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Weekly Digest: Medically-important antimicrobials used excessively in Pakistani chickens; US sees rise in antimicrobial sales for use in food animals; Unnecessary antibiotic prescriptions common among children in LMICs.

Weekly Digest: Medically-important antimicrobials used excessively in Pakistani chickens; US sees rise in antimicrobial sales for use in food animals; Unnecessary antibiotic prescriptions common among children in LMICs.

Medically-important antimicrobials used excessively in Pakistani chickens. Researchers at CDDEP, the University of Agriculture in Faisalabad, Pakistan, and ETH Zurich studied antimicrobial use in a broiler chicken farm in Punjab, Pakistan from 2013-2017 and identified excessive use of medically-important antimicrobials. Annual antimicrobial consumption on the farm was 250.84 mg per population unit of the final flock weight, which exceeds antimicrobial use in chickens in all countries across the world except China. Colistin, tylosin, doxycycline, and enrofloxacin were the most common medically-important antibiotics identified in the study. Findings suggest that food animals from Pakistani broiler farms consume up to 568 tons of antimicrobials per year. [Global Health Action]

US antimicrobial sales for food animals rise for the first time in 3 years. The US Food and Drug Administration (FDA) released a 2018 summary report on Antimicrobials Sold or Distributed for Use in Food-Producing Animals, which notes a 9 percent increase in antimicrobial sales and distribution between 2017 and 2018 in the United States. Tetracyclines accounted for two-thirds of all domestic sales and distribution in 2018, followed by penicillins (12 percent) and macrolides (8 percent). The distribution and sales of medically-important antimicrobials in food animals decreased by 38 percent overall between 2015 and 2018. [FDA]

Unnecessary antibiotic prescriptions common among children in LMICs. In a cross-sectional study of sick children younger than 5 across eight low- and middle-income countries (LMICs), researchers found that 80.5 percent of children who were diagnosed with a respiratory illness were prescribed antibiotics. Antibiotics were also prescribed to 50.1 percent of children with diarrhea and 28.3 percent with malaria. On average, 24.5 antibiotic prescriptions were issued to sick children between birth and 5 years old in LMICs, with the highest mean number of antibiotics prescribed to children in Senegal. [The Lancet Infectious Diseases]

Inappropriate antibiotic prescribing identified in 25 percent of US ambulatory care visits. Using data from a nationally representative survey in the United States, researchers found that one-fourth of antibiotics prescribed during ambulatory care visits in 2015 were inappropriate, and 24 million did not have a documented indication. Patients who were male, who spent a long duration with a care provider, and who saw a non-primary care specialist were more likely to be prescribed an antibiotic without documented indication compared to other patients. [BMJ]

Worldwide measles deaths have decreased significantly since 2000. The World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) reported a significant reduction in worldwide measles incidence (66 percent) and death (73 percent) between 2000 and 2018, although measles incidence has increased in 5 regions in the past 2 years. Researchers estimated that the measles vaccine has prevented 23.2 million deaths overall since 2000. Even so, 19.2 million infants failed to receive vaccination through routine immunization services in 2018. [CDC MMWR]

Whole-genome sequencing may be a strong tool for AMR surveillance. Researchers in the UK tested the resistance of 515 Escherichia coli isolates from pigs, and identified whole-genome sequencing as a strong tool for antimicrobial resistance (AMR) surveillance. The study found that the presence of AMR genes predicts reduced susceptibility of the pathogen to the 9 antimicrobials tested. [Eurosurveillance]

Asymptomatic carriage of C. diff common among New York hospital patients. A prospective cohort study involving 220 patients at a tertiary-care hospital in New York found that 9.6 percent of patients were asymptomatic carriers of Clostridioides difficile, and asymptomatic carriage of the pathogen was associated with a significant risk of progression to C. difficile infection (CDI) (hazard ratio: 23.9). The study suggests that C. diff screening among asymptomatic patients may be an important strategy in reducing CDI. [SHEA]

Vaccine confidence is moderately high among a majority of European parents. Results from a European survey spanning 18 countries found that a majority of parents (56 percent) were “not at all hesitant” about vaccinating their 1-4 year old children, while 24 percent were “somewhat hesitant”. Of the countries studied, vaccine hesitancy was lowest in Portugal and Cyprus and highest in Bulgaria and Poland. [Vaccine]

Arab mothers and nurses have positive attitudes toward vaccines. In a qualitative study of 70 Arab mothers and 20 nurses in Israel, a majority of interview participants had positive attitudes toward vaccines. Nurses in the Tipat Halav Family Health Centers, which is run by Israel’s Ministry of Health, were highly trusted and noted as the largest platform for sharing childhood vaccination information throughout the country. Some interviewees also believed that vaccines portrayed the comprehensive services that are available to the Arab population living in Israel. [Vaccine]

Sales and distribution of medically-important antimicrobials increases among US food animals. [CDDEP]