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Weekly Digest: Extensively drug-resistant gonorrhea rising globally; DRC Ebola outbreak ends

A weekly roundup of news on drug resistance and other topics in global health.

Extensively drug-resistant gonorrhea rising globally. World Health Organization officials report the rising incidence of antibiotic-resistant Neisseria gonorrhoeaeand call for international collaborative action to control the growing problem in a PLoS Medicine study and commentary. Gonorrhea is increasingly difficult or impossible to cure using extended-spectrum cephalosporins, the only currently effective treatment. Of the 77 countries surveyed for the study, 97 percent reported cases resistant to ciprofloxacin, the most widely available treatment, 81 percent reported resistance to azithromycin, and 66 percent reported resistance to cephalosporins. [PloS Medicine study, Commentary, WHO, Nature]

Erratic availability of first-line antibiotics may drive resistance rates. The World Health Organization (WHO) recently updated its Essential Medicines List (EML) with a special focus on antibiotics, including 29 that should be universally available. The Indian news website Scroll.in investigated the supply of these antibiotics in India, finding evidence of substantial lapses in availability. CDDEP fellow Sumanth Gandra reported that three of the most basic antibiotics—benzathine penicillin, ampicillin, and nitrofurantoin—have limited availability. Without these first-line agents, doctors are forced to use more advanced reserve antibiotics, which may shorten their effective lifespan as last-resort treatments. Government policies, such as price controls on essential medicines, may be driving drug manufacturer decisions to curtail their production. [Scroll.in, WHO]

Incidence of multiply-recurrent C. diff quickly rising in U.S. The incidence of multiply-recurrent Clostridium difficile infections (mrCDI) has risen by almost 200 percent from 2001 to 2012 in the United States, according to researchers from the University of Pennsylvania, reporting in the Annals of Internal Medicine. The study is based on records of 39 million patients in a large U.S. health insurance database, including 45,000 who developed CDI. Multiple recurrences were defined as at least three closely-spaced CDI episodes treated with antibiotics. Between 2001 and 2012, the annual incidence of CDI per 1000 person-years rose by 43 percent and the incidence of mrCDI nearly doubled. Study author James D. Lewis, MD, MSCE, notes, “An additional driver of this rise in incidence could be the recent emergence of new strains of C. difficile, such as NAP1, which has been shown to be a risk factor for recurrent CDI.” The finding points to an increased burden on the healthcare system and underscores the need for new mrCDI treatments. [Annals of Internal Medicine, CIDRAP, Press release]

No more Ebola cases in DRC. The World Health Organization (WHO) has declared the end of the Ebola outbreak in the Democratic Republic of the Congo (DRC), first notified in early May. The outbreak claimed four lives, with another four people infected. Almost 600 probable contacts of patients were monitored with no new cases for 42 days, equal to two infection cycles. WHO commended the DRC for early and rapid response, which contained the epidemic within two months. [WHO, CIDRAP]

Antibiotic overuse in pregnant women in Uganda. Pregnant women with urinary tract infections (UTIs) should be treated with antibiotics, but UTIs cannot be diagnosed by symptoms alone. In study from Uganda published in Clinical Infectious Diseases, only 23 out of 578 (4 percent) pregnant women with UTI-like symptoms were actually infected, but all of them were given antibiotics—96 percent of them unnecessarily.  Significant resistance levels were also found in the isolates that were cultured: 18 percent were extended-spectrum beta-lactamase (ESBL)-producers and 36 percent were multidrug-resistant. In another component of the study, a relatively simply diagnostics test, the dipslide, was found to be almost as good as the gold standard bacterial culture at identifying the most common cause (Escherichia coli), and was interpreted correctly most of the time, particularly for negative tests. Use of the dipslide or other rapid tests could substantially decrease the overuse of antibiotics for UTIs.  [CID]

G20 Summit an opportunity for coordinated action against AMR. In a Comment in Lancet Infectious Diseases, AMR experts on behalf of the DRIVE-AB Steering Committee call on members of the G20 Summit to further develop economic tools that promote research and development of antimicrobials. The G20 Summit convened this week in Hamburg to discuss international financial stability, with leaders from major developed and developing economies. Health ministers of the G20 met for the first time in May 2017, issuing the Berlin Declaration of the G20 Health Ministers and agreeing to work together on pressing global health issues, including antimicrobial resistance. The authors note the 2016 G20 commitment to “unlock research and development into new and existing antimicrobials from a G20 value-added perspective,” and suggest next steps for members states. [Lancet ID]

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