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Weekly Digest: Faces of Antimicrobial Resistance; Access to Vaccines Index 2017

Weekly Digest: Faces of Antimicrobial Resistance; Access to Vaccines Index 2017

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

Faces of Antimicrobial Resistance: personal stories of resistant infections. The Infectious Diseases Society of America (IDSA) tells the stories of 13 people who contracted antibiotic resistant infections and their often long-term ordeals in overcoming and in some cases, succumbing, to them. IDSA President Dr. William Powderly explains, “We’ve all seen the numbers: antibiotic resistance alone accounts for at least 23,000 deaths, over 2 million illnesses, and over $20 billion in unnecessary healthcare costs each year. But press reports and statistics only tell part of the story. Patients like mine—real people, grandparents, parents, children, neighbors, and friends—are the reason we must address the problem of antimicrobial resistance.” CDDEP is a “Faces” co-sponsor. [IDSA report]

How do vaccine producers compare in making their vaccines accessible? The Access to Vaccines Index 2017 from the Access to Medicine Foundation examines industry activity to improve immunization coverage, offering key findings in vaccine research and development, pricing, manufacturing, and more. The Index includes report cards for the top eight companies currently producing vaccines, noting a diversity of approaches to aligning supply with demand. [Access to Vaccines Index, Access to Medicine Foundation]

Air pollution can alter bacterial biofilms and allow bacteria to resist antibiotics and spread farther. In a series of experiments reported in Environmental Microbiology, researchers exposed developing biofilms of Streptococcus pneumoniae and Staphylococcus aureus to black carbon (BC), the main particulate matter in air pollution. BC affected biofilm architecture, resulting in thicker biofilms that spread more easily throughout the body. In a separate experiment, they compared the effects in mice of 1) Streptococcus pneumoniae alone, 2) S. pneumoniae plus BC, 3) BC alone and 4) untreated controls. The bacteria alone colonized the nasopharynx, as expected, but in the mice with both bacteria and BC, the infection had spread to the lungs—initiating invasive infections. BC alone and saline had no effect. [Environmental Microbiology]

In India, first-ever antimicrobial treatment guidelines for 10 common infections. The Indian Council of Medical Research (ICMR) has released Antimicrobial Treatment Guidelines for all healthcare settings based on data from the ICMR Antimicrobial Resistance Surveillance Network, implemented in select hospitals. According to ICMR scientist Dr. Kamini Walia, “Most antimicrobial treatment guidelines available are based on pathogenic bacteria easily available in the Western literature. Now for the first time we have guidelines which are based on reliable Indian antimicrobial resistance data from domestic healthcare settings.” [The Tribune (Chandigarh)]

Antibiotic therapy after hospital discharge, an opportunity for improved stewardship. According to researchers from the University of Colorado, post-discharge antibiotic therapy is often unnecessarily broad spectrum and prolonged. Their research, published in Infection Control & Hospital Epidemiology, examined 300 patients prescribed oral antibiotics at discharge before and 200 patients after interventions involving institutional guidance for step-down antibiotic selection and duration of therapy, and pharmacy audits of discharge prescriptions with real-time recommendations for clinicians. Broad-spectrum prescribing decreased with the intervention, from 51 to 40 percent, with a particularly large drop for fluoroquinolones (38 to 25 percent). During the intervention period, the total duration of therapy decreased from a median of 10 to 9 days and the duration prescribed at discharge declined from 6 to 5 days. [Infection Control & Hospital Epidemiology abstract, CIDRAP]

A review of clinical decision support systems for antimicrobial stewardship. Clinical decision support systems (CDSS) for antimicrobial management have proliferated in recent years, with the rise of antimicrobial stewardship, but have they been designed for maximum benefit and evaluated appropriately? A systematic review in Clinical Microbiology and Infection supports a role for CDSS in better antimicrobial prescribing, but suggests substantial room for improvement in how they are developed, evaluated, and used.   According to the review, “DSS must not be viewed as a magic bullet and as such, interventions must be multi-modal so that potential synergistic effects can be explored to ensure that interventions are utilised.” Principles for uniform development and reporting on CDSS are proposed by the authors. [Clinical Microbiology and Infection]

Reducing penicillin allergy overreporting: Most patients reported with penicillin allergies are, in fact, not allergic, but relying on past report leads clinicians to prescribe antibiotics that are often less effective, more toxic, more costly, and broader spectrum than actually needed. A study in The Journal of Allergy and Clinical Immunology reports on two interventions to improve antibiotic prescribing for patients with reported penicillin allergy: 1) a skin testing approach and 2) a computerized guideline and decision support tool.  Both interventions worked to reduce the number of patients identified as penicillin allergic, and the computerized tool resulted in a measurable increase in patients prescribed narrow-spectrum penicillins and cephalosporins instead of the non-penicillin choices. [Journal of Allergy and Clinical Immunology]

Series on Antimicrobial resistance, from Essays in Biochemistry: A special issue of Essays in Biochemistry from The Biochemical Society focusing on antimicrobial resistance includes articles addressing environmental aspects of resistance and innovations in treatment and diagnostics. According to the Biochemical Society, “Overall, these articles … give us hope that there are viable solutions being developed to this seemingly insurmountable global problem. It is important that all possible avenues are considered, as some less obvious approaches may end up being sources of future success.” [Essays in Biochemistry]

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