APUA Highlights: July 2013
Supporting Chapters APUA Project Partnerships
APUA - Abu Dhabi The Bill and Melinda Gates Foundation National Biodefense Analysis and Countermeasures Center
APUA - Australia The Pew Charitable Trusts World Health Organization (WHO)
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)
World Bank Ministries of Health
U.S. Agency for International Development (USAID) World Bank
U.S. Department of Agriculture (USDA) Ministries of Health
U.S. Office of Homeland Security
APUA gratefully acknowledges unrestricted grants from corporate sponsors:
APUA Headquarters in Action
In a letter published in NEJM, APUA cautions against use of antibiotics to treat malnutrition
On June 20, a letter crafted by the APUA Nutrition Group was published in the New England Journal of Medicine. The letter, which cautioned against the use of antibiotics to treat malnutrition in resource-limited settings, was a response to an earlier article by researchers at the University of Washington in St. Louis who tested antibiotic treatment of severely malnourished Malawi children in a clinical trial. 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 their outpatient treatment with ready-to-use therapeutic foods (RUTFs).
APUA compiled expert opinion from its Scientific Advisory Board, including co-authors Iruka Okeke, Jose Ramiro Cruz, and Gerald Keusch, in order to formulate an editorial in response to the suggested implementation of routine antibiotics for severe malnutrition. APUA supports further research because the potential broad-scale expansion of antibiotic use could prompt widespread antibiotic misuse and resistance in the community. Instead, researchers should focus on immediate expansion of validated interventions, including breast-feeding, the use of probiotics, and increased access to traditional RUTFs and clean water. These strategies will be more effective in reducing malnutrition in the long run.
APUA study cited in The Preventing Antibiotic Resistance Act of 2013
The Preventing Antibiotic Resistance Act of 2013, introduced in late June, would limit the use of antibiotics important to human health in the livestock industry. Put forth by Senator Dianne Feinstein (D-CA) and cosponsored by Senators Susan Collins (R-ME), Jack Reed (D-RI), Maria Cantwell (D-WA), Kirsten Gillibrand (D-NY) and Barbara Boxer (D-CA), the act allows for therapeutic use of antibiotics in livestock, with dosages geared toward treating a specific disease or infection. The standard industry practices of adding antibiotics to feed for prophylactic and growth-promoting purposes, however, would no longer be allowed.
An APUA study was cited to support the claims of the bill: “In 2009, Cook County Hospital and the Alliance for Prudent Use of Antibiotics estimated that the total health care cost of antibiotic resistant infections in the United States was between $16,600,000,000 and $26,000,000,000 annually.”
Senator Edward Kennedy had originally suggested to APUA that an authoritative estimate on the cost of resistant infections in the U.S. was necessary to gain the attention of policy makers in Washington. The previously published figures available were outdated, incomplete, and woefully underestimated. APUA instituted this study through an unrestricted grant from bioMérieux. APUA staff designed the methodology and engaged expert partners at Cook County Hospital to do a thorough analysis based on case records and coauthored the peer reviewed report, which appeared in Clinical Infectious Diseases.
PBS Frontline interviews APUA President Levy on antibiotic use in food animals
Dr. Stuart B. Levy was recently interviewed by David Hoffman, former editor and reporter for the Washington Post, for a PBS Frontline story on antibiotics and modern meat. Data on antibiotic use in the meat industry are not publicized, but Dr. Levy estimates that there are 15-17 million pounds of antibiotics used sub-therapeutically in food animals in the U.S. each year. The debate over this practice centers on scientists’ concerns about the link between low-dose usage of antibiotics in food animals and drug-resistant infections in people, especially the acquisition of drug-resistant pathogens through improperly cooked food.
While some stakeholders find the quality and quantity of scientific evidence inconclusive, the consensus among scientific experts is that growth-promotion antibiotic use in animals should be banned for those drugs that are also used in human medicine.
Read more here.
APUA receives unrestricted grant from Alere to produce educational materials
APUA received an unrestricted grant from Alere, a diagnostics and health management company to produce educational materials on antibiotic stewardship. APUA is producing independent, non-commercial content on antibiotic resistance and stewardship through 2014. One of the first events is an accredited webinar on antimicrobial stewardship programs, hosted by Dr. Phil Carling of Carney Hospital in Boston, MA and the Boston University School of Medicine.
Last year, APUA hosted a webinar, "Containing Healthcare Associated Infections Through Antibiotic Stewardship" during the CDC's Get Smart about Antibiotics Week. The webinar, also supported by Alere, was presented by Stuart Levy, APUA President, and Shira Doron, a professor at Tufts University School of Medicine.
APUA attended Massachusetts Coalition Workshop on UTI in the elderly
On June 18, 2013, APUA staff participated in a workshop titled Improving Evaluation and Treatment of UTI in the Elderly: A Cross-Continuum Approach to Antibiotic Stewardship Final Workshop, sponsored by the Massachusetts Coalition for the Prevention of Medical Errors. The workshop, which focused on improving the evaluation and treatment of urinary tract infections (UTI) in the elderly, highlighted new multi-drug resistant organisms (CRE and ESBLs) that are raising concern in Massachusetts and elsewhere. Experts encouraged antibiotic stewardship through improved surveillance, diagnosis, and treatment of UTI in short- and long-term care facilities. Participants shared informal presentations on failures and successes in decreasing unnecessary testing and antibiotic over-prescription for UTI in their healthcare facilities. Break-out groups addressed specific topics, such as how to successfully encourage behavioral modification among staff that might be resistant to change. Overall, workshop leaders encouraged engagement in order to create a useful learning experience that will lead to more prudent usage of antibiotics for UTI in the elderly.
Learn more about Mass Coalition’s tools for improving evaluation & treatment of UTI in the elderly.
APUA signs on to antibiotic resistance-related initiatives
Representative Jim Matheson (D-Utah) reintroduced the Strategies to Address Antimicrobial Resistance (STAAR) Act, urging Congress to address the growing problem of antimicrobial resistance and the scarcity of new antimicrobials. “Antimicrobial resistance is often caused by the overuse of antibiotics. My bill addresses this problem by calling for data collection on antibiotic use as well as research to combat so-called ‘superbugs,’” said Matheson in a press release. The STAAR Act would reauthorize the Antimicrobial Resistance Task Force, build upon existing efforts by the NIH and CDC for research and prevention of resistance, and develop and test quality measures on antimicrobial use. The IDSA led a group of more than 20 organizations, including APUA, to support the Act.
Antimicrobial Data Collection Act
The Antimicrobial Data Collection Act, introduced May 8 by U.S. Senators Kirsten Gillibrand (D-NY), Dianne Feinstein (D-CA), and Susan Collins (R-ME), requires the FDA to report more information on the annual sales of antibiotics used among industrial farm animals. The bipartisan bill would give the agency a deadline to finalize policies proposed last year to eliminate the use of antibiotics for growth promotion purposes in meat production. Provisions call for comprehensive and public reporting of data by the FDA each year. Under the bill, the agency’s reports on these sales would be broken down by dosage form (in feed, in water, or by injection), marketing status (that is, whether they are available over the counter or by veterinary order), and indication of whether the drugs are important in human medicine.
Groups challenge FDA defense of NARMS 2011 Retail Meat Report
The FDA recently released a statement that challenged the findings of the Environmental Working Group’s (EWG) summary report of the National Antimicrobial Resistance Monitoring System (NARMS) 2011 Retail Meat Report. The FDA claimed the EWG report was alarmist, oversimplified the NARMS data, and provided misleading conclusions. In support of the EWG, the group Keep Antibiotics Working was troubled by the fact that the FDA downplayed the risks of antimicrobial resistance and de-emphasized the importance of resistantEnterococcus. KAW has drafted a sign-on letter, reviewed by Pew Trusts, asking the FDA to rescind the public statement that labeled the EWG as providing inaccurate and misleading information.
News and Publications of Note
UK raises alarm on rise of deadly superbugs
UK Science Minister David Willetts proposed extensive measures at the G8 Summit in June to control the overprescription of antibiotics by doctors and the misuse of antibiotics to boost yields on farms and in fisheries. Willetts told the Guardian that “the spread of antibiotic resistance [is] a global challenge that is up there with climate change, water stress and environmental damage, and there are genuine policy consequences that follow from that.” Great Britain appears to be taking the lead on this important issue, as Dame Sally Davies, England’s chief medical officer, has already asked for antibiotic resistance to be added to the UK government’s national risk register. Davies ultimately seeks a UN treaty banning antibiotics in food production, streamlining the regulatory process for licensing new drugs, and committing nations to educate the public on more prudent usage of the drugs. The UK government is set to publish an antimicrobial resistance strategy in July, and used the G8 meeting as an opportunity to urge other countries to follow its example.
Read more here and watch the video here.
FDA backs off from fecal transplant regulation
The Food & Drug Administration will no longer require agency approval before performing fecal transplant procedures, and will instead exercise enforcement discretion. In response to backlash from health care professionals when it announced the original plan, the FDA conceded that it would not impede patients’ access to such a promising therapy. Fecal transplants are quickly becoming a popular treatment for patients diagnosed with Clostridium difficile, or C. diff, a severe infection of the colon that is hard to treat and often life-threatening. The highly effective treatment involves the infusion of microbe colonies from the stool of a healthy person into the intestines of an infected patient. Federal regulators worry, however, that patients may be exposed to unforeseen risks if the procedures continue to be unregulated. The FDA maintains its plan to develop policy guidelines for both the study and use of the fecal transplants.
Drug-resistant gonorrhea on the rise in Great Britain
Gonorrhea is becoming increasingly resistant to existing antibiotics. A recent study in England and Wales found a nearly six-fold increase in the number of gonorrhea cases exhibiting decreased sensitivity to the drug cefixime between 2004 and 2011. One by one, the effectiveness of drugs for gonorrhea has declined, as the incidence of drug-resistant strains continues to grow worldwide. Cefixime and ceftriaxone are the only two agents that remain effective in treating gonorrhea, but their efficacy is also threatened. Mounting resistance is a cause for alarm in many countries, including in the US, where the CDC issued new guidelines last summer for the treatment of the sexually transmitted disease.
Read more here.
Stewardship intervention helps limit antibiotic misuse in children
Researchers have found that a one-hour educational session followed by personalized feedback for 12 months aided pediatricians in prescribing antibiotics in greater accordance with national guidelines. The researchers tracked how often doctors prescribed a broad-spectrum antibiotic versus a narrow-spectrum one for children with pneumonia or a sinus infection. Broad-spectrum antibiotics, which can kill a wider variety of bacteria than narrow-spectrum agents, are seen as more likely to contribute to antibiotic resistance. Doctors at 9 of the 18 pediatric primary care practices involved in the study received education and electronic feedback guidance. Those receiving the intervention reduced prescription of broad-spectrum antibiotics by nearly half (48.1%), while the control group showed a 17.9% reduction. While it is unclear from these findings if the benefit of education and feedback would continue after regular feedback ceased, it is important to note the possibility for increased education efforts to limit the misuse of antibiotics at the doctor’s office.
Are antibiotics in our meat breeding “superbugs”?
Tom Ashbrook and NPR’s On Point hosted a discussion on the issue of antibiotic resistance that stems from the overuse of antibiotics as growth promoters in food animals. U.S. Representative Louise Slaughter, the only trained microbiologist in Congress, offered her opinion on the alarming use of antibiotics in livestock and the need for policy changes to prevent breeding more superbugs. Slaughter is currently promoting two bills in the House: the Preservation of Antibiotics for Medical Treatment Act (PAMTA) and the Delivering Antimicrobial Transparency Act (DATA) to improve the quantity and quality of publicly available information about the use of antibiotics in livestock. Mike Apley, veterinarian and researcher at Kansas State University, expressed the concerns of farmers in raising livestock without antibiotics and cautioned that the statistics reported on antibiotic use are often misinterpreted. Lance Price, Professor of Environmental and Occupational Health at GWU, spoke of the public’s right to such data and the need for transparency that allows reliable tracking of drug use and infection incidence. Lastly, Stephen McDonnell, Founder and CEO of Applegate Farms, added that his company’s method of producing organic and natural meats without antibiotics is feasible and one that the whole country can and should adopt.
New guidelines advise delaying antibiotics for children with sinusitis
In its July issue of Pediatrics, The American Academy of Pediatrics encourages doctors to wait a few extra days before prescribing antibiotics to young patients with sinus infections. The new guidelines, based on 17 randomized studies of sinusitis in children, were recommended by the AAP Subcommittee on Acute Sinusitis. In an acknowledgement of the rampant overuse of antibiotics and its implications for bacterial resistance, The AAP has been encouraging a reduction in antibiotic use, which includes new guidelines for ear infections published earlier this year.
ANTIRESDEV research project publishes findings on antibiotic resistance
ANTIRESDEV, an EU-funded 42-month research project on antibiotic resistance selection recently published its final report to the European Commission. The researchers, coordinated by Professor Michael Wilson at University College London, studied the impact of different antibiotics on resistance selection among pathogenic and commensal members of the microbiota that are indigenous to humans. It also sought to determine the effects that antibiotics have on the composition of indigenous microbial communities using both culture-dependent and culture-independent approaches.
APUA Chapter News
APUA-Mexico holds workshop on the rational use of antibiotics at AMIMC
In May, the APUA-Mexico Chapter participated in the 38th annual Congress of the Infectious Diseases and Microbiology Clinic Mexican Association (AMIMC). The chapter held a workshop on "Rational Use of Antibiotics” in Guadalajara attended by physicians interested in the area of infectious diseases, control of the use of antibiotics and bacterial resistance. Speakers re-emphasized antimicrobial resistance as one of the top health priorities in the Congress. The workshop was held to exchange best practices and foster discussion about solutions such as improved data collection and surveillance, eliminating the overuse of antibiotics, and reducing the use of critically important antibiotics. In particular, the workshop drew attention to the alarming upward trend in antibiotic resistance.
Dr. Miguel A. Peredo from the APUA-Mexico chapter also addressed the links between antibiotic use in hospitals, communities and animals. He concluded that the problems of high antibiotic consumption levels in both humans and animals cannot be solved in isolation.
APUA-Lebanon conducts research on Acinetobacter baumannii
APUA-Lebanon conducted a study on the epidemiology and resistance of Acinetobacter baumannii in northern Lebanon. The research, led by Ziad Daoud, professor of clinical microbiology at the University of Balamand, will be published in the summer issue of the APUA Newsletter.
Aug 2 – 3: Australasian Society for Infectious Diseases (ASID): Gram Negative 'Superbugs' Meeting | Gold Coast, Australia
ASID is holding a 2-day meeting to bring together clinicians, microbiologists, pharmacists, infection control nurses and researchers from Asia, Australia and New Zealand to provide a state-of-the-art update 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.
Aug 30 – Sept 1: Clinical Infectious Diseases Society Conference (CIDSCON 2013) | Mumbai, India
The 3rd Annual Conference of The Clinical Infectious Diseases Society will be held in Mumbai, India. Advances in basic sciences are influencing the practice of Infectious Disease on an unprecedented scale. The theme of this conference is ‘How Science Drives the Art’. The sessions, geared towards practitioners and students, will be clinically relevant, interactive, and lively. Building on the success of the previous meetings, CIDSCON 2013 promises to be the premier scientific event of the year.
Sept 10 – Sept 13: Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC 2013) | Denver, CO, USA
ICAAC 2013 is an annual scientific conference that provides an educational forum covering current trends in infectious diseases. The sessions are meant for health care professionals, particularly physicians, clinical microbiologists, researchers, and pharmacists specializing in infectious diseases. The objectives of the conference are to:
- Disseminate new data from research of basic microbiological sciences related to human disease;
- Update medical professionals on clinical diagnoses, preventative modalities and therapeutics;
- Investigate the pathogenesis and epidemiology of old and new microbes;
- Evaluate the spread of infectious diseases throughout the world;
- Analyze the developing resistance of pathogens to divers therapeutics;
- Introduce new antimicrobial agents; and
- Consider the most recent trends in healthcare management.
Sept 28: MRSA Survivors' Network hosts 5th Annual World MRSA Day Kickoff Event and the Global MRSA & C. diff Summit | Chicago, IL, USA
World MRSA Day is designed to raise the awareness of MRSA around the globe and to activate survivors, communities, governments, healthcare officials and personnel to join together to stop the spread of this preventable disease. The event was launched by Jeanine Thomas, President and Founder of MRSA Survivors Network, the first advocacy group in the U.S. to raise the alarm about the MRSA epidemic and other healthcare-acquired infections.
Oct 2 – 6: IDWeek 2013 | San Francisco, CA, USA
“Advancing Science, Improving Care” is the theme of IDWeek, which features the latest science and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases. Hosted by the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS), IDWeek is a forum for health professionals of varied backgrounds to collaborate, cooperate, and learn from each other’s expertise. The conference is one of the largest infectious diseases meetings in the world and features interactive sessions, symposia, poster discussion rounds, and exhibits.
Program Director, International Society for Infectious Diseases (ISID)
The International Society for Infectious Diseases seeks a Program Director to oversee all scientific training, educational, and professional development programs. Principal responsibilities include program development and management, supervision of personnel, and fund-raising in conjunction with the Development Director. This position requires an MD or a Ph.D. with a strong understanding of infectious diseases clinical practice and research, management and communications skills, the ability to work with individuals from diverse background around the world, and solid writing skills. This position is located in Boston, requires a half-time commitment, and involves some travel.
For more information, please visit the ISID website.
Editor-in-chief, Open Forum Infectious Diseases (OFID)
The Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) announce the search for Editor-in-Chief of a new journal, Open Forum Infectious Diseases (OFID), to be launched early in 2014 and published by Oxford University Press. OFID will provide a global forum for the rapid publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID will provide the international community of infectious diseases experts a venue for articles that further the understanding of all aspects of infectious diseases.
For more information, please visit the IDSA website.