Weekly Digest: Europe’s new action plan on AMR; Third colistin resistance gene

1 Jul 2017

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

WHO protocol for AEFI surveillance successful in India. Surveillance of adverse events after immunizations is important for identifying and understanding vaccine-related risks and for boosting public confidence in vaccination. In 2013, the World Health Organization and the Council for International Organizations of Medical Sciences introduced a revised Causality Assessment Protocol (CAP) for Adverse Events Following Immunization (AEFI), which India was one of the first countries to implement. CDDEP South Asia Associate Dr. Jyoti Joshi and colleagues report on the first results using the new CAP in Vaccine. The system was successful in classifying 89 percent of the 771 AEFIs reported between 2012 and 2015 without further investigation, despite programmatic challenges. The authors conclude that improvements in causality assessment and standardization in reporting between countries can improve public confidence in vaccines and provide an early warning of potential vaccine safety issues. [Vaccine]

Europe’s new action plan on AMR. The European Commission, responsible for forming common policies for the European Union, has adopted its second action plan against antimicrobial resistance (AMR), building on the previous action plan published in 2010. The plan has three main pillars: making the EU a “best practice” region; supporting research, development, and innovation; and shaping the global agenda on AMR. The action plan takes a One Health approach, which considers the interconnected wellness of animals, humans, and the environment. The Commission has also launched EU guidelines on the prudent use of antimicrobials in human health prepared with input from EU Member State experts and stakeholders. [European Commission Action Plan, CIDRAP]

Third colistin resistance gene identified. Researchers in China report discovery of a third gene that confers resistance to the last-resort antibiotic, colistin, in a study published in mBIO. The novel mcr-3 gene was found in colistin-resistant Escherichia coli in fecal samples from a pig farm in China’s Shandong province during routine antimicrobial resistance surveillance.  mcr-3 is preceded by mcr-1, also found first in China; and mcr-2, reported first from Belgium. Both have now been detected in many countries. The authors say that mcr-3 may already be widespread globally and stressed the need for increased surveillance. The findings raise concern as colistin is a critical last-resort drug for multidrug-resistant infections. [mBIO, CIDRAP]

Bacterial transmission and resistance during Hajj on the rise. In Travel Medicine & Infectious Disease, a meta-review of studies around the annual Islamic pilgrimage to Mecca reveals rising rates of resistance among certain Gram-positive and Gram-negative bacteria. The 31 reviewed studies involved pilgrims, Hajj workers, and local hospital patients in Mecca, Mina, and Medina, from 2000 to 2015. Third-generation cephalosporin-resistant bacteria have been common in the Hajj region, with rising rates, ranging from 19 to 94 percent over the review period. Methicillin-resistant Staphylococcus aureus (MRSA) isolated from pilgrims rose from 1 percent in 2000 to 63.2 percent in 2015. Rates of vancomycin-resistant Gram-positive bacteria remained low across all studies. More than 2 million people from over 184 countries make the pilgrimage each year. The study authors note that pilgrims "have the potential to disseminate or acquire [antibiotic resistant] bacteria during their stay in Saudi Arabia and to spread these bacteria when returning to their home country.” [Travel Medicine & Infectious Diseases, CIDRAP]

AMR spells poorer outcomes in cancer patients. Cancer patients are disproportionately disposed to Clostridium difficile infections (CDI) due to health care exposure and medications that impair immune response. A study in BMC Infectious Diseases reports on CDI incidence and health outcomes among cancer patients in the United States, using discharge data from 2001 to 2010 from more than 30 million cancer discharges. Researchers found a CDI incidence of 8.6 per 1,000 cancer discharges, with significantly higher mortality than in cancer patients without CDI (9.4 vs. 7.5 percent) and longer median length of stay. The Norwegian Cancer Society has launched a campaign naming AMR “the biggest threat to cancer treatment,” focusing on the importance of antimicrobial stewardship for cancer patients. The campaign website provides educational resources and strategies to control the problem locally and globally. [BMC Infectious Diseases, Kreft Foreningen]

Antibiotic in addition to surgery beneficial for treating small skin abscesses. Patients who undergo treatment for skin abscesses do better when surgical procedures are combined with antibiotic treatment, according to a study in the New England Journal of Medicine. The multicenter randomized trial involved 786 participants, most infected with Staphylococcus aureus, more than half of whom had methicillin-resistant infections (MRSA). After abscess incision and drainage, participants were randomized to treatment with clindamycin, trimethoprim-sulfamethoxazole (TMP-SMX), or placebo. Cure rates in the clindamycin and TMP-SMX groups were significantly higher (83.1 percent and 81.7 percent, respectively) than in the placebo group (68.9 percent). The antibiotics are not without side effects, however, which must be weighed in treatment decisions. [NEJM, CIDRAP]


Image via Amio Cajander (CC BY-SA 2.0)