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Weekly Digest: The role of the ‘antibiotic footprint’ in reducing antibiotic use; Candida auris in India; EPA expands use of antibiotics for agriculture.

Weekly Digest: The role of the ‘antibiotic footprint’ in reducing antibiotic use; Candida auris in India; EPA expands use of antibiotics for agriculture.
Examples of antibiotic footprint by country (metric tonnes) in 2015 based on official and open-access data for the countries shown.

The role of the ‘antibiotic footprint’ in reducing antibiotic use. Researchers at CDDEP and partners have published a paper on the use of an ‘antibiotic footprint’ metric that aims to reduce antibiotic use and misuse in humans, animals, and the environment in an effort to address antibiotic resistance. This tool mirrors the ‘carbon footprint’, which aims to holistically minimize carbon use in an effort to tackle climate change. In order to effectively raise awareness on antibiotic resistance, the ‘antibiotic footprint’ should be used as a mass communication tool to educate the public on antibiotic use and misuse behaviors that will directly and indirectly reduce antibiotic consumption worldwide. The tool can be used to compare antibiotic consumption rates across countries and prompt questions and concerns from policy makers as well as community members. [JAC, CDDEP]

CDDEP researchers explain the deadly threat of Candida auris in India. Candida auris is a multi-drug resistant fungus that leads to invasive infections, especially in immunocompromised hospital patients. Effective diagnosis and treatment of C. auris are challenging due to its resistance to many drug therapies and misidentification by common microbiological tests. The fungus is transmitted through contaminated hospital surfaces and found to be deadly in one-third of those infected. C. auris disproportionately affects vulnerable populations in India where resources, time and capital for the detection and treatment of the strain are often lacking. CDDEP researchers noted the need for improved infection control in hospitals and stricter policies on the availability and consumption of antimicrobials in India. [The Quint Fit]

EPA expands use of antibiotics for agriculture, ignoring CDC and FDA warnings. In the US, the Environmental Protection Agency (EPA) has approved the expanded use of streptomycin and oxytetracycline for the spraying of citrus crops in states such as California and Texas. The EPA’s expanded use approval comes following warnings from the Food and Drug Administration (FDA) and the Centers for Diseases Control and Prevention (CDC), which caution that antimicrobial use in agriculture could fuel antimicrobial resistance and threaten human health. The approval will allow for up to 650,000 pounds of streptomycin to be used annually in agriculture, whereas humans in the US currently use 14,000 pounds of the antibiotic each year. [NYTimes]

Clinician perceptions and knowledge of an eIMCI tool in Burkina Faso. Swiss researchers conducted a qualitative study in Burkina Faso to evaluate health care worker perceptions on the use of an electronic Integrated Management of Childhood Illness (eIMCI) tool. Interviews and focus groups were facilitated to identify common themes on the use, impact, and knowledge of the eIMCI tool among clinicians. The study found that a majority of participants accepted and acknowledged the need for the tool in improved quality of care and antimicrobial use, but only 5 out of 21 participants correctly identified that antibiotics have no effect against viruses. While the tool has positive impacts on daily practices in low-resource countries, more clinician training is needed on antimicrobial resistance for the optimal use of eIMCIs. [BMC Public Health]

HIV prevalence and distribution across sub-Saharan Africa, 2000-2017. In a study of the prevalence and distribution of HIV in adults (age 15-49) across sub-Saharan Africa between 2000-2017, HIV prevalence was found to be the highest in southern sub-Saharan countries. One-third of infected individuals were located in small, highly-infected areas in other regions of the continent. HIV prevalence increased in 15 out of the 49 countries between 2000-2017. In 2017, Swaziland had the highest country-level HIV prevalence in sub-Saharan Africa, at 27.2 percent. These large variations in HIV rates and changes across countries and regions in sub-Saharan Africa suggest the need for targeted interventions at the local level. [IMHENatureNPR]

Adolescent pregnancy associated with childhood undernutrition in India. Using data from India’s fourth National Health Survey, 2015-2016, researchers analyzed the effect of adolescent pregnancy (age 10-19) on anthropometric measures of undernutrition in their children. Results found that children born to adolescent mothers had higher indicators of undernutrition including lower Z scores for height-for-age, weight-for-age, and weight-for-length (mean difference -0.53, -0.40, -0.16 SD, respectively) compared to children born to young adult or adult mothers. Adolescent mothers also tended to have less access to healthcare, a lower level of education, and lower socioeconomic status than adult mothers. [The Lancet Child & Adolescent Health]

Rapid testing for drug-resistant TB in China. Scientists evaluated the use of rapid resistance testing among patients with diagnosed pulmonary tuberculosis (TB) in middle and eastern China. After a 12-month baseline period and a 12-month intervention period, the number of patients with smear-positive TB that showed rifampin-resistance more than tripled, from 30 to 97. The number of patients with smear-negative TB that showed rifampin-resistance increased from 0 to 13. Introducing resistance testing increased the number of patients with rifampin-resistant TB who received second-line treatment from 60.6 percent to 85.5 percent. [CDC]

Partial-dose polio vaccination shows success in Bangladesh. To measure the effect of a partial-dose polio vaccine, researchers conducted a randomized controlled trial comparing the immunogenicity of two doses of a fractional inactivated poliovirus vaccine (fIPV) compared to one full dose of an intramuscular IPV among infants in Bangladesh. Results indicated that for all polio serotypes, two doses of fIPV provided a significantly higher vaccine response than one dose of IPV (16% and 36% higher, p<0.0001). The immunogenicity of fIPV booster for an outbreak response was non-inferior to IPV for serotypes 1, 2 and 3 (-1.12%, 0.40%, 1.51%). [The Lancet]

Failure to reduce the worldwide prevalence of low birthweight. In 2015, approximately one in seven children worldwide were born with low birthweight (LBW). At the 2012 World Health Assembly (WHA), a global nutrition target was set to reduce LBW prevalence by 30 percent between 2012 and 2025. Researchers analyzed LBW prevalence and trends across 148 countries between 2012 and 2015 to assess progress made towards this target. Findings revealed a 1.32 percent average annual reduction rate of LBW prevalence between 2000 and 2015, which would need to more than double to reach the WHA goal.
[The Lancet Global Health, WHO]

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