Weekly Digest: EU has not failed on antimicrobial resistance; “Handshake” antibiotic stewardship

18 Feb 2017
Author: Ellyse Stauffer

A weekly roundup of news on drug resistance and other topics in global health.  

CDDEP Blog: Phantoms of the Pharmacy. Phantom prescriptions—prescribed by  doctors without in-person consultations—may be more common than expected. Research Analyst Andrea White discusses a first-of-its-kind study of phantom antibiotic prescriptions, which appeared in Infection Control and Hospital Epidemiology. White notes that while the phantom designation does not necessarily mean a prescription is inappropriate, it does raise suspicion in light of high rates of inappropriate antibiotic prescriptions even with consultations. In the new study, the records of more than 185,000 Medicare beneficiaries were tracked for one year following a heart attack, finding that 52,000 (15 percent) of more than 350,000 antibiotic prescriptions filled had no evidence of a related doctor’s visit. White points to the need to address phantoms in antibiotic stewardship efforts.  [CDDEP, ICHE]

The EU has not failed on antimicrobial resistance. As debate surrounds the future of the European Union, Professor Herman Goossens of the University of Antwerp points to significant progress coordinated by the EU and European Commission in the fight against antimicrobial resistance. Professor Goossens writes, "To prevent further breakdown of the EU, scientists must shout from the rooftops that many of our problems today can be solved only at a European, or even a global, level." [Nature]

“Handshake” antibiotic stewardship presents opportunities for ID consultations. An antibiotic stewardship program at Children’s Hospital Colorado added daily review of prescribed antimicrobials, real-time decision support for rapid diagnostic test reporting, and in-person communication between the stewardship team and attending physicians to the routine audit and feedback approach. The more intensive program—called “handshake” antibiotic stewardship—resulted in a one-third increase in the number of infectious disease consultations, which the authors believe may be a result of the greater personal contact between the two groups. The report was published in Clinical Infectious Diseases. [CID, CIDRAP]

Colistin-resistant E. coli carrying MCR-1 reported in Brazilian chicken meat. Researchers in São Paulo, Brazil, identified the colistin-resistance conferring MCR-1 gene in Escherichia coli in commercial chicken meat. Their findings are reported in Antimicrobial Agents and Chemotherapy. Forty-one chicken samples from São Paulo markets were tested for susceptibility to polymixin B and colistin, as well as for the MCR-1 gene itself. Colistin-resistant E. coli isolates with the MCR-1 gene were found in eight samples, all of which were clonally unrelated.. Brazil is the world’s third largest producer of chicken meat and the presence of MCR-1 could be linked to frequent use of colistin in Brazilian pigs and poultry, though its use in animal feed was banned by Brazil in 2016. [AAC, CIDRAP]

Influenza Update: current vaccine protects roughly half of recipients. Flu activity began to increase in the United States in mid-December 2016 and is expected to remain so throughout February 2017. Influenza A (H3N2) is the predominant strain, but influenza A (H1N1)pdm09 and Influenza B are also circulating.

The overall estimated vaccine effectiveness (VE) of this year’s seasonal influenza vaccine was 48 percent, as reported in the The Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report (MMWR). Effectiveness was 43 percent against the predominant influenza A (H3N2) virus and 73 percent against the influenza B virus.  Ed Belongia, MD, Director of the Center for Clinical Epidemiology & Population Health at Marshfield Clinic Research Foundation and coauthor of the study, commented that vaccine protection for H3N2 is consistently lower than for H1N1 (last year’s predominant strain), in the 30-50 percent range. [MMWR VE estimates, MMWR flu update, CIDRAP]

Public consultation for European Commission One Health Action Plan against Antibiotic Resistance, open until April 28, 2017. The European Commission is inviting input from administrations, associations, and individuals on its 2011-2016 action plan against the rising threat of antimicrobial resistance through an online questionnaire. The EC will launch a “Commission communication on a One Health action plan to support Member States in the fight against antimicrobial resistance (AMR)” by mid-2017. [EU]