Unapproved antibiotic combinations contribute to increasing antimicrobial resistance in India.  According to a journal article published by UK researchers, sixty-four percent of Fixed-Dose Combinations (FDCs) on the market in India were not approved by the country’s regulatory organization, in spite of laws against selling unregulated antibiotics. Fewer than four percent of the FDCs sold in India had been approved in the US or UK. CDDEP Director Ramanan Laxminarayan stated that the sale of FDCs with no clinical evidence “would not be acceptable practice in the United States” and questioned why “[multinational] companies engage in these practices in India and other lower- and middle-income countries.”  [British Journal of Clinical Pharmacology, CIDRAP]

Plumbing at NIH Clinical Center (NIHCC) found to contain carbapenem-resistant organisms. A study by the US National Institutes of Health (NIH) found a “reservoir” of resistant bacteria and transferable plasmids present in wastewater pipes inside the hospital and in sewage pipes sampled outside the NIH complex. Less than two percent of high touch surfaces, such as door handles and bed rails within reach of NIHCC patients, tested positive for carbapenem-resistant organisms (CRO). On a related topic, UK researchers found that use of toilet covers and sink trap heating/vibration devices was successful in preventing the transmission of Klebsiella pneumoniae carbapenemase (KPC)-producing organisms to hospital patients. [mBio, LA Times, Genomeweb, Clinical Infectious Diseases]

Fewer coinfections in patients with high blood levels of malaria parasite. A study in Ghana of severely ill, febrile children hospitalized with malaria found that the higher the level of malaria parasites in the blood, the less likely the patient is to be co-infected with a non-malarial pathogen. Researchers collected blood and urine specimens from 1238 children and collected nasopharyngeal, stool, or cerebrospinal fluid specimens of any study participant who had respiratory symptoms, diarrhea, or meningitis. The authors concluded that accurate quantitative tests for parasite density (rather than rapid diagnostic test for malaria in the blood) and appropriate testing for coinfections are critical to ensure appropriate antibiotic choice.  [Clinical Infectious Diseases]

New approach to summarizing and analyzing antimicrobial use in hospitals. The Standardized Antimicrobial Administration Ratio (SAAR) calculates observed-to-predicted antibiotic use (AU) wherein predicted use is estimated from a statistical model. By allowing hospitals to compare their AU over time and compare their data to national data, the SAAR was developed to improve stewardship of antibiotics by US hospitals. Five categories of SAAR will be collected: broad-spectrum agents for hospital-onset/multi-drug resistant bacteria; broad-spectrum agents for community-acquired infections; anti-MRSA agents; agents predominantly used for surgical site infection prophylaxis; and all antibiotic agents. [Clinical Infectious Diseases]

In cystic fibrosis patients, mutations that cause resistance to one antibiotic can bring about sensitivity to another. Chronic Pseudomonas aeruginosa infections, in individuals with cystic fibrosis (CF), often evolve resistance to treatment with antibiotics, over time.  Researchers have found, however, that the same mutations that cause resistance to one antibiotic can bring about sensitivity to another. Specific knowledge of mutations carried in one patient can optimize treatment and even bring about eradication of resistant strains in that patient, and paving the way for more personalized treatments. Science Magazine Editor Caroline Ash nicely summarizes the original article. [Cell, Science Magazine]

Children at increased risk of serious infection if mothers are exposed to antibiotics during pregnancy.In a study covering 15 years and 750,000 pregnancies in Denmark, data showed that the risk is higher if antibiotics are taken closer to birth, and even more so if the baby is born vaginally. [International Journal of Epidemiology, Brisbane Times.]