APUA Highlights: July 2016
APUA HEADQUARTERS NEWS
APUA attends ASM Microbe 2016 annual meeting in Boston
APUA staff manned an informational booth at the Boston Convention Center—site of the June annual meeting of the American Society for Microbiology—where we met numerous old friends and acquired many new acquaintances interested in the work and mission ofAPUA.
APUA Presdient Dr. Stuart Levy at ASM
During that exhibit, a number of international visitors expressed a keen interest in forming APUA chapters abroad. Please let us know if you have colleagues interested in establishing an APUA chapter.
APUA receives Allergan award
We are pleased to announce that Allergan has awarded a grant of $10,000 to APUA in connection with our plans to expand surveillance and intervention in the Caribbean, subject to receipt of additional grant funds.
APUA attends Boston BAARN meeting
APUA staff attended the 4th annual meeting of the Boston Area Antibiotic Resistance Network (BAARN) held on June 15 at the American Academy of Arts and Sciences Norton Woods Conference Center in Somerville, MA. Four sessions focused on the topics of novel antibacterial therapies and strategies; creating a sustainable ecosystem for antibiotic production; entrepreneurship; and needs and advances in diagnostics. The keynote address was delivered by Maryn McKenna, who spoke on Superbugs and global pandemics. Ms. McKenna was APUA’s 2015 recipient of the APUA Leadership Award. Her most recent blogs on the emergence and spread of colistin resistance can be foundhere.
APUA joins FOAR program
The U.S. Stakeholder Forum on Antimicrobial Resistance (S-FAR) is a 100+member national partnership convened by the Infectious Diseases Society of America (IDSA). One of the missions of S-FAR is to guide U.S. policymakers and federal officials on policy choices that best protect the public from the antibiotic resistance threat. As a member, APUA is participating in its FOAR program: Faces of Antibiotic Resistance—aproject that seeks the personal stories of patients or family members who have first-hand experiences with a resistant infection such as MRSA or CRE. The stories will be collected and published by S-FAR and used to put a human face on the true costs of resistance and to demonstrate the urgent need for efforts to combat resistance and protect patients. To read the full request and/or submit a personal story, go here.
APUA CHAPTER NEWS
As part of its national approach to addressing antimicrobial resistance, Australia has developed a National Antimicrobial Resistance Strategy 2015-2019 and released the First Australian report on antimicrobial use and resistance in human health (AURA 2016). The report, issued by the Australian Commission on Safety and Quality in Health Care, provides the most comprehensive picture to date of antibiotic use and prescribing habits and resistance in Australia. The national, coordinated surveillance efforts, which are derived from a range of sources, are seen as a priority effort to identify emerging issues and track trends. The AURA Surveillance System is expected to provide critical information to all stakeholders in the development of antimicrobial resistance policy and stewardship programs.
RESISTANCE IN THE NEWS
Resistance to “last resort” antibiotic is now widespread
The colistin resistance gene mcr-1 has now been identified in isolates of animal, environmental or human origin from 30 countries across 5 continents. A number of foreign reports have linked the gene in sick patients to contact with livestock. In June, MCR-1 was reported in seagulls from Lithuania and Argentina, suggesting a potential for acceleration of resistance spread. The finding of the gene on a highly transmissible plasmid represents a marked shift away from its former restrictions to chromosomal mutation and vertical transmission.
In a recent screening of travelers returning from India, a standard plate screening test revealed no colistin resistance or evidence of MCR-1. However, when an overnight enrichment was utilized that incorporated selection on CHROMagarTM supplemented with colistin, 10% of the travelers (4/38) were found to be colonized with colistin-resistantE. coli
The report of another mcr-1 gene from a stored E. coli, submitted by the U.S. SENTRY Surveillance system in May 2015, predates the earlier “first report” in the U.S. this year in a Pennsylvania woman, and suggests that other cases may be found. Meanwhile, a Belgium research team has reported finding a novel plasmid-mediated colistin resistance gene which they have called mcr-2. The new gene, which has 76.7% nucleotide identity with mcr-1 was found in porcine and bovine E. coli with a prevalence rate higher (40.8%) than that of mcr-1 (13.2%). Italian researchers have likewise identified yet another variant, mcr-1.2. The findings reinforced calls for immediate screening for mcr-1 and also mcr-2, which may be missed by current diagnostics. While these strains are resistant to colistin, they are not pan-resistant. Of greater concern is the finding of the mcr gene in KPC, (carbapenemase-carrying Klebsiella pneumoniae) which is resistant to the last-resort carbapenems and several other antibiotic classes.
Travelers acquire antibiotic resistance genes in two days
Building on prior studies that show travelers pick up antibiotic resistance genes in their gut bacteria, Dutch researcher van Schaik and his team have completed a new study that looks at how quickly this event can happen. They examined the bacteria of stools and hand swabs from 7 tourists from the Netherlands, prior to, during and following trips to China, India, Canada, S. Korea and the Philippines. Antibiotic resistance genes were picked up as soon as two days after arrival. Notably, the qnrB gene (encoding resistance to quinolones) and CTX-M (encoding extended-spectrum beta-lactamase [ESBL]) were acquired and persisted for at least one month following the tourist’s return. Previous results from 122 tourists had shown acquisition of resistance in <10% up to 55% of the stool flora. The suspected culprits were food- and water-containing native bacteria, rather than sources in flight.
Medicare /Medicaid proposes antimicrobial stewardship rule for U.S. hospitals
A new rule proposed by the Centers for Medicare and Medicaid Services would require 6,228 hospitals and critical- accesshospitals in the U.S. to have specialized programs for preventing infections, improving antibiotic use and following nationally recognized guidelines. The rule would strengthen conditions of participation and prevent discrimination of underserved or excluded populations. The rule is open for comments until Aug 15.
Operating under President Obama’s Affordable Health Care Act, hospitals have already saved 87,000 lives and reduced health care costs by ~$20 billion by reducing health-care associated infections. A recent PEW report of 10 U.S. hospitals (A Path to Better Antibiotic Stewardship in Inpatient Settings) showed that the most successful antimicrobial stewardship programs contained the following elements: routine review of antibiotic appropriateness with monitoring and limitation of unnecessary use; and regular and clear communications between clinicians, laboratory workers and pharmacists.
New studies report antibiotic over-prescription rates in U.S; falling prescriptions in England and the EU
A new CDC study conducted in 2010-2011 and reported in the Journal of the American Medical Association, shows that more than 12% of outpatient visits resulted in antibiotic prescriptions, and of these, 30% were unnecessary. Overprescribing occurred largely for acute respiratory conditions, in which only 50% of prescriptions were appropriate.
In contrast, more than 75% of antibiotic prescriptions issued for sexually transmitted diseases in emergency departments were considered unnecessary when evaluated by a Detroit Michigan research team. Of 440 individuals tested and treated for possible chlamydia or gonorrhea, 70% (308) had neither infection. Since serious symptoms must be treated before test results are available, the results point out the tricky balance between getting proper STD treatment and not promoting antibiotic resistance by over-prescribing. The findings suggest better methods are needed to identify the correct recipients of treatment.
Meanwhile, England’s health watchdog, NHS Improvement, has reported a decline of 16% in all antibiotic prescription types (down more than 2.5 million in just one year). The news was labelled “a fantastic result”, and reflects NHS’s success in encouraging British physicians not to over-prescribe antibiotics. Among the 28 European Union member states, 16 now show decreasing antibiotic consumption, resulting in a 6% decline overall. Still, the recent June 16 report of the Special Eurobarometer Survey shows that public knowledge on antimicrobials remains poor. Fifty-seven per cent of Europeans are still unaware that antibiotics are ineffective against viruses.
New treatment for multi-drug resistant TB is shorter and cuts costs
Nearly half a million people globally have multidrug-resistant tuberculosis (MDR-TB), but only one-fifth are being properly treated. In a major advancement, WHO has now recommended a 7-drug treatment regimen that would reduce the current 18-24 month treatment to 9-12 months and lower the cost from $3,000 down to $1,000. Patient eligibility relies on susceptibility to second-line drugs and testing utilizes a new rapid diagnostic that can identify drug susceptibility in 1-2 days instead of 3 or more months. The new treatment, known as the “Bangladesh Regimen”, emerged from an observational study of 10 countries in which shorter regimens were used successfully, and cure rates increased from 50% to 84% due to better compliance.
Concerns arise over 2016 Olympic water quality
In two unpublished studies obtained by Reuters, investigators have reported finding carbapenemase-producing Klebsiella pneumoniae (KPC) in the beach waters of Rio de Janeiro where the Olympic events of rowing, canoeing and swimming will occur. The multidrug-resistant bacteria were identified in 10-100% of all samples taken from 5 beach sites. The KPC superbug, which is considered an urgent health threat by the CDC, is an opportunistic pathogen that can cause pulmonary, bloodstream, urinary and gastrointestinal infections and meningitis. The contamination of the beach sites reportedly results from a failure of city officials to treat 80% of the city’s sewage and wastewater—amajor promise made in Brazil’s bid as host of the 2016 event. Officials counter that the water was treated and any contamination results from the illegal dumping of sewage water into storm drains by the public.
Poverty breeds antimicrobial resistance
In a PLOS blog titled Public Health Perspectives, Harvard public health instructor Jason Silverstein provides commentary on the socioeconomic origins of antimicrobial resistance. He states that the “clearest link between poverty and the rise of antimicrobial resistance is that poor people may not see a qualified health care provider or complete a course of quality antibiotics. Instead they might turn to unregulated markets for substandard drugs.” A study by Marcella Alsan has suggested that out-of-pocket payments were most strongly correlated with antimicrobial resistance and were driven by countries that require copayments. Such requirements are steering the poorest to tap into “unregulated markets” and to take “partial prescriptions”— known factors which drive antibiotic resistance.
Fast food companies urged to curb antibiotic abuse
Fifty-four investment groups, valued at $1 trillion, have coalesced to apply pressure to the top 10 fast food companies in the US and UK—urging them to act immediately to curb food sources that utilizegrowth-promoting antibiotics. The activities of the investment groups are managed by the Farm Animal Investment Risk & Return Initiative (FAIRR) and charity ShareAction. The FAIRR Initiative is a collaborative investor network that aims to raise awareness of the material impacts farm animal welfare issues can have on investment portfolios. Expressing concerns over health and damage to the firms’ reputations, the letter states, “Whilst we agree that antibiotics should be used for the treatment of sick animals, they should not be used to support irresponsible practices such as growth promotion or routine disease prevention of animals kept in closely confined and unsanitary conditions.”
New diagnostic differentiates staph strains
A new diagnostic test designed by Arizona-based research teams (TGen-NAU) promises to cut identification of MRSA and multiple types of drug-resistant staph, including the Coagulase Negative Staphylococcus (CNS) from 48hrs to 60min. The molecular-based test is more accurate and expected to widely replace the 150-yr old methodology currently used in the U.S. and abroad.
In recent years, CNS, most commonly S. epidermidis, have increasingly outnumbered MRSA as a cause of health-care associated infections—particularly in medical implants. Identifying these hospital strains from the common environmental strains that contaminate laboratory cultures has posed a diagnostic challenge. The new rapid diagnostic assay, based on identifying a single nucleotide polymorphism, represents a breakthrough in this dilemma and can better direct appropriate antibiotic therapy when needed. The test also aids in the detection of infections harboring multiple staph types.
Novel innovations offer promise in infection control
In a departure from traditional messaging techniques used to instill hand hygiene compliance, a Detroit, Michigan-based group has utilized assays of ATP (adenosine triphosphate) levels on hands – converting them to photographs of bacterial images that are designed to promote emotional reactions of disgust. When utilized in low-compliance units of the hospital for 10 weeks, hand hygiene compliance rates increased from 11 to as much as 48 percentage points.
Meanwhile, a Geneva-based hospital group has determined that hand rubbing with alcohol-based disinfectant (isopropanol 60%) for more than 30 seconds does not appear to confer any additional benefits in pathogen reduction. The study has answered questions about how long a healthcare worker should spend on performing hand hygiene. A separate study showed that at least 1 log10 of pathogen is needed for hand-to-hand transmission between a contaminator and a recipient.
The Israeli-based company, Nano Textile, has announced that it can embed zinc-oxide (ZnO) nanoparticles into any ready-made textile, making it antibacterial. The technology uses sonochemistry, a powerful ultrasound radiation, to form the particles and project them at high speed onto the textile surface. In the hospital, the fabrics are potentially useful for staff uniforms, patient apparel and linens and curtains and can withstand up to 100 wash cycles without loss of antibacterial activity.
Unlike conventional germicidal UV light, which causes damage to exposed skin, scientists at Columbia University Medical Center have demonstrated that “far-UVC” (207 nanometers) is a safe and potentially equally effective means of reducing surgical sites infections, such as those caused by MRSA. The far-UVC does not penetrate the epithelial skin, but does penetrate and kill bacteria and viruses. Experiments will soon move from mice to surgical settings in humans and larger animals.
Harvard chemists use novel platform to create new antibiotics
In a divergence from the classic “semisynthesis” method of modifying known antibiotic molecules, Harvard chemist Andrew Myers and colleagues are using a fully synthetic approach towards building new erythromycin molecules. As reported in the journalNature, the novel method utilized the 8 chemical building blocks of the macrolide antibiotic and reshuffled and reassembled them to create over 300 chemically similar molecules. Of these, 83% retained activity against Streptococcus pneumoniae and two showed superior activity against resistant S. pneumoniae, Pseudomonas aeruginosa, CRE (carbapenem-resistant Enterobacteriaceae) and MRSA. The new platform is expected to speed the process by which prospective antibiotics can be generated. Promising candidates will be advanced through toxicity and efficacy studies in animals and humans.
Longitude Prize launches new animated presentation/game
The Longitude Prize, developed and run by Nesta, the UK’s innovation foundation, is a challenge with a £10 million prize fund to help stop antibiotic resistance. The competition invites submission of ideas for an affordable, point-of-care, 30-minute diagnostic that can be used in any health setting to help rule out the use of antibiotics when they are not needed. In an effort to attract greater attention to, and understanding of its goals, the developers have created an animated presentation that succinctly explains the history of the prize and the current challenge to address the urgent, global problem of antibiotic resistance.
Utilizing the concept that electronic games are hugely popular among youth and are particularly effective in conveying scientific content, the developers have introducedSuperbugs: the mobile game. The game is a free, fast paced action game that is instrumental in teaching about the huge problem of drug-resistant bacteria.
To play the new game, go here: https://longitudeprize.org/superbug
EVENTS OF INTEREST
August 23-26, 2016:
Eighth International Conference on Antimicrobial Agents in Veterinary Medicine in Budapest, Hungary
August 30 – September 2, 2016:
17th International Symposium on Staphylococci and Staphylococcal Infections, Seoul, South Korea
September 8-9, 2016
World Anti-microbial Resistance Congress U.S. 2016, Washington, D.C.
September 26 – 28, 2016
4th International Conference on Responsible Use of Antibiotics in Animals, The Hague, The Netherlands
September 26 – 28, 2016
Infection Prevention 2016, Harrogate, England.
October 3-5, 2016
2nd World Congress and Exhibition on Antibiotics (Antibiotics 2016). London, UK
October 20-22, 2016
6th Clinical Microbiology Conference: One Health: To attain optimal health for people, animals and the environment. Rome, Italy
October 24-26, 2016:
6th International Conference on Clinical Microbiology and Microbial Genomics. Rome, Italy
October 26-30, 2016
ID Week 2016, New Orleans, Louisiana
October 29 – November 2, 2016
American Public Health Association Annual Meeting and Expo. Creating the Healthiest Nation: Ensuring the Right to Health. Denver, Colorado
November 14-15, 2016
Superbugs & Superdrugs USA Conference and Exhibition, Iselin, New Jersey.
November 14-20, 2016
Get Smart about Antibiotics Week –The CDC’s annual one-week observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use.
November 30 – December 3, 2016
The Australian Society for Antimicrobials will be hosting the 16th Asia-Pacific Congress of Clinical Microbiology and Infection (16th APCCMI). Melbourne, Australia
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