FDA needs to use all the tools it has available to begin rolling back this massive use of antibiotics.”
The Senate subcommittee hearing on Animal Drug User Fee Agreements: Advancing Animal Health for the Public Health was held on February 27.
On Feb 26, representatives Waxman and Slaughter introduced legislation, H.R. 820, Delivering Antimicrobial Transparency in Animals (DATA) Act of 2013, to better monitor antibiotic use in animals.
APUA drafts editorial on routine antibiotic use for severe malnutrition
A recent New England Journal of Medicine article by researchers at the University of Washington in St. Louis reports results of a clinical trial in Malawi children treated for severe, acute malnutrition. The authors claim that recovery rates were higher and mortality rates were lower among children who received antibiotics than among those who received placebo as part of the outpatient treatment with ready-to-use therapeutic foods.
APUA is compiling expert opinion from its Scientific Advisory Board in order to formulate an editorial in response to the suggested implementation of routine antibiotics for severe malnutrition. We believe that further research is needed because a broad-scale expansion of antibiotic use could prompt widespread antibiotic misuse and resistance in the community.
APUA Chapter News
APUA-Cuba conducts courses on tropical diseases and risks of imprudent antibiotic use
In January, APUA-Cuba conducted a week-long course on tropical diseases, particularly Chagas disease, malaria, leishmaniasis, shistosomiasis, tuberculosis, dengue, filariosis, and onchocerciasis at the Manuel Fajardo Hospital in Havana. Pictured above are the attendees, interns, and residents from various Latin American and African countries. In February, APUA-Cuba (Villaclara Province Subchapter) conducted a two-day workshop on the risks of imprudent antibiotic use at the Arnaldo Milian Castro University Hospital. The workshop was attended by physicians, nurses, pharmacists and other stakeholders from Villaclara province.
Recently, APUA-Cuba President Dr. Moisés Morejón-García has published two editorials (in Spanish) in successive issues of Revista Cubana de Medicina titled “Mutirresistencia bacteriana y médico de asistencia” (Multi-resistant bacteria and the attending physician) and “Multirresistencia en bacilos gramnegativos y médico de asistencia” (Multidrug resistance in gram-negative bacteria and the attending physician).
APUA-Nepal presents at Kathmandu International Conference
The First International Conference on Infectious Diseases and Nanomedicine (ICIDN – 2012) was held from December 15-18, 2012 in Kathmandu, Nepal. APUA-Nepal participated with two abstracts: “Present Scenario of Hospital Acquired Infections (HAI) at Tribhuvan University Teaching Hospital (TUTH) - a tertiary care hospital” and “Efforts of APUA-Nepal in Reducing the Emergence and Spread of Resistance”.
APUA-India conducts course on promoting rational drug use
APUA-India is conducting a course on promoting rational use of drugs and prevention of antimicrobial resistance in the community at the Institute of Health Management Research in Jaipur, India from February 25 to March 5, 2013. It is a condensed version adopted from the official two-week WHO course on ‘Promoting Rational Drug Use in the Community’.
News and Publications of Note
LPAD aimed at speeding approval of new antibacterials
As described by Infectious Diseases Society of America (IDSA), LPAD (Limited Population Antimicrobial Drug) is an approval pathway through which a new drug’s “safety and effectiveness would be studied in substantially smaller, more rapid, and less expensive clinical trials.” The proposed LPAD legislation would facilitate faster approval of badly needed new antibacterials and provides the necessary incentives for drug developers to meet the challenge. Pew’s New Pathways conference indicated that LPAD may offer smaller companies a break since they are more challenged by regulatory hurdles of early-stage clinical trials than bigger companies. It is anticipated that the expensive price tag of LPAD drugs ($15,000-$30,000 per treatment course) will act as a deterrent to potential overuse that could lead to the rapid emergence of drug resistance.
Cefixime-resistant gonorrhea emerges in North America
Canadian doctors have documented the first failure in North America of cefixime, the front-line antibiotic for treatment of gonorrhea. The findings are published in the January 9th issue of the Journal of the American Medical Association. Having outwitted four classes of antibiotics over the past 70 years, Neisseria gonorrhoeae has become multidrug resistant (MDR). With the reported failure of the cephalosporin class, there remains a diminishing arsenal of agents with which to treat this escalating MDR pathogen. The emerging crisis prompted the CDC to revise its guidelines last August to include therapy with two different drug classes.
Chennai Declaration tackles antimicrobial resistance in India
There are at present no functioning national policies on antibiotics or for containment of antimicrobial resistance in India. At the August 2012 meeting of the 2nd annual conference of the Clinical Infectious Disease Society (CIDSCON) held in Chennai, the medical societies of India organized their first ever meeting to address these deficits and issued “The Chennai Declaration: A roadmap to tackle the challenge of antimicrobial resistance.”
Among its multiple directives, the Declaration recommended: implementing mandatory infection control teams in all hospitals; revising curricula to include training on antibiotic use and infection control; and organization of a National Task Force to guide and supervise infection control activities. The Declaration also called for broadening the resistance surveillance network to include both government and private sector hospitals; standardizing microbiology laboratories country-wide; and evaluating and regulating usage of antibiotics in veterinary practice. The media and NGO’S are called upon to raise public awareness of the dangers of antibiotic misuse. Implementation of a national public policy is considered imperative.
“Hydrogel” poised to eradicate drug-resistant bacteria on contact
Hydrogel, a research product of IBM, is a biodegradable, nontoxic, and biocompatible polymer of nanoparticles that shows promise in treating antibiotic-resistant infections and protecting medical devices against biofilms. The “nanomedicine”, which would be a cream or gel that is rubbed on wounds or injected into infected regions, makes use of the bacteria’s natural electrical charge. Upon contact with water, the product self-assembles into a polymer that is electrostatically attracted to bacterial cells, leaving healthy human cells untouched. The polymer acts to destroy the bacterial cell membrane, a mode of attack that is distinct from that of antibiotics.
Michael Otto, a biofilms expert at the federal NIAID Laboratory of Human Bacterial Pathogenesis, cautions that the present studies still lack in vivo demonstration and the product may behave differently in the presence of tough-to-penetrate biofilms.
Read more here.
Fecal Transplants more effective than vancomycin for recurrent C. diff infection
Recurrent Clostridium difficile is a recalcitrant infection with high failure rates for antibiotic therapy. A recent clinical trial reports the promising use of fecal transplants as an alternative to conventional antibiotics. The trial compared a standard vancomycin regimen against an initial vancomycin regimen (followed by bowel lavage) and a subsequent infusion of a solution of donor feces administered through a nasoduodenal tube. The trial was halted early due to the overwhelming success of the transplants. At least two other trials are now underway, in Canada and in the United States, where transplants are done via colonoscopy. Leaders in gastroenterology are advocating not only to make fecal transplants mainstream, but to make them the primary treatment for C. diff and other gut disorders.
Vincent Young, a microbiologist at the University of Michigan, lauds the success of the procedure for recurrent C. difficile infections, but cautions that more research is needed before broadening the therapy. "Gut bacteria that make one person healthy might cause health problems in another," he says.
Novel strategy weakens bacteria against antibiotics
A team from Harvard's Wyss Institute for Biologically Inspired Engineering and Boston University has manipulated the byproducts of E. coli’s innate metabolism (specifically the reactive oxygen species, or ROS production system) to render the cell weaker to antibiotics. By deleting a series of genes, they ramped up the cells production of molecules such as superoxide and hydrogen peroxide—by-products of normal metabolic activity—which, in overproduction, render the cell more susceptible to antibiotics and biocides. The team's next steps are to use molecular screening technologies to identify molecules that boost ROS production, and to test the approach on other bacterial species.
Read more here.
Evolutionary consequences of antibiotic use exposed
The widespread use of antibiotics has evolutionary and ecological consequences that have been only minimally examined, according to Michael Gillings, professor of biological sciences at Macquarie University in Australia. Antibiotics should be regarded as pollutants, since human production exceeds natural synthesis, and a large proportion enters the waste stream unmodified. Such antibiotic pollutants raise the general rates of mutation, recombination, and lateral gene transfer in the total microbiome. Their selective force results in the assemblage of complex, novel genetic elements that are now fixed at high frequency in diverse bacterial species. As such, these become “xenogenetic pollutants” that can replicate rather than degrade. Because these molecules act as drivers of bacterial evolution, the human use and release of antibiotics into the environment is having second-order effects on the microbial world.
Read more here.
February 26 – March 5, 2013: Global Health Week on the Hill
Global Health Week on the Hill includes briefings for Hill staffers, release of important new numbers in global health, and a reception. This year, the Global Health Experience exhibit —a47’ x 9’ global health display— will transport visitors to Tanzania and India through replica village displays and a5-minute, mobile phone-guided tour. The exhibit focuses on two key issues: the health of mothers and their babies, and malaria. Visitors will learn that maternal and infant deaths have declined globally, though much effort is needed to halt millions of preventable child deaths. While malaria is preventable and treatable, it continues to exact a devastating toll on the world’s poorest populations.
The Global Health Experience exhibit in Washington, D.C. is sponsored by The Washington Global Health Alliance, along with partners from PATH, the GAVI Alliance, the UN Foundation’s Nothing But Nets campaign, World Vision, International Medical Corps, the Institute for Health Metrics & Evaluation, the Global Health Council and the Global Health Technologies Coalition.
March 8-10, 2013: National Foundation for Infectious Diseases’ Clinical Vaccinology Course
This 2 1/2-day course in Chicago focuses on new developments and issues related to the use of vaccines. Expert faculty will provide the latest information on both current and prospective vaccines, updated recommendations for vaccinations across the lifespan, and innovative and practical strategies for ensuring timely and appropriate vaccination. The target audience includes physicians (family, internists, pediatricians, and infectious disease specialists), nurses, nurse practitioners, physician assistants, pharmacists, vaccine program administrators, federal, state, and local public health professionals, and other healthcare professionals interested in clinical aspects of vaccine delivery. Credit hours are available (21.75 max; CME, CNE, ACPE).
August 2 – 3, 2013: ASID Gram Negative ‘SUPERBUGS’ Meeting
The Australasian Society for Infectious Diseases will hold a two-day meeting on the Gold Coast to convene clinicians, microbiologists, pharmacists, infection control nurses and researchers from Asia, Australia and New Zealand and will provide updates on the issues of Gram-negative “Superbugs”. International and local speakers will review novel therapeutic approaches, the importance of the microbiology laboratory, dosing optimization and the use of combination therapy and innovative approaches to infection control. This is the first meeting of its kind.
The International Fellowship Program, offered through the American Society for Microbiology (ASM), gives young investigators from developing countries the opportunity to work with microbiologists in the U.S. or Canada. Each awardee visits North America for a minimum of six weeks and collaborates with an ASM member who is permanently employed at an accredited institution. ASM currently has Fellowship programs in Latin America, Asia, Africa, and India.