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Weekly Digest: CDDEP finds drug-resistant infections associated with mortality in India; New antibiotic for gonorrhea; Transmission of E. coli in wild giraffes.

CDDEP study finds MDR and XDR bacterial infections associated with mortality in India. In one of the largest studies to measure the burden of antibiotic resistance in a low- or middle-income country, researchers at CDDEP analyzed antimicrobial susceptibility testing results and mortality outcomes for over 4,000 patients who visited one of ten tertiary or quaternary referral hospitals across India in 2015. Overall, patients who acquired MDR bacterial infections were 1.57 times more likely to die, compared to patients with similar susceptible infections, while patients who acquired XDR infections were 2.65 times more likely to die when accounting for age, sex, site of infection, and the number of coinfections. Among MDR infections, those caused by Gram-negative bacteria were associated with higher mortality rates compared to those caused by Gram-positive bacteria, with rates of 17.7 percent and 10.8 percent, respectively. [Clinical Infectious Diseases]

Most recent antibiotic use and resistance data for the US now available on CDDEP website. CDDEP published updated antibiotic use and resistance data for the United States on its Resistance Map platform. Antibiotic use data by state is now available through 2017 and is reported in prescriptions per 1,000 people and daily defined doses per 1,000 people. Antibiotic resistance data for the US is available by region through 2016. [Resistance Map]

WHO reveals wide differences in global antibiotic use. For the first time, the World Health Organization (WHO) has published data on global antibiotic consumption collated using standardized methodologies. Across 65 countries, including 16 low- and middle-income countries, antibiotic consumption ranged from 4.4 to 64.4 daily defined doses (DDD) per 1,000 inhabitants per day. Within WHO’s European region, the median antibiotic consumption rate was 17.9 DDDs per 1,000 people per day. Discrepancies in antibiotic use worldwide may be due to overuse, lack of access, or the availability of data in different countries. The WHO also reported on trends in types of antibiotics used worldwide and provided guidelines for improving data collection on antibiotic use. [WHO, CIDRAP]

First assessment of planetary boundaries for antibiotic and pesticide resistance. Researchers from the Living with Resistance Project, including CDDEP research fellow, Eili Klein, propose a framework for assessing the potential impact of biocide resistance on key functions in society. The article discusses the effect of biocide use – which include both pesticides and antibiotics – on ecosystems and the consequent impact on human and planetary health and outlines the beneficial role of susceptible organisms in these communities to regulate resistant organisms by competing with them for common resources. Resistance to biocides is growing worldwide, increasing the risk of large-scale health and agricultural crises. Antibiotic resistance among Gram-negative bacteria has already surpassed its planetary boundary, and the risks associated with resistance to transgenic cropping systems is also high. [Nature]

Exposure to bacteria in milk and water linked to AMR. In Tanzania, antimicrobial use in people and livestock was not associated with prevalence of drug-resistant Escherichia coli strains at the household level, according to survey data and analysis of several hundred stool samples. Instead, exposure to bacteria through consumption of contaminated water sources or unboiled milk was most closely associated with increased prevalence of resistant strains. [The Lancet Planetary Health]

Researchers estimate more than 33,000 people die each year from antibiotic-resistant infections in Europe. According to a disease modelling study, researchers estimate there were over 650,000 infections caused by select antibiotic-resistant bacterial pathogens of public health importance in 2015 in countries of the European Union or European Economic Area. This estimate includes bloodstream, respiratory, surgical, and other types of infections caused by bacterial species including Acinetobacter species, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Streptococcus pneumoniae. Overall, these infections accounted for 33,110 deaths and 874,541 disability adjusted life-years. These findings corresponded to an incidence rate of 131 per 100,000 people and a mortality rate of 6.44 per 100,000. The overall burden was found to be similar to that of influenza, tuberculosis, and HIV combined. [The Lancet]

A new antibiotic to treat gonorrhea. In a small phase two clinical trial, a new single-dose oral antibiotic, Zoliflodacin, cured 96 percent (109 of 113) of uncomplicated urogenital gonorrhea infections and 100 percent (12 of 12) of rectal infections. However, the antibiotic, which uses a different mechanism of antibiotic activity as currently available treatments, was less successful in treating pharyngeal infections with cure rates of 50 percent (4 of 8) and 82 percent (9 of 11) among participants who received two or three grams of Zoliflodacin, respectively. New treatment options for gonorrhea are urgently needed as resistance to current treatment with azithromycin and ceftriaxone is rapidly emerging worldwide. A multi-national phase three trial will begin in 2019. [NEJM]

Transmission of E. coli in wild giraffes. Antibiotic-resistant strains of the Escherichia coli bacteria in wild giraffes likely originate from human sources, report researchers from the University of Minnesota and the University of California at Davis. Researchers analyzed the genetic and social networks of nearly 200 wild giraffes and found that 5.1 percent harbored E. coli isolates resistant to one or more antibiotics. However, there was little evidence that resistant bacterial strains were being transmitted between giraffes via inter-host interactions. [Applied and Environmental Microbiology]

Merck ends agreement to supply rotavirus vaccine in west Africa. The pharmaceutical company Merck & Co. Inc. announced it plans to stop supplying the rotavirus vaccine, RotaTeq, for children in West Africa citing supply constraints as a reason behind the decision. More than 500,000 children in west Africa may not receive the vaccine as a result, according to NPR and Gavi, the Vaccine Alliance. [NPR]

Clinical and economic impact of implementing an antimicrobial stewardship program in hospital in India. In the year following the implementation of an antimicrobial stewardship program (ASP) in a tertiary care hospital in Kerala, India, antibiotics were prescribed to 1,020 of almost 50,000 patients; 56 percent of those prescriptions were determined to be appropriate by clinical and ASP guidelines. In that same time period, the ASP team identified and intervened upon almost 3,000 inappropriate antimicrobial prescriptions, and mean monthly costs, associated with consumption of restricted drugs, were reduced by 14.4 percent following ASP implementation. [Open Forum Infectious Diseases]

Multi-drug resistant Shigella outbreak in Vermont. As of November 6, 2018, 22 confirmed and 44 probable cases of extensively drug resistant Shigella sonnei infections were reported among staff, residents, and visitors of a retirement community in Shelburne, Vermont. The Vermont Department of Health and officials from the Centers for Disease Control and Prevention are responding to the outbreak. The source of the outbreak has not yet been identified, but the rate of new cases is slowing, officials reported. [Vermont Department of Health]

Watch: CDDEP’s Superbug Story: Diary of a Staph. Learn about superbugs from a superbug itself! This animated video explains how bacteria develop resistance to antibiotics and eventually turn into superbugs that are resistant to most known antibiotics. Available online here.

Photo: Antibiotic Use in the United States in 2017; Source: CDDEP Resistance Map, IQVIA