Weekly Digest: Serious MRSA-related infections not declining; antibiotic “courses” driving resistance

29 Jul 2017

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

Serious MRSA-related infections not declining, despite overall MRSA decline. A new study from CDDEP researchers and collaborators finds that rates of the most serious methicillin-resistant Staphylococcus aureus (MRSA) infections—blood infections and pneumonias—did not decline from 2010 to 2014, despite a decline in all MRSA infections. Rates of S. aureus and MRSA-related hospitalizations were tracked for septicemias, pneumonias, and other infection sites, using inpatient records from the National Inpatient Survey, part of the Healthcare Cost and Utilization Project of the Agency for Health Research and Quality. Hospitalization rates for MRSA skin and soft-tissue infections decreased 29 percent (from 3.8 to 2.0 per 1,000 hospitalizations) between 2010 and 2014, while rates for serious, invasive MRSA infections remained constant. [Clinical Infectious Diseases]

Are “standard” antibiotic courses too long and do they contribute to resistance? British researchers ignited a firestorm by suggesting in The BMJ that a standard course of antibiotics—averaging one to two weeks—may in fact be driving antibiotic resistance rates higher, while providing no more benefit to the already-cured patient. The dictum of fully completing an antibiotic course, established to prevent undertreatment in the mid-20th century, is just another form of overtreatment, they claim. No reliable evidence supports the idea that antibiotic resistance is quelled by completing the course. Everyone seems to agree that antibiotic exposure drives resistance, but a raft of critics of the analysis fault the authors for not proposing a responsible alternative message to “complete the course.” The authors and their critics agree that the topic is deserving further study. [BMJ, Scientific American]

CARB-X announces additional funding for antibiotic development in Europe, the United Kingdom, the United States, and India. CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) announced seven projects in its second round of funding, totaling US$17.6 million, to stimulate the development of new antimicrobials. The projects include five potential new classes of antibiotic for Gram-negative bacteria, a potential new treatment for drug-resistant gonorrhea, an agent to treat a superbug affecting cystic fibrosis patients, and a new oral broad-spectrum antibiotic. CARB-X is the world’s largest public-private partnership focusing on preclinical antibacterial research and development, and efforts to repair the “broken pipeline” for antimicrobials. [CARB-X press release, CIDRAP 7/25 news story, CIDRAP 7/27 feature]

European Union report informs link between antibiotic use and resistance in food-producing animals and humans. A second report from the Joint Interagency Antimicrobial Consumption and Resistance Analysis (JIACRA) links the increased use of antimicrobials in food-producing animals and humans to an increasing prevalence of antimicrobial-resistant bacteria. Using data from the agencies’ EU-wide surveillance networks for 2013-2015, the report draws out a One Health web of associations among antimicrobial consumption in animals and humans and antimicrobial resistance in both spheres, separately by important bacterial species and antimicrobial class. JIACRA is a joint effort of the European Food Safety Authority, the European Medicines Agency, and the European Centre for Disease Prevention and Control [JIACRA report, EFSA]

CDC 2017 progress report on U.S. antibiotic use: Antibiotic Use in the United States 2017: Progress and Opportunities, from the Centers for Disease Control and Prevention (CDC) reports that antibiotic prescribing in outpatient settings has decreased by 5 percent between 2011 and 2014, with variability across settings and regions. In hospitals, use of the most powerful antibiotics increased substantially: 40 percent for carbapenems and 30 percent for vancomycin. An estimated 30 percent of all antibiotics prescribed for outpatients and in hospitals are unnecessary or incorrect. Not enough information is available to fully understand antibiotic use in nursing homes—one of CDC’s next priorities—but in a small sample, 11 percent of patients were taking antibiotics on a given day, and 40 percent of those orders lacked important information. The progress report outlines CDC resources to support stewardship programs for antibiotic and promote their responsible use. [CDC]

PHFI strained by funding restrictions: In April this year, the Indian government revoked permission for the Public Health Foundation of India (PHFI) to receive international funds, under the Foreign Contributions Regulation Act (FCRA). Begun as a public-private partnership in 2006, PHFI has been funded by many of the world’s prominent public and private sector supporters of health programs. The abrupt ban has forced shutdowns, displacements and transfer of large programs. These include a unit supporting the national immunization program, another that supports the national HIV-AIDS program, and a host of other projects. PHFI has raised the profile of public health in the country and has had a wide-ranging impact in many areas in just a few short years at both the national and state levels. [Indian Express]

Hunting the Nightmare Bacteria: The PBS Frontline program, originally aired in October 2013, has been updated with recent research on antibiotic resistance and related changes in federal policy. The program features an interview with CDDEP Director Ramanan Laxminarayan and is available online:

http://www.pbs.org/wgbh/frontline/film/hunting-the-nightmare-bacteria/ [PBS Frontline]


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