October 14, 2017
A weekly roundup of news on drug resistance and other topics in global health.
Procalcitonin guided therapy associated with significant clinical improvement. A study in The Lancet that analyses data from twenty-six randomized trials describes clinical outcomes of antibiotic therapy when guided by procalcitonin marker tests. Procalcitonin guided antibiotic treatments significantly reduce 30-day mortality rates, length of hospital stay, antibiotic exposure and side effects, and improve survival rates in patients with acute respiratory disease across all clinical settings. [The Lancet]
Gram-negative resistant infections in African children. A study in The Lancet Infectious Diseases finds that most of the neonatal sepsis cases in sub-Saharan Africa are caused by gram-negative bacteria, whereas infections in older children are due to gram-positive bacteria. The study also highlights the paucity of surveillance and data, especially for community-acquired infections in the region. [The Lancet Infectious Diseases, CIDRAP]
Antibiotic use before minor surgeries may not lead to resistance. A study in the Journal of the American College of Surgeons finds that using preventive antibiotics before low-risk surgeries does not increase the risk for antibiotic-resistant infections. The study followed 689 surgical patients who developed postoperative infections out of more than 22,000 who had operations and found little difference in rates of drug-resistant infections between those who were on prophylactic antibiotics and those who were not, at fourty-nine percent and forty-seven percent, respectively. [Journal of the American College of Surgeons, Press release]
Mapping high-risk areas in Africa for epidemics. A study in The Lancet identifies high-risk zones for Ebola, Marburg, Lassa fever, and Crimean-Congo haemorrhagic fever in Africa. The Central African Republic (CAR), Chad, Somalia, and South Sudan were found to be highly vulnerable to all four diseases, whereas the areas around the Congo River in the CAR would be most at risk of Ebola and Marburg. [The Lancet]
Is the prevalence of malaria decreasing in Africa? A review of more than 50,000 surveys finds that malaria cases have declined in sub-Saharan Africa in the last century except in the high-transmission zones of West and Central Africa. The study published in Nature reports that the disease prevalence dropped from forty percent between 1900 and 1929 to twenty-four percent between 2010 and 2015. [Nature]
Behavioral interventions with peer comparison may be effective in controlling AMR. A letter in the Journal of the American Medical Association reports that behavioral interventions to tackle antimicrobial resistance (AMR) that include peer comparisons may have a lasting effect, even after the interventions have ended. A follow-up study that reviewed nearly 7,500 antibiotic prescription practices found that those clinicians who were part of the peer comparison method reported a lower rate of antibiotic prescriptions even a year after the original intervention. [Journal of the American Medical Association, CIDRAP]
Rare virus spreads in Nigerian states. Seven states in Nigeria have reported suspected cases of monkeypox, a rare virus similar to smallpox, according to the Nigeria Centre for Disease Control. None of the thirty-one cases has been confirmed, and no deaths have been recorded so far. Monkeypox is transmitted through infected animals and is rarely fatal. [Nigeria Centre for Disease Control update]
Outbreak of plague in Madagascar. More than 500 cases of pneumonic plague have been reported in Madagascar since August. The outbreak has hit all major cities and is spreading rapidly. Left untreated, pneumonic plague can be fatal in most cases. The World Health Organization (WHO) has supplied nearly 1.2 million doses of antibiotics and released $1.5 million in aid, and the Malagasy Red Cross has mobilized 700 volunteers to monitor the problem and spread awareness in the country. [WHO press release, Al Jazeera, Los Angeles Times, ScienceMag, CBC News]
Yemen may see a million cholera cases by year end. The cholera epidemic in Yemen may surpass a million cases by the end of 2017, with at least 600,000 cases in children, according to a new warning by the organization, Save the Children. More than 800,000 suspected cases and over 2,000 deaths have been reported across Yemen since April. [Save the Children press release, CIDRAP]
Two Ebola vaccines provide year-long immunity. A study in The New England Journal of Medicine reports the results of two Ebola vaccine trials in Liberia. Both vaccines have been found to provide immunity for at least a year, with antibody responses between 60 and 80 percent in adults at 12 months, and with no major safety concerns. [The New England Journal of Medicine]
MCR-1 prevalence in the United States. Three studies presented at IDWeek 2017 reported detection of the MCR-1 gene in five new cases in the United States, including a child. The authors highlight the need for increased surveillance, especially in international travel, as three of the reported cases had a history of travel. [IDWeek 2017 Abstract 1, Abstract 2, Abstract 3]
Behavioral interventions with peer comparison may be effective in controlling AMR. A letter in the Journal of the American Medical Association reports that behavioral interventions to tackle antimicrobial resistance (AMR) that include peer comparisons may have a lasting effect, even after the interventions have ended. A follow-up study that reviewed nearly 7,500 antibiotic prescription practices found that those clinicians who were part of the peer comparison method reported a lower rate of antibiotic prescriptions even a year after the original intervention. [Journal of the American Medical Association, CIDRAP]
Inappropriate antibiotic use by dentists could be increasing C. difficile cases. A study presented at IDWeek 2017 finds that up to fifteen percent of patients with community-associated Clostridium difficile infections between 2009 and 2015 in Minnesota had been prescribed antibiotics for a dental procedure. The study authors say that antibiotics may have been inappropriately prescribed in many of these cases and highlight the need for stewardship programs to address inappropriate dental prescribing of antibiotics and the association with C. difficile infections. [IDWeek 2017 abstract]
Denmark reduces antibiotic use in animals. A new report finds that antimicrobial use in food animals in Denmark fell by five percent in 2016 as compared with the previous year. The decrease is mainly due to reduction in antibiotic use in pig production, which constitutes a large part of the meat production in Denmark. The trend has been consistent for the past three years. [DANMAP report]
ASPs may be effective, sustainable. A study in the American Journal of Infection Control reports that an antimicrobial stewardship program (ASP) at a hospital in Detroit reduced prescribing of two commonly used antibiotics between 42 and 58 percent, resulting in cost savings of $55,000. The authors conclude that ASPs are sustainable and potentially replicable. [American Journal of Infection Control]
Image courtesy Melanie Tata (CC By-SA 2.0)
