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Weekly Digest: Research and response to mass administration of azithromycin; Antibiotic-resistant pathogens found in India fish markets; A third of hospital patients receive antibiotics, most without lab tests.

Weekly Digest: Research and response to mass administration of azithromycin; Antibiotic-resistant pathogens found in India fish markets; A third of hospital patients receive antibiotics, most without lab tests.

Research and response to mass administration of azithromycin. A study conducted in Niger, Malawi and Tanzania and published in the New England Journal of Medicine found that distributing azithromycin was able to reduce all-cause mortality in children under five by 13.5%.  However, the decline in mortality was statistically significant only in Niger (18.1% lower and 95% confidence interval 10.0%—25.5%). Although targeted use of antibiotics in high-risk groups could make sense, generalized use of antibiotics could induce resistance to the antibiotic, cautions CDDEP director Ramanan Laxminarayan in Nature and NPR, leading to potential future problems in treating infections. He reiterated that giving antibiotics to healthy children is, at best, a stopgap measure to use only in areas with extremely high childhood mortality rates. [Nature, National Public Radio Goats and Soda, New York Times, New England Journal of Medicine]

Aquaculture grows in India; antibiotic-resistant pathogens found in fish markets. Antibiotic-resistant pathogens have been found in five varieties of fish in Mumbai markets, according to Department of Biotechnology researchers at the University of Mumbai.  Fish-farming practices that involve antibiotics need to be studied, and their impacts understood, according to CDDEP researcher Sumanth Gandra, in his comments on the study.  Ingesting undercooked foods containing antibiotic resistant pathogens can cause disease and lead to the transfer of resistance genes to microflora in the human gut. [Hindustan Times, Mongabay-India, Environmental Science and Pollution Research]

Worldwide, one-third of hospital patients receive antibiotics; most are prescribed without lab tests. The first Global Point Prevalence Survey (Global-PPS), published in The Lancet, compares antibiotic use and resistance across 303 hospitals in 53 countries in 2015. According to Professor Herman Goosens, project lead for Global-PPS, the main findings show that more than one in three hospitalized patients receives antibiotics, with huge variations among hospitals and countries. “A diagnostic test is used to support prescription in only 22% of cases, despite the decisive role that diagnostics play in ensuring the appropriate use of such medications,” Goossens continued.  Global-PPS was repeated in 2017, surveying 400 hospitals in 51 countries. Global-PPS data was presented in poster sessions this week at the 2018 European Congress of Clinical Microbiology and Infectious Diseases (ECCMID). [Lancet, EECMID, bioMerieux]

Study: Rifampicin-resistant TB in South Africa almost doubled among new cases. A new study reports that while South Africa’s prevalence of multidrug-resistant tuberculosis (TB) in 2012–14 (2.8%) was similar to that in 2001–02 (2.9%), rifampicin resistance almost doubled among new cases during that interval, increasing from 1.8% to 3.4%, respectively. Notably, 4.9% of all TB cases were extensively drug-resistant (XDR) and nearly 18,000 cases were caused by isoniazid mono-resistant strains. [Lancet]

Study: Relebactam safer than colistin in medically fragile patients. A Phase 3 trial targeting drug-resistant infections in hospitals found that 15 of 21 (71.4%) inpatients given imipenem/relebactam (IMI/REL) had a favorable clinical response at Day 28, compared to 4 of 10 inpatients (40.0%) who were given colistin plus imipenem. Serious adverse events occurred in 10% of IMI/REL patients and 31% of colistin+IMI patients.  Merck is reportedly planning to submit a new drug application to the US Food and Drug Administration for the use of IMI/REL to treat drug-resistant, difficult-to treat infections.  [Healio, EECMID Live]

Study: Antibiotic cycling does not reduce resistance in ICU patients. Researchers in Belgium, France, Germany, Portugal, and Slovenia found that structured rotation of antibiotic prescriptions was no more effective than mixing prescriptions to fight Gram-negative infections in intensive care units (ICUs). [Lancet]

App predicts cost-effectiveness of combining disease-control programs. A paper published by GWU researchers describes a new application which can be used on a computer or mobile phone to determine the cost-effectiveness of combining infectious disease control programs in sub-Saharan Africa and the Middle East.  Stakeholders can input population and epidemiological data to determine whether specific infectious disease programs can be combined to save costs. A case study on combining malaria and schistomiasis control in Uganda is presented. [PLoS Neglected Tropical Diseases, Science Speaks]

WHO advisers issue recommendation on Sanofi Pasteur’s Dengvaxia®The dengue vaccine Dengvaxia should not be administered to people without proof of previous dengue infection, according to experts from the World Health Organization’s Strategic Advisory Group of Experts (SAGE) on Immunization. The SAGE announcement is consistent with Sanofi Pasteur’s own November 2017 advisory, which cautioned that following vaccination of dengue naïve individuals, severe disease could occur upon a subsequent dengue infection. No rapid, reliable test exists for prior dengue infection. [Science, CIDRAP]

Faster progress urged on antibiotic resistance. Hundreds of presentations and posters from this week’s ECCMID conference are now available online at Keynote speaker Otto Cars highlighted both progress and problems in the global fight against antimicrobial resistance, asking the nearly 13,000 delegates at the conference “are we achieving enough?” [ECCMID2018]

London “fatberg autopsy” reveals antibiotic-resistant bacteria in clogged sewers. Laboratory testing found potentially pathogenic Listeria, Campylobacterand E. coliin London’s sewer lines, as shown in a documentary video about the dissection of a fatberg, televised on Channel 4 in the United Kingdom. A team of microbiologists also found that bacteria in the fatbergs had become resistant to antibiotics.  [Channel 4, YouTube, Telegraph]


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