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Weekly Digest: National antimicrobial treatment guidelines from African Union Member States vary substantially; Methicillin-resistant S. aureus emerged in the pre-antibiotic era.

A hedgehog on a piece of wood with greenery behind it

National antimicrobial treatment guidelines from African Union Member States vary substantially. A review for national treatment guidelines in Africa Union member states found that only 36% of countries had guidelines that provided disease-, syndrome- or pathogen-specific antimicrobial treatment recommendations. Antimicrobial recommendations for common infectious diseases varied wildly across these guidelines. Few cited clinical evidence or incorporated antimicrobial stewardship principles, culture, or susceptibility testing into treatment recommendations. Researchers called for future guidelines to meet internationally accepted standards and be based on the region’s disease burden and resistance profiles. [Bulletin of the World Health Organization] 

Methicillin-resistant Staphylococcus aureus emerged in the pre-antibiotic era. Genomic analysis shows certain lineages of methicillin-resistant Staphylococcus aureus (MRSA) in European hedgehogs may have preceded the arrival of antibiotics in clinical use. This pathogen is believed to have developed methicillin resistance as an adaptation to the colonization of dermatophyte-infected European hedgehogs. The hedgehog dermatophyte Trichophyton erinacei produces two β-lactam antibiotics, giving methicillin-resistant S. aureus an advantage over others.  S. aureus lineages are thought to have spread between other hosts, including livestock, migratory birds, and humans. The mechanisms that resulted in the emergence and spread of this pathogen highlight the importance of a One Health perspective on antibiotic resistance prevention. [Nature] 

Pfizer and Merck’s COVID-19 pills will become available globally thanks to the Medicines Patent Pool. The Medicines Patent Pool nonprofit encourages generic manufacturers to make low-cost versions of their products available to low-income countries and has been used to create antiretrovirals for HIV and drugs for hepatitis C and tuberculosis. Both Pfizer and Merck’s COVID-19 treatments require 5 days of pills and cost $530 and $712, respectively. With the support of the Medicines Patent Pool, generic versions of these treatments are expected to cost as little as $20 per treatment course. [Science Insider] 

India’s cumulative COVID-19 mortality is 6-7 times higher than the reported number. Despite 35 million reported COVID-19 cases, mortality in India is reported at 345 deaths per million, a likely underreported figure. An independent, nationally representative survey and government data were used to compare India’s reported COVID-19 mortality during the 2020 and 2021 viral waves to expected all-cause mortality. This analysis found that COVID-19 was the cause of 3.2 million (29%) deaths between June 2020 and July 2021, with most deaths (2.7 million), occurring between April and July 2021, during the second wave. [Science] 

Immune responses to COVID-19 vaccine boosters reduced in patients with hematological malignancies compared to those with solid cancers. The third dose of a COVID-19 vaccine boosts neutralizing antibody responses in patients with cancer, even when responses have waned significantly following the second vaccine. While patients with solid cancers had immune responses comparable to individuals without cancer following their third dose, a significant number of patients with hematological malignancies showed no detectable neutralizing responses. [Cancer Cell] 

Neonatal mortality in urban areas is nearly double that of rural areas in Tanzania. Historically, neonatal mortality in Sub Saharan Africa has been lower in urban areas, however, a time series analysis of 21 Sub-Saharan African countries shows a shifting trend in Tanzania, where urban neonatal mortality (38 per 1,000 live births) was significantly higher than rural neonatal mortality (20 per 1,000 live births), with the largest difference occurring during the first week of life. While reporting bias may be partly to blame for the disparity in death rates, similar patterns might be emerging in other countries warranting urgent investigation [BMJ Global Health] 

Long-term exposure to low ambient air pollution increases mortality. A multicenter longitudinal study analyzed population-based cohorts of deceased adults aged 30 or older from Belgium, Denmark, England, the Netherlands, Norway, Rome (Italy), and Switzerland. Non-accidental mortality was associated with average concentrations of fine particulate matter, black carbon, and nitrogen dioxide, but not tropospheric warm-season ozone. Long-term exposure to concentrations of fine particulate matter and nitrogen dioxide lower than current annual limit values was associated with cardiovascular, non-malignant respiratory, and lung cancer mortality. [The Lancet Planetary Health 

The first two years of the COVID-19 pandemic highlight ways to improve pandemic preparedness. Investing and building trust in resilient health systems, including health-related government bodies, is key to efficient pandemic management. Additionally, issues such as healthcare inequity and the ability to perform adequate testing and surveillance must be addressed. Achieving this requires the world to strengthen supply chains and establish diverse regional manufacturing. It also requires countries to address economic, racial, and ethnic disparities in their populations, which act as long-standing social determinants of health. [JAMA] 

Nucleic acid point-of-care testing can improve healthcare inequities and strengthen primary healthcare. The cost, accessibility, and manufacturing limitations of PCR and rapid lateral flow tests represent barriers that have contributed to global inequity in COVID-19 testing. However, inequities in access to diagnostics go beyond the pandemic and may be resolvable through the use of low-cost, multi-disease rapid nucleic acid tests. These tests can be particularly useful in primary healthcare, where diagnostics are limited and disease outbreaks are likely. Multi-disease nucleic acid tests would benefit health systems long-term, allowing them to deal with both existing and emerging diseases. [Clinical Infectious Diseases] 

Learner responses to antimicrobial stewardship courses can be used to overcome cultural barriers across different health systems and economies. During a 3-week free online course launched to educate individuals about antimicrobial resistance and stewardship, participants were asked about their experiences with antimicrobial stewardship as they progressed through modules. Responses highlighted unique challenges in healthcare systems, including ill-defined roles for non-physician healthcare workers, lack of ownership of antibiotic decision-making in clinical settings, resource limitations, and lack of patient involvement. Larger-scale issues, including inadequate governance and policy inconsistencies on antibiotic consumption, were also notable. [JAC – Antimicrobial Resistance]   

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