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Weekly Digest: Uncertainty in antimicrobial resistance estimates; Measuring antimicrobial use needs global harmonization; India faces issues with vaccination campaigns despite relative success

Uncertainty in antimicrobial resistance estimates – how close are we to the true rates? In a recent paper, researchers from CDDEP and Johns Hopkins University show that confidence intervals (CI) around antimicrobial resistance (AMR) estimates based on antimicrobial susceptibility test (AST) results from a sample population often fail to include the “true” population estimate when constructed with standard methods that assume data independence.  Data from different laboratories or hospitals may be correlated, and accounting for this source heterogeneity using cluster-robust errors significantly increases the probability of including the population estimate in the CIs. [Antimicrobial Resistance & Infection Control]

Measuring antimicrobial use needs global harmonization. Researchers from CDDEP and other international institutions address the importance of monitoring antimicrobial use (AMU), a key driver of antimicrobial resistance (AMR). However, variations in AMU reporting metrics across countries challenge data comparison and highlight the need for standardization of national-level AMU reporting methodologies. While this is possible for human AMU data, heterogeneities among livestock systems prevent the harmonization of AMU data in the animal health and production sector. The authors propose establishing a tripartite WHO/OIE/FAO collaboration to leverage existing initiatives and create a globally relevant AMU metric to enable AMU comparison across countries. [Global Challenges

Rotavirus vaccination reduces hospitalization in children under five in Africa. A study by the WHO and CDC revealed that the introduction of rotavirus vaccinations in countries in the WHO African region led to a decrease in the number of children under five hospitalized with acute gastroenteritis (AGE) and rotavirus. The number of hospitalizations declined from 39.2% to 25.3% in the post-vaccine period, representing a 35.5% reduction. Rotavirus is the leading cause of severe AGE among children and causes over 215,000 deaths in children under five every year. [Clinical Infectious Diseases

Patients with severe HIV disease more likely to develop severe COVID-19. Using data from March to December 2020, researchers in Zambia showed that HIV infection itself was not associated with worse outcomes among hospitalized COVID-19 patients. However, patients with severe HIV were more likely to develop severe COVID-19 or die of the infection than those with controlled disease. These findings have important implications for Zambia and other countries with high HIV and COVID-19 infection rates and highlight the importance of ART adherence and viral suppression among HIV-positive individuals. [MMWR

High rates of antibiotic use among patients with severe COVID-19 in England. A multi-center cohort study conducted in England revealed that COVID-19-related infections among hospitalized COVID-19 patients were rare ( 1,107 out of 48,902). The majority were secondary infections that occurred more than two days after hospital admission. However, of the 46,061 patients with available data, 85.2% received one or more antimicrobials during their hospital stay, with patients admitted to critical care receiving antimicrobials more frequently than ward-level patients. [The Lancet

New research on the link between COVID-19 hospitalization and underlying illness among children. According to researchers, between March 2020 and January 2021, 62.9% of patients aged 18 years or younger hospitalized with severe COVID-19 infections in the US had at least one underlying illness, and 28.7% had at least one chronic condition. Patients with type 1 diabetes and obesity were most likely to be hospitalized at adjusted risk ratios of 4.6 (95% CI 3.91 to 5.42) and 3.07 (3.07, 2.66 to 3.54), respectively. [JAMA

 Non-communicable diseases are understudied in low- and middle-income countries. A literature review on cost-effectiveness analysis (CEA) studies found that mental and behavioral health diseases and neonatal disorders were severely understudied compared to communicable diseases on a global level. In high and upper-middle-income countries, CEA volume for communicable diseases was 100-fold higher than in low- and middle-income countries where research is mostly allocated to communicable diseases like HIV/AIDs and neglected tropical diseases. [BMJ Global Health

India faces issues with vaccination campaigns despite relative success. As of May 19, 2021, an India vaccine tracker reported administration of 186 million vaccine doses, third only to the US and China. Despite this relative success, the vaccination campaign still struggles; as of May 13, 2021, India’s vaccinations were mostly walk-in appointments under crowded conditions with a high risk of superspreading events. Less than 5% of vaccination centers have administered almost 50% of vaccines, mostly in high burden, urban areas. Rethinking the vaccination strategy would require moving away from rushed, mass vaccination rollouts and moving toward incorporating systematic and strict non-pharmacological measures during vaccine delivery. [The Lancet Global Health

Antibiotics and heavy metals in industrial waste promote antibiotic resistance. The concentration of antibiotics and heavy metals in wastewater is higher in industrialized areas; a study found high levels of antibiotics such as ciprofloxacin and norfloxacin and heavy metals such as zinc and lead. While some of the analyzed antibiotics correlated with antibiotic resistance genes detected in the samples, heavy metals were correlated with the concentrations of these genes, highlighting their role in promoting antibiotic resistance. [PLOS One

International travelers acquire drug-resistant bacteria. International travel significantly increased the presence of antimicrobial-resistant genes, according to researchers from the US and the Netherlands who analyzed pre-and post-trip fecal samples from 2,001 adults who traveled to Asian or African countries for durations longer than one week but shorter than three months. Genetic sequencing identified 56 unique drug-resistant genes acquired during international travel. Genetic profiles of resistant bacteria were similar among those who traveled to the same destination suggesting that acquisition of such genes may be destination-specific. [Genome Medicine

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