APUA Highlights: October 2013
APUA Partners
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
APUA attends IDSA’s annual Infectious Diseases (ID) Week
APUA’s President, Dr. Stuart Levy, and Executive Director Kathleen Young hosted a booth at this year’s ID Week, which took place from October 2-6 in San Francisco, CA. ID Week is an annual collaboration between the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Associate (HIVMA), and the Pediatric Infectious Diseases Society (PIDS). Every year, more than 5,500 professionals from 80 different countries attend the five-day meeting, which serves as an educational and networking event for those with an interest in infectious diseases.
In addition to hosting a booth that shared APUA’s mission and recent work, Drs. Stuart Levy and Kavita Trivedi (CA Department of Public Health) held a “Learning Lounge” presentationand discussion titled, “Antibiotic Stewardship and the Role of Diagnostics: Barriers and Opportunities,” which drew a crowd of over one hundred participants.
Winners of the 2013 APUA Leadership and Chapter Awards celebrated at ID Week
This year, Dr. Keith Klugman received the 2013 APUA Leadership Award for his work on the pneumococcal vaccine. He was recently appointed as the Director of Pneumonia at the Bill and Melinda Gates Foundation and has served as an expert in antimicrobial resistance for numerous committees, including at the WHO and the CDC. He has published more than 450 scientific papers on pneumonia, meningitis, antimicrobial resistance, and vaccines for bacterial pathogens.
APUA-Cuba received the 2013 APUA Chapter Award. The Cuba chapter draws over 1,800 members from 63 different medical specialties and has hosted multiple symposia on antimicrobial resistance and the need for new antibiotics. Please see the APUA Chapter News section for a full update on APUA-Cuba’s notable work.
APUA honored the accomplishments of both Dr. Klugman and APUA-Cuba at a celebratory dinner held in San Francisco during ID Week 2013.
APUA co-signs letter honoring Representative Louise Slaughter (D-New York)
In honor of Food Day—held on October 24, 2013 to celebrate “healthy, affordable, and sustainably produced food”—Representative Louise Slaughter (D-New York) took part in a congressional cooking series event. The event, hosted by the Center for Science in the Public Interest, Living Social, and the PEW Foundation, featured members of Congress teaming up with local chefs to teach a cooking class while raising awareness of food-related issues. At the event, PEW and its related working group member organizations presented Rep. Slaughter with a letter of thanks, honoring her devotion to the issue of antibiotic resistance. APUA co-signed the letter to express its appreciation for Rep. Slaughter’s significant efforts towards reducing antibiotic use in food animals.
Microbe publishes “Minitopic” on antibiotics and malnutrition
In its September 2013 issue of Microbe, the American Society for Microbiology featured a“Minitopic” column titled, “Cautions Raised over Using Antibiotics as a Nutrition Supplement.” It outlines the concerns raised by APUA over the potential routine addition of antibiotics to food regimens in the treatment of severe pediatric malnutrition.
Earlier this year, researchers at the University of Washington in St. Louis published a study in the New England Journal of Medicine (NEJM) on the use of antibiotics for treatment of severely malnourished Malawian children. The authors found that recovery rates were higher and mortality rates were lower among children who received antibiotics than among those who received a placebo as part of their outpatient treatment with ready-to-use therapeutic foods (RUTFs). In response, APUA submitted a letter to NEJM cautioning against the implications of the study, which could lead to community-wide usage of antibiotics for this purpose, thereby increasing the selective pressure for bacterial resistance. In the “Minitopic,” Dr. Levy states that our team is “worried that extending this practice to a community setting could ... [lead] to increased antibiotic resistance.”
APUA to participate in Cuban conference on antimicrobial resistance
APUA’s President, Dr. Stuart Levy, will be traveling to Havana, Cuba from November 14-16, 2013 to participate in the International Union of Microbiological Societies’ (IUMS) “Conference on Antimicrobial Resistance.” Dr. Levy will be giving the opening and closing discussions, providing him with the opportunity to introduce the global issue of antimicrobial resistance to an array of international scientists and researchers. APUA-Cuba will have a large presence at this conference, which will give Dr. Levy the opportunity to present the Chapter with APUA’s 2013 Chapter Award and to learn more about the Chapter’s research and many influential activities.
APUA’s Twitter account reaches 1,000 tweets!
On October 11, 2013, APUA’s twitter account posted its 1,000th tweet. APUA has utilized Twitter as an effective method of social media since March 2010. Members of our communications team post news articles daily on the most pressing topics in antibiotic resistance, antibiotic stewardship, and new drug development. Follow us @APUANews.
APUA Chapter News
APUA-Cuba letter appears in MEDISAN
MEDISAN, a Spanish language medical journal, recently published a Letter to the Editor(2013;17(10):1) submitted by Dr. Moisés Morejón García, President of APUA-Cuba. The letter describes the extensive activities of his Chapter organization, which has grown to include over 1,800 members from 63 different medical specialties. The Chapter has participated in over 15 annual events in the past six years —activities characterized by collaboration between various medical disciplines for the purpose of increasing antibiotic stewardship. APUA-Cuba has been prioritizing the need for antibiotic committees in every health center to craft rational use policies and implement monitoring efforts. The Chapter has been involved in extensive research geared towards the reduction of healthcare-associated infections, and has established an electronic database that streamlines the dissemination of new information to its members. In 2011, the Chapter formed APUA-vet, a subsidiary group focused on reducing the use of antibiotics in healthy food animals.
APUA-Cuba is the recipient of the 2013 Chapter Award, in recognition of its exemplary efforts to improve antibiotic stewardship and awareness in Cuba and throughout Latin America.
APUA-Nepal presents research at major antimicrobial resistance workshops
Members of APUA-Nepal have presented two influential papers on antibiotic resistance this year. The first, "Antimicrobial Prescribing Practice and Rational Use of Antimicrobials in Nepal,” appeared at the Advocacy Workshop on Antimicrobial Resistance (AMR) in Selected Bacterial Pathogens in Nepal, organized by the National Public Health Laboratory/MOHP in February 2013. The more recent paper, "Antibiotic Use and Drug Resistance Patterns," was presented at the Inaugural Meeting and Workshop of the Global Antibiotic Resistance Partnership (GARP) in Nepal, Kathmandu, in July 2013.
APUA-Italy organizes educational event on carbapenemases and resistance gene spread
In collaboration with the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), APUA-Italy organized an educational event focused on carbapenemases and how antibiotic usage affects the spread of resistance genes. The event was titled, “Carbapenemases: a last frontier for beta-lactams?" and took place in Verona, Italy on May 24, 2013. The Chapter is planning similar events with ESCMID in 2014.
APUA-Italy’s President, Dr. Giuseppe Cornaglia, recently received an honorary degree in Public Health from St. Elizabeth University of Bratislava, Slovakia, for his “outstanding contribution to public health in the field of antimicrobial resistance research.”
News and Publications of Note
CDC Report: Antibiotic Resistance Threats in the United States, 2013
In mid-September, the U.S. Centers for Disease Control and Prevention (CDC) released a comprehensive and ground-breaking report on the serious and growing issue of antibiotic resistance. The report focuses on the current threats to antibiotic efficacy and outlines CDC actions to address them. This is the first CDC report on antibiotic resistance to specifically address and evaluate 18 different pathogens with emerging resistance to currently available drugs. Three microorganisms were designated “urgent” threats to public health: Clostridium difficile, carbapenem-resistant Enterobacteriaceae, and drug-resistant Neisseria gonorrhoeae. The remaining 15 pathogens were categorized with a threat level of “serious,” (12) or “concerning” (3). To combat resistance, the CDC recommends four approaches that are in line with APUA’s mission: preventing infections, tracking resistance patterns, practicing antibiotic stewardship, and developing new antibiotics and new diagnostic tests.
The report was publicized extensively in numerous media outlets, including the New York Times.
Antibiotic resistance causes major treatment problems in U.S. Salmonella outbreak
An outbreak of Salmonella Heidelberg is proving especially alarming, as a higher than normal proportion of those infected with the bacteria require hospitalization. Of 317 confirmed cases, 42% have been hospitalized—largely due to the strain’s resistance to multiple antibiotics. The salmonella outbreak has been traced to three chicken plants in the Central Valley of California, and 73% of recorded infections have occurred in California. All victims to date have survived, but 13% of patients developed blood poisoning, which can be life threatening. The outbreak salmonella strain is resistant to the antibiotics commonly used as sub-therapeutic growth promoters in food animals. While the government has previously suggested that farmers should reduce antibiotic use in their livestock, and urges consumers to use caution when preparing raw meats, little has actually been done to tackle the problem. Because the USDA does not consider salmonella to be an adulterant, the chicken has not been officially recalled.
New delivery vehicle for fecal transplants
Clostridium difficile infection can be treated with a powerful and expensive antibiotic regimen; however, this process also kills off the healthy bacteria living in the patient's gut, making them more vulnerable to future infections. Transplanting stool from a healthy donor via colonoscopy, throat tubes or enemas can help restore the normal balance of bacteria. A new oral preparation further facilitates delivery of donor feces for serious gut infections such as C. difficile. The stool, usually donated by a relative, is processed to clean the bacteria and then encased in acid-tolerant capsules for ingestion. Canadian researchers who applied this new treatment found that, of 27 patients who had suffered at least four C. difficile infections and relapses, none experienced a relapse after the fecal pill transplant.
Dermatologists contribute to overuse of antibiotics
Dermatology is not widely considered to have significant effects on antibiotic resistance, as dermatologists prescribe only 5% of all antibiotic prescriptions. This may seem relatively insignificant, but according to a new article, dermatologists are much more likely to prescribe antibiotics chronically—for conditions such as acne or rosacea. Years of chronic prescriptions are encouraging bacteria, such as Propionibacterium acnes, to emerge with resistance to common acne-fighting drugs. According to Whitney Bowe, MD, the prevalence of antibiotic-resistant P. acnes grew from 20% in 1978 to 62% in 1996. Resistance rates of P. acnes to antibacterial drugs such as topical erythromycin now range from 30-50%. While dermatologists may only represent 1% of all U.S. physicians, it is important for them to be aware that any prescription of antibiotics, especially chronic ones, can lead to serious and irreversible resistance patterns.
Senator Sherrod Brown (D – Ohio) to reintroduce the STAAR Act to Congress
In response to the U.S. CDC’s September report on antibiotic resistance threats and the New York Times’ subsequent editorial on the issue, Senator Sherrod Brown (D—Ohio) has announced plans to take action. In a Letter to the Editor of the New York Times, Sen. Brown wrote that we are facing an urgent need to address the growing problem of antibiotic resistance, which has implications not just for human life, but also for the U.S. economy. The Senator has plans to reintroduce the Strategies to Address Antimicrobial Resistance (STAAR) Act to Congress in order to strengthen the federal response to this looming public health crisis.
Reprogrammed E. coli can kill pathogens
A new type of E. coli has been developed to target bacterial biofilms that are responsible for many difficult-to-treat infections. The report, published in the journal ACS Synthetic Biology, explains that the engineered E. coli can sense an infection, even when the bacteria are hidden behind sugars, DNA, and proteins. The researchers reprogrammed E. coli to sense and attach to Pseudomonas aeruginosa, a bacterium that can form biofilms and infect the lungs and gut. The E. coli then attacks the bacteria using an antimicrobial peptide and an enzyme that is capable of breaking down biofilms. Researchers are hopeful that this strategy could be used to attack other bacteria as well.
Upcoming Events/Opportunities
November 2-6: American Public Health Association's (APHA) Annual Meeting and Exposition, Boston, MA.
The APHA Annual Meeting & Exposition attracts more than 13,000 national and international physicians, administrators, nurses, educators, researchers, epidemiologists, and related health specialists. APHA's meeting program addresses current and emerging health science, policy, and practice issues in an effort to prevent disease and promote health.
November 12-18: the Australasian Society for Infectious Diseases (ASID) and NPS MedicineWise host Antibiotic Awareness Week, Online.
Antibiotic Awareness Week is a global initiative encouraging health professionals and the wider community to learn more about antibiotic resistance and the importance of taking these life-saving medicines appropriately.
November 18-24: CDC hosts Get Smart About Antibiotics Week, Online.
Get Smart About Antibiotics Week is an annual effort to coordinate the U.S. Centers for Disease Control and Prevention’s (CDC) campaign, “Get Smart: Know When Antibiotics Work,” with non-profit partners, for-profit partners, and state-based campaigns supporting appropriate antibiotic use. The collaboration sets the state for a week-long observance of antibiotic resistance and the need for proper usage of antibiotics.
November 19-22: Epidemics4 - International Conference on Infectious Disease Dynamics, Amsterdam, Netherlands.
Epidemics4 is the Fourth International Conference on Infectious Disease Dynamics, a gathering of speakers and researchers from all over the world who will be discussing the study of epidemic diseases and the dynamics of infection. The conference will take place at the NH Grand Krasnapolsky hotel, in Amsterdam, The Netherlands.