April 23, 2019
Superbug segment on 60 Minutes highlights the threat of antibiotic resistance. In a 60 Minutes episode that aired Sunday on CBS, CDDEP’s Ramanan Laxminarayan and other superbug experts explained the drivers of antibiotic resistance across the globe. [CBS]
CDDEP researchers track global trends in antibiotic effectiveness using the Drug Resistance Index. To better communicate the problem of antibiotic resistance, researchers at CDDEP developed the Drug Resistance Index (DRI) which provides a snapshot of the effectiveness of antibiotic therapy by country. The DRI resembles stock market indices and combines antibiotic consumption measurements with resistance data to help compare aggregate resistance across time and between countries. Using resistance data from CDDEP’s ResistanceMap and antibiotic use data obtained from IQVIA’s MIDAS database, researchers calculated the DRI rates for 41 countries. Overall, the DRI rates varied widely across countries and ranged from a low of 8.1 in Sweden to a high of 71.6 in India. [BMJ, CDDEP]
Whole genome sequencing suggests transmission of antibiotic resistance genes from wastewater treatment plants into surface water. Austrian scientists took water samples from four rivers, located upstream and downstream from major cities, and used whole genome sequencing (WGS) to compare three ESBL-producing strains and two carbapenem resistant strains to 95 patient isolates from Austrian hospitals. WGS data revealed three clusters consisting of water and clinical isolates with carbapenem resistant (clusters 1 and 2) and ESBL-producing strains (cluster 3). The downstream water isolates shared genetic concordance with patient isolates from the nearby cities in clusters 2 and 3, suggesting the transmission of antibiotic resistance genes from wastewater treatment plants into neighboring surface water. [Science Direct]
Increasing prevalence of antimicrobial-resistant Neisseria gonorrhoeae throughout the Asia Pacific. The WHO Collaborating Centre for Sexually Transmitted Infections and Antimicrobial Resistance, in Sydney, Australia reviewed ceftriaxone and azithromycin susceptibility data for Neisseria gonorrhoeae in the Asia Pacific region between 2011-2016. Researchers identified gonococcal isolates which surpassed antibiotic resistant minimum inhibitory concentration (MIC) breakpoints to ceftriaxone and azithromycin. The proportion of locations with >5 percent of gonococcal isolates that met WHO’s definition of decreased antibiotic susceptibility, increased for both ceftriaxone (14.3 percent to 35.3 percent) and azithromycin resistance (14.3 percent to 38.9 percent) between 2011-2016. [PLOS One]
Antibiotic alternative for the treatment of bacterial meningitis. Researchers in Sweden and Denmark obtained cerebrospinal fluid samples from 16 patients with S. pneumoniae meningitis, neuroborreliosis, acute viral meningitis, and subarachnoid hemorrhage. Using advanced microscopy, the researchers looked for neutrophil extracellular traps (NETs), which can interfere with the body’s natural immune response in clearing bacteria as well as the effectiveness of antibiotics. Researchers used DNase to dissolve NETs in rats, which proved to be effective in treating bacterial meningitis. [Nature Communications, EurekAlert!]
Therapeutic HPV vaccine resolves pre-cervical disease more frequently than placebo. Researchers conducted a phase II randomized controlled trial to test the efficacy and safety of a therapeutic HPV vaccine, Tipapkinogen Sovacivec(TS), in resolving HPV-associated cervical intraepithelial neoplasia grades two and three (CIN 2/3) in women. Complete resolution of CIN 2 and CIN 3 occurred significantly more frequently in the vaccine group compared to the control group (28.3 percent vs. 20.0 percent, and 21.1 percent vs. 0.0 percent, respectively). Overall, the TS vaccine safely provided complete or partial resolution of HPV-associated CIN 2/3 in 36% of women. [Science Direct]
Knowledge and attitudes about antibiotic resistance across European healthcare workers. Research presented at the European Congress of Clinical Microbiology and Infectious Diseases last week highlighted knowledge and attitudes about antibiotic resistance among European healthcare workers. Questionnaire results were obtained from 10,484 healthcare workers across 30 countries in Europe. Results showed that 96 percent of respondents were confident in their understanding of antibiotic resistance, although only 60 percent answered all knowledge questions correctly. Only 28 percent of respondents felt that national antibiotic resistance campaigns were effective in decreasing antibiotic use, and only 29 percent were aware that antibiotic use for growth promotion in farm animals is illegal in the European Union. Knowledge gaps about antibiotic resistance exist among European healthcare workers and vary by professional group. [ECCMID]
Spatial and temporal trends in diphtheria-pertussis-tetanus vaccine coverage in Africa. Researchers conducted an analysis of 183 surveys and the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 to model spatial and temporal trends in diphtheria-pertussis-tetanus (DPT) vaccine coverage across 52 African countries between 2000-2016. Results estimated that third-dose vaccine coverage (DPT3) increased in 72.3 percent of second-level administrative units during the analysis timeframe, but only two countries met the Global Vaccine Action Plan target of at least 80 percent DPT3 coverage in 2016. Findings identified specific areas with low DPT coverage to support targeted resources and interventions. [The Lancet]
H1N1 influenza epidemic in Canada disproportionately affects children under 10. A new study compared the age distribution of H1N1 influenza cases in Canada during the 2018-19 flu season to prior seasons (2014-15 and 2013-14). Significantly more cases than controls were under 10 years old (29 percent vs. 16 percent) during the 2018-19 epidemic. Children 5-9 years old account for 5 percent of the general population, yet accounted for 14 percent of cases this flu season in Canada, which is at least twice as much as that age group’s contribution to cases in past flu seasons. These findings suggest that children 5-9 years old were disproportionately affected by the 2018-19 flu season due to their lack of exposure to the 2009 H1N1 pandemic. [Eurosurveillance]
DRC Ebola outbreak still not a global health threat. Although the ongoing Ebola outbreak in the Democratic Republic of Congo (DRC) continues to worsen with significantly increasing cases, the World Health Organization (WHO) has determined that the outbreak does not meet the criteria of a Public Health Emergency of International Concern (PHEIC). WHO experts have no concerns about international spread of the virus, and believe the outbreak will be brought under control in the foreseeable future, especially with progress in increasing Ebola vaccination rates (>90 percent). [CIDRAP, MSF]
Photo: Drug Resistance Index (DRI) across countries. Each bar reports the DRI for countries reporting antibiotic resistance for 5 or more pathogens and for 15 or more pathogen–antibiotic combinations for at least 1 year between 2012 and 2015.
Source: CDDEP
