APUA Highlights: June 2015
APUA Headquarters in Action
President Levy attends White House summit on antibiotic stewardship
Since its founding in 1981, APUA has worked diligently to educate and alert the medical establishment and the public about the dangers of antimicrobial resistance. While the threat has unfortunately escalated tocrisis proportions, it is encouraging to see that this critical issue has finally reached the attention of the White House, propelling the President to take action in the form of several executive actions to promote the responsible use of antibiotics. On June 2, 2015, APUA President Stuart Levy was invited to the first ever “White House Forum on Antibiotic Stewardship”—aday-long summit which was attended by over 150 human and animal health stakeholders and widely publicized by the press. APUA joined multiple government, non-profit and commercial entities in pledging its support by supplying the Centers for Disease Control with plans designed to confront the antibiotic resistance issue over the next 5 years.
APUA proposed activities that are in line with its mission of strengthening educational programs: promoting good antibiotic stewardship; working towards the elimination of antibiotics for growth promotion in food animals; advancing the development and use of rapid diagnostics; and using its country-based chapters for international collaboration on research and development, information dissemination, and prevention, surveillance and control of antimicrobial resistance.
APUA announces 2015 Honor Roll Companies
On June 23, APUA announced its second roster of Honor Roll awardees—commercial food production companies that have made a public commitment in their policy towards responsibly limiting antibiotics in their food production. In its press release, APUA commended the following companies, based on their antibiotic practices and guarantees: Costco, McDonald’s, Perdue Farms, Smithfield and Tyson Foods.
It is notable that in 1 year, the number of companies taking a stand towards responsible antibiotic use has continued to expand, thereby spreading the initiative to exert more stringent controls on antibiotic use in food production. APUA’sfirst Honor Roll, issued in 2014, honoredApplegate, Bell & Evans, Chipotle, Coleman Natural, Heritage Acres Foods, Niman Ranch, Panera Bread, Sweetgreen, and Whole Foods.
The Honor Roll project is aligned with recent US federal actions which aim to combat the rise in antibiotic resistant bacteria, in particular by addressing the overuse of antibiotics for growth promotion in food animals.
APUA and BacterioScan collaborate on diagnostics webinar
The importance of rapid diagnostics in identifying bacterial pathogens and their antibiotic susceptibilities cannot be over-emphasized and has been underscored by the recent $ 20M prizes offered both here and abroad for a rapid point-of-care diagnostic test to identify bacterial pathogens and the need for an antibiotic. As part of its educational outreach efforts, APUA has teamed up with BacterioScan to produce the webinar titled “Rapid Diagnostics in Clinical Microbiology as an Aid to Antibiotic Stewardship” with Dr. Geraldine S. Hall PhD., D (ABMM), F (AAM) This webinar:
- Describes and explores the impact of existing and novel methods for the rapid determination of antibiotic susceptibility and
- Looks at possibilities for integration of these to improve antimicrobial use and clinical and economic outcomes.
Access the webinar here.
APUA President Levy featured on Paris forum
APUA President Levy is among a select list of speakers invited to the forum, “Early Days of Multidisciplinary Reflection”, sponsored by Merck, Sharpe and Dohme, France. Dr. Levy will offer a plenary talk titled: “A Rebirth for Antibiotics”. The June 30 - July 1 symposium, “Antibiotics: Innovation Breaking out of the Innovation”, will feature expert talks on current problems in bacterial resistance and antibiotic development.
International Chapter News
APUA-Kenya remains active under the leadership of Sam Kariuki. Some activities from the last quarter of 2014 and early 2015 are listed below:
1. Kenya’s Antimicrobial Resistance (AMR) Week was launched on November 17, 2014 by the Director of Medical Services, Ministry of Health, with representatives from the Director of Veterinary Services, Ministry of Agriculture Livestock and Fisheries, Country Director Center for Disease Control, and Country Representative, Management Sciences for Health. The event was attended by 120 participants drawn from various institutions across the country.
2. The Director of Medical Services, Ministry of Health has committed to: a) the appointment of a multidisciplinary AMR advisory board, and b) the establishment of a focal point to coordinate AMR at the National Level.
3. The University of Nairobi, in conjunction with the Infectious Diseases Society of Kenya hosted a 3-day symposium on Antimicrobial Use and Resistance in East Africa, June 18-19, 2015. President Sam Kariuki gave a plenary talk on Antimicrobial Resistance in Livestock and Public Health Implications.
APUA-Brazil continues to give national interviews concerning the problem of antimicrobial resistance. Additionally, it is working jointly with the Infectious Disease Society of Brazil in the ongoing process of developing a Guide for Isolation and Contact Precautions on Multidrug Resistant Organisms (MDROs). Using its posters and fact sheets about MDROs, the chapter is reaching out to other organizations to provide support. A list of more than 400 doctors, nurses, pharmacists, etc. has been compiled and targeted to receive ongoing publications on antibiotics, bacterial resistance, education, precautions contact training, and diagnostics. APUA-Brazil strongly supports and values the importance of disseminating such publications because not all medical professionals have the opportunity to attend an International Congress.
In the near future, the Chapter would like to organize a meeting on Antimicrobial Resistance. The Chapter is in collaborative discussion on a meeting focused on the importance of the microbiology laboratory in the control of MDROs.
News and Publications of Note
Consumer Reports commits to supporting antibiotic resistance initiatives
Consumer Reports has announced its commitment to help rein in the mounting problem of antibiotic-resistant bacteria. Beginning with participation in the recent White HouseForum on Antibiotic Stewardship, the organization has launched an initiative that includes an upcoming investigative Consumer Reports series on antibiotic resistance—targeting overuse and misuse of antibiotics, the surge of superbugs in hospitals, and the role of antibiotics in meat production. The August 2015 issue of Consumer Reports magazine and ConsumerReports.org will feature Part One of “How to Stop a Superbug.”
With support from the Robert Wood Johnson Foundation, the organization has also announced its collaboration with seven U.S. health care organizations to reduce the inappropriate use of antibiotics. Continuing its multi-year efforts to highlight the issue of antibiotic overuse in humans and animals, Consumer Reports will lend its support to the following initiatives:
· Requiring health-care providers to report antibiotic use and antibiotic-resistant infections.
· Mandatory real-time reporting of antibiotic-resistant outbreaks.
· Better diagnostic tests to differentiate viral from bacterial infections
· Rigorous pre-market safety tests for new antibiotics.
· A ban on antibiotic use in healthy food animals.
CDC shows support for antibiotic stewardship programs
As antibiotics become increasingly compromised in the face of escalating antibacterial resistance, antibiotic stewardship is rising in importance and has become one of several strategies being promoted by the President’s National Action Plan for Combating Antibiotic-Resistant Bacteria. The CDC supports this initiative by providing essential information and data to stewardship programs in health care facilities around the country. These programs have a track record of cutting healthcare costs and improving patient outcomes.
The agency teaches that antibiotic stewardship does not mean stopping the use of antibiotics, but rather, using antibiotics only when necessary and appropriate. The CDC’sAntibiotic Resistance Solutions Initiative has been published as a comprehensive response and features three key message points:
- Ask your doctor if antibiotics are necessary.
- Take your antibiotics exactly as prescribed by your doctor.
- Do not share or save antibiotics.
Read more here.
US FDA urged to establish more stringent antibiotic policies for livestock
The United States FDA has long been criticized by pro-antibiotic stewardship groups for not doing enough as a regulatory body to monitor and control antibiotic misuse and overuse in animal food production. In early June, the agency published an update to its policies, called the Veterinary Feed Directive, which officially bans the use of antibiotics for growth-promotion in animal production. This legislation makes it impossible for farmers to purchase antibiotics over the counter, and necessitates that a veterinarian be consulted. This will limit the amount of antibiotics that are being dispensed, in theory.
As much as this development is celebrated, it unfortunately will not do much to curb the ongoing dangerous misuse of antibiotics on farms, as the agency does not have a mechanism for proper monitoring of the use of these drugs on farms. Additionally, it is estimated that 30% of drugs allowed by the FDA do not have specific duration of treatment, which means it is impossible to tell whether or not an animal is being given antibiotics for disease-prevention, treatment, or growth-promotion. Realizing this gap, the agency plans to collaborate with the CDC and USDA to collect animal and farm-specific data that will lead to more meaningful conclusions and reveal trends of resistance.
Poor communication breeds superbugs
It is clear that, in the United States, progress is being made in the fight against antibiotic-resistant bacteria. However, in a recent Huffington Post article (Super Bug Silos), microbiologist Lance Price explained that there are silos that inhibit even more rapid development. These silos are primarily defined by lack of communication between the various stakeholders engaged in this fight – researchers communicate their ground-breaking findings with other researchers, but not with policymakers, journalists, industry representatives, or the general public.
This phenomenon was further observed at the recent White House Forum on Antibiotic Stewardship where the various stakeholders were kept apart in two groups—onefor human stewardship and the other for animal stewardship. The argument is made that these two are closely linked, and thus should not be treated as different issues if accelerated progress is to be made. Dr. Price stressed this point, stating “We must break out of these silos and work together to stop the flow of superbugs and protect antibiotics for future generations.”
Azithromycin proves to be more valuable than previously thought
Researchers at the University of California, San Diego have discovered that contrary to popular belief, the antibiotic azithromycin proves to be effective against many multi-drug resistant bacteria when tested under conditions that mimic the human body. Although azithromycin is the most prescribed antibiotic in the United States, it is often used only for common bacterial infections such as strep throat and sinusitis, but not for multi-drug resistant bacterial infections. In studying virulent and highly antibiotic-resistant strains of Pseudomonas aeruginosa, Klebsiella pneumoniae and Acinobacter baumannii, researchers found that when these gram-negative bacteria were cultured n mammalian tissue, (rather than the standard bacteriologic media), the sensitivity to azithromycin was significantly different. It was further observed that when azithromycin is paired with the antibiotic colistin or naturally-occurring antibacterial peptides, the superbugs were completely eliminated. In mice infected with these same strains and treated with a single dose of azithromycin, (similar in concentration to that administered to humans), lung tissue had 99% fewer bacteria 24 hours after infectionthan that of untreated mice.
The researchers believe that their findings will lead to a reevaluation of the current standard of care for patients afflicted with these deadly superbugs.
Interview: Biopharma expert Steve Projan poses more optimistic view on future of anti-infectives
Unit Head of Infectious Diseases and the Vaccines Innovative Medicines at MedImmune, Dr. Steve Projan, was interviewed by BioPharma Dive in which he talked about new developments in biotechnology and antibiotic resistance. When asked about the widespread belief that we might be heading towards a future with rampant AMR—a so-called ‘pre-antibiotic era’—Dr. Projan was not so pessimistic. Noting that the large majority of bacterial infections are still treatable, he also cites examples, such as the bacterium Treponema pallidum (agent of syphilis), which possesses no capacity for developing resistance and remains acutely susceptible. Further, he also believes there are mechanisms that can be implemented to ensure the efficacy of present and future antibiotics. Of priority importance is the early detection and prevention of infections. Second is to develop highly species-specific antimicrobials that will essentially eliminate pathogens. Read the complete interview here.
Director Michael Graziano turns his attention to Clostridium difficile and fecal transplants in new film
Michael Graziano, director of the film Resistance, (also available on Netflix and from the iTunes store) has a new film that explores the use of fecal transplants to combat Clostridium difficile (C. diff). Entitled Why Would Anyone Get a Fecal Transplant? this 12-minute film follows a young woman who developed C. diff after intensive treatment for a dangerous antibiotic-resistant staph infection (MRSA). This short film explains Fecal Microbiota Transplantation (FMT), what is at stake with C. diff and the reasons FMT remains a marginal treatment.
Drug development, stewardship programs encouraged in the US to tackle antibiotic crisis
Hampton, T. June 23/302015. Novel programs and discoveries aim to combat antibiotic resistance JAMA 313(24):2411-2413
Antimicrobial resistance (AMR) has become a leading global public health concern of our times. With ~ 700,000 deaths per year worldwide, it is estimated that 10 million will die by 2050 if the current trend continues. For the past several decades, the notion that developing new antibiotics is not as profitable as other medications has kept large pharmaceutical companies out of the antibiotic sphere. New innovations and discoveries in antibiotics have been relegated to academic centers and smaller companies who lack the clout of the pharma giants. Harvard professor Aaron Kesselheim urges a reversal of this thinking, stating “We need to support this work with greater public investment and other tailored incentives that focus on antibiotics of high clinical need, but we also need systems in place to ensure rational use of the products once approved, or else we’ll never break the cycle we’re in now.” This article, published in The Journal of the American Medical Association, explores the current response to the antibiotic crisis in the United States, including increases in federal funding, financial incentives in stewardship and infection prevention, novel approaches, new diagnostic tools, and new innovations in the antibiotic pipeline, including non-antibiotic therapies.
New NARMS report reveals resistance trends in enteric bacteria
The National Antimicrobial Resistance Monitoring System (NARMS) recently published its 2013 Human Isolates Final Report on enteric bacteria. The report includes CDC surveillance data for nontyphoidal and typhoidal Salmonella, Shigella, Campylobacter, E. coli O157, and non-cholerae Vibrio species. 2013 isolates were compared with isolates from two references periods: 2004-2008 and 2008-2012 in order to determine current trends. Additionally, the report notes increased resistance to macrolides in Campylobacter; increasing non-susceptibility to quinolones among nontyphoidal Salmonella and a continued rise of MDR resistance in Salmonella ser 14,.12:i:-. In 2013, NARMS added cefotaxime, ceftazidime, gentamicin, and imipenem to the already existing cadre of antimicrobial agents.
The full report can be accessed here.
ILRI publishes report on AMR in the developing world
In early June, the International Livestock Research Institute (ILRI), published its Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries. The report, (authored by D. Grace) examines the sources of resistance, the gaps that exist in the knowledge of livestock and fisheries-linked antimicrobial resistance, and identifies current and planned initiatives to address the issue in the developing world. Although antimicrobial-resistant pathogens are found in animals, animal food products, and the agro-food environment, a lack of surveillance systems and reliable data make it difficult to draw conclusions on how these affect human bacterial infections.
According to the report, China, Brazil and India are current antimicrobial resistance (AMR) hotspots due to a rapid growth in intensive agricultural production systems. If the trend continues, more AMR is expected to be seen across Southeast Asia, South America, and Nigeria. The most effective strategies currently being used to address AMR in developing countries include training, education and changing market conditions to provide incentives for compliant farmers.
Upcoming Events & Opportunities
September 17-21, 2015: ASM's Interscience Conference on Antimicrobial Agents and Chemotherapy and ISC's International Congress of Chemotherapy, San Diego, CA, USA
ICAAC/ICC 2015 will bring together an impressive group of clinical microbiologists, infectious disease physicians, pharmacists, and researchers together in San Diego for 5 days of learning and connecting. It will provide an environment for discussion and collaboration while exploring new advances in drug development and research with a focus on antibiotic resistance and antibiotic stewardship.
The objectives of the congress include:
- 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 diverse therapeutics
- Introduce new antimicrobial agents
- Consider the most recent trends in healthcare management
October 15-16, 2015: IACMAC Volga Region Conference on Antimicrobial Therapy, Saratov, Russia
IACMAC is a non-profit organization devoted to the promotion of research and education in the fields of clinical microbiology and antimicrobial chemotherapy. It was founded in 1997 and now includes over 2300 members from 36 regions of Russia. IACMAC has been affiliated with the International Society of Chemotherapy (ISC) and the Federation of the European Societies for Chemotherapy and for Infection (FESCI) since 1997, and with The Federation of European Microbiological Societies (FEMS) since 2001, and works in collaboration with WHO, the Alliance for the Prudent Use of Antibiotics (APUA), the European Society for Clinical Microbiology and Infectious Diseases (ESCMID), the American Society for Microbiology (ASM), and the European Commission.
IACMAC holds scientific conferences, supports postgraduate education and teaching, and collaborates on research projects and professional matters.
October 31- November 4, 2015: The American Pulic Health Association Annual Meeting & Exposition, Chicago, IL, USA
At APHA’s Annual Meeting and Exposition, public health professionals convene to discuss latest research, trends, advocacy and policy issues, and engage with one another to strengthen the field. The 143rd Annual Meeting will offer over 1,000 scientific sessions and general sessions featuring keynote speakers on the most pertinent global public health issues. Participants will also have the option of attending:
- Learning Institutes for more intensive learning
- Public Health Awards Ceremony and Reception
- Business meetings
- Social hours
- Social Media Lab
April 9-12, 2016: 26th European Congress of Clinical Microbiology and Infectious Diseases, Istanbul, Turkey
Congress sessions are geared toward participants with different levels of experience and different positions. ECCMID 2016 will include a variety of active and interactive session formats such as: Educational Workshops, Scientific Symposia, Meet-the-Expert Sessions, Oral Sessions, Keynote Lectures and the Trainees Day.