Bon Appetit updates its antibiotics policy to include seafood
The Bon Appetit Management Company, which in 2003 became the first US food service company to pledge to reduce antibiotic use in the animals it uses for food, has updated and streamlined its antibiotics policy, which for the first time includes seafood.
The company, based in Palo Alto, Calif., said in a press release, "Our companywide purchasing standard is to buy only meat, poultry, and seafood raised without the use of antimicrobials, except where necessary to treat sick animals in the documented presence of disease in the flock, herd, or fish population as verified by a veterinarian.
"This standard exceeds the World Health Organization's most recent recommendations, which recommend restricting only those drugs important in human medicine. Although it may seem simpler, policy-wise, for us to have declared that we will buy only proteins raised without any antibiotics (by requiring the 'never ever' standard that consumers are beginning to recognize), that approach unfairly penalizes some of our smaller farmers and ranchers."
Bon Appetit explained that these growers want to be able to treat sick animals with appropriate medicines but are not large enough to have a secondary, "conventional" sales channel in which to sell a food animal that has required antibiotics.
In incorporating seafood for the first time into its antibiotic standards, the company said, "The seafood supply chain is not yet transparent enough to allow us to parse within specific rating subcategories for each fishery. With the exception of salmon, for which our companywide standard has long been wild-caught (and thus no antibiotics, ever), Bon Appetit's seafood supply does not yet meet our new standard. This is an area in which we will continue to seek transparency and apply pressure."
Jan 23 Bon Appetit news release
CDC warns of raw milk exposure to drug-resistant Brucella after 3rd case
Originally published by CIDRAP News Jan 24
A New York resident who drank raw milk from a Pennsylvania dairy has contracted the nation's third known case of brucellosis caused by the antibiotic-resistant Brucella RB51 strain, the Centers for Disease Control and Prevention (CDC) said yesterday in a Health Alert Network (HAN) notice. The previous two illnesses occurred in 2017.
"The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, Pennsylvania," the CDC said. Officials say people in 19 states across the country have consumed raw milk products from the farm and may have been exposed to the bacterium.
The New York resident was diagnosed as having brucellosis in November after drinking raw milk from the farm, and milk samples from the dairy tested positive for Brucella RB51. Anyone who drank raw milk or consumed other raw milk products from the dairy since 2016 may have been exposed, the CDC said.
Brucella strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans who drink the milk without pasteurization. The strain is resistant to rifampin and penicillin, so the CDC recommends both doxycycline and trimethoprim-sulfamethoxazole as first-line treatment. Blood culture is recommended for diagnosis.
Symptoms of brucellosis can include fever, sweats, general malaise, loss of appetite, headache, fatigue, muscle and joint pain, and potentially more serious complications like endocarditis and neurologic symptoms. Pregnant women are at risk of miscarriage.
The CDC reported the first two confirmed US RB51 cases in a Texas woman in September 2017 and in a New Jersey woman in November of that year.
Jan 23 CDC HAN advisory
Sep 15, 2017, CIDRAP News story "CDC issues alert over raw milk and Brucella infection"
Sep 21, 2017, CIDRAP News story "CDC issues raw milk Brucella warning for 4 states"
FDA clears first test for Mycoplasma genitalium
Originally published by CIDRAP News Jan 24
The US Food and Drug Administration (FDA) today cleared a new test for diagnosing the common sexually transmitted infection (STI), Mycoplasma genitalium, a step that could aid antibiotic stewardship efforts.
The test—Aptima, manufactured by Hologic Inc, of Marlborough, Mass.—is the first on the market to target M genitalium, which the Centers for Disease Control and Prevention (CDC) called an emerging public health threat in 2015.
According to Hologic, more than 15% of Americans in certain high-risk groups may be infected with the bacterium, and as many as 50% of women and 42% of men may have antibiotic-resistant infections. Also, some patients may be asymptomatic or have symptoms similar to those caused by chlamydia, so accurate diagnostic testing is crucial. If left untreated, M genitalium infections can result in infertility in women and an increased risk for HIV transmission.
"Although Mycoplasma genitalium is typically more common than gonorrhea, there is very little public awareness of this rising sexually transmitted infection, which can cause serious and potentially devastating health problems," said Damon Getman, PhD, the senior principal research scientist and director of research at Hologic, in a company press release.
The FDA said the STI test will help clinicians choose the correct antibiotic to target the bacterium, potentially limiting the misuse of antibiotics that results in antimicrobial resistance.
"In the past, it has been hard to diagnose this organism," said FDA Commissioner Scott Gottlieb, MD in a statement. "By being able to detect it more reliably, doctors may be able to more carefully tailor treatment and use medicines most likely to be effective. In cases where M. gen. is detected, doctors can consider forgoing use of antibiotics that are known to be ineffective against M. gen. and choose a treatment more likely to be appropriate."
Jan 23 Hologic press release
Jan 23 FDA statement
KFC makes good on pledge to eliminate medically important antibiotics
Originally published by CIDRAP News Jan 24
Fast food chain KFC announced today that it has fulfilled its pledge that 100% of the chicken purchased by the company would be raised without medically important antibiotics by the end of 2018.
KFC said that it has worked closely with more than 2,000 US poultry producers to meet its promise, which was announced in April 2017. KFC is one of several fast food chains to commit to reducing or eliminating chicken raised with medically important antibiotics in recent years, a move that has been driven by consumer demand and growing public health concern about antibiotic resistance.
"Recognizing the rising public health concerns about the increased threat of resistance to human antibiotics, KFC has advanced this initiative while keeping both customers—and the health of flocks from which they source—top of mind," the company said in a press release.
Matthew Wellington, antibiotics program director for US PIRG (Public Interest Research Group), which was among a coalition of groups that had urged KFC to enact better antibiotic policies, said the announcement illustrates the important role that food companies play in efforts to reduce antibiotic use in food-producing animals.
"KFC making good on its promise to cut the use of medically important antibiotics in its chicken supply shows that food companies can use their purchasing power to make a positive impact," he told CIDRAP News. "It's good news for consumers and will help preserve these life-saving medicines for future generations."
Jan 24 KFC press release
CDC experts say US-wide C diff prevention could net $25 billion in benefits
Originally published by CIDRAP News Jan 23
Experts from the CDC estimated yesterday in Antimicrobial Resistance & Infection Control that establishing nationwide antibiotic stewardship programs to prevent Clostridioides difficile infections in hospitals would result in an annual net benefit of $25.5 billion.
The investigators used new Department of Health and Human Services guidelines for their cost-benefit analyses of a national in-hospital C difficile prevention program to improve health and preserve antibiotics. They included estimates of antibiotic stewardship staffing and incorporated value-of-statistical-life estimates to derive economic values associated with decreasing morbidity and mortality risk.
They estimated that, if they were to ignore the benefits from reducing the risk of illness and death, net benefits of such a nationwide intervention would range from $300 million to $7.6 billion from 2015 to 2020. But if they include the value of such risk reduction, the net social benefits jump from $21 billion to $624 billion. The authors say the most likely outcome scenario would realize a net benefit of $25.5 billion per year.
The experts conclude, "As the US federal government intensifies its efforts to control antibiotic resistant infections, our results suggest that these ambitious goals can produce very large net societal benefits. As these benefits accrue mostly to patients, policy makers can address how the burden for the additional prevention costs should be shared among patients, third party payers and healthcare providers."
Jan 22 Antimicrob Resist Infect Control study
UK study: Antimicrobial resistance strategy linked to drop in prescribing
Originally published by CIDRAP News Jan 23
Researchers with the University of Oxford report today in the Journal of Antimicrobial Chemotherapy that antibiotic prescribing has dropped by 14% in England since the government implemented its 5-year antimicrobial resistance strategy.
Using annual prescription cost analysis data from 1998 to 2017 and monthly prescribing data from 2010 to 2018, the researchers calculated the volume of antibiotic prescriptions and measured the change in prescribing rate after the strategy was implemented in 2013. The strategy, introduced in a report by England's Chief Medical Officer (CMO), included optimizing prescribing practice by reducing unnecessary prescribing and creating a website that provides clinicians with prescribing data by practice and month.
The researchers found that while the annual prescribing rate was stable from 1998 through 2012, there was a downward change after 2013, despite an increase in population. The annual rate dropped from 1,378 per 1,000 Specific Therapeutic group Age-Sex Related Prescribing Units (STAR-PU) per year in 2013 to 1,184 per 1,000 STAR-PU in 2017. Applying the pre-2013 prescribing rate to the period from July 2017 to June 2018, the researchers estimated that an additional 9.7 million antibiotic prescriptions would have been dispensed had the strategy not been implemented.
Though they note that they cannot firmly say that the 5-year antimicrobial resistance strategy caused the reduction in prescribing, the authors of the study say the magnitude and timing of the change are noteworthy.
"National strategic public health interventions are an important and potentially effective way to modify clinical practice," they write. "The CMO report and Antimicrobial Resistance Strategy appears to have had a substantial impact on prescribing of antibiotics at the population level in England."
Jan 23 J Antimicrob Chemother study
CDC says 2018 Candida auris cases topped 550
Originally published by CIDRAP News Jan 23
Confirmed and probable Candida auris cases in the United States through Dec 31 rose to 551, an increase of 88 from the end of October, the CDC said in an update yesterday.
Illnesses caused by the deadly, multidrug-resistant fungus have been reported in 12 states, though 90% are in New York (280), Illinois (118), and New Jersey (100). Of the 551 cases, 520 are confirmed and 31 are listed as probable.
In comparison, from when the fungus was first identified in the country in June 2016 through Aug 31, 2017, US states reported 153 clinical cases.
Screening for C auris in six states has found an additional 975 patients who are colonized. The testing is part of efforts to control the spread of the fungus, known to persist on surfaces in healthcare facilities and spread among patients. That total reflects an increase of 174 since the CDC's October update.
Since its first identification in 2009 in Japan, C auris has triggered outbreaks in health facilities in more than 20 countries and has shown resistance to three major antifungal drug classes. The fungus can cause serious invasive infections in patients who have compromised immune systems, and the CDC has estimated that C auris infections are fatal in 30% to 60% of patients.
Jan 22 CDC C auris case count page
Sep 18, 2017, CDC clinical update
Study finds high rate of antibiotic prescribing for respiratory infections
Originally published by CIDRAP News Jan 22
A new study by Emory University researchers reports that more than half of the patients visiting primary care clinics in the university's healthcare network with acute respiratory infections (ARIs) received antibiotics, with substantial variation in prescribing rates by site and provider. The findings were published in Open Forum Infectious Diseases.
The cross-sectional study, conducted from October 2015 through September 2017, examined all patients with a presenting diagnosis of ARI (as indicated by the ICD-10 code) at Emory Clinic's 15 primary care clinics. The researchers also looked at patient demographic data (age, race, and gender), comorbid conditions, the presence of co-infection, and provider type. Provider-specific prescribing rates were compared within and between clinic sites, and multivariable logistic regression was used to determine the impact of patient, provider, and clinic characteristics on antibiotic prescribing.
Of the 9,600 eligible visits with a primary diagnosis of ARI, 53.4% resulted in antibiotics being prescribed. When data were summarized at the clinic level, two clinics prescribed antibiotics more frequently than other clinics, with unadjusted prescribing rates of 75% and 72%, respectively.
In multivariable analysis, the odds of an encounter resulting in an antibiotic prescription were independently associated with white race (adjusted odds ratio [aOR], 1.59; 95% confidence interval [CI], 1.47 to 1.73), older age (aOR, 1.32; 95% CI, 1.20 to 1.46 for patients 51 to 64 years and aOR, 1.32; 95% CI, 1.20 to 1.46 for patients over 65 years), and presence of comorbid conditions (aOR; 1.19; 95% CI, 1.09 to 1.30). Of the 109 providers, 13 (12%) had a higher rate of prescribing than predicted by modeling.
"These data lay the foundation for quality improvement interventions to reduce antibiotic prescribing rates," the authors of the study concluded. "Our team is using these data to define the context of peer-to-peer interactions within the outlier clinics as a first step to change prescriber practice."
Jan 18 Open Forum Infect Dis abstract
Alternative antibiotics for UTIs tied to more severe outcomes in elderly
Originally published by CIDRAP News Jan 22
In another study in Open Forum Infectious Diseases, UK researchers report that prescribing alternatives to the recommended empiric antibiotic for urinary tract infection (UTI) in older adults was associated with lower rates of treatment failure but also with higher risk of hospitalization and death.
The retrospective cohort study aimed to compare the risk of adverse outcomes in adults 65 and older prescribed empirical nitrofurantoin versus cefalexin, ciprofloxacin, or co-amoxiclav for suspected UTI. While clinical guidelines in the United States and United Kingdom recommend nitrofurantoin for uncomplicated UTI, previous studies have found that roughly 15% of older adults treated receive cefalexin, ciprofloxacin, or co-amoxiclav for UTIs.
The hypothesis is that clinicians choose these broad-spectrum antibiotics, which are associated with increased rates of adverse events, to prevent treatment failure, worsening of symptoms, and hospitalization. Using an electronic database of primary care records, the researchers looked specifically at risk of treatment failure, hospitalization for UTI, sepsis, or acute kidney injury, or death.
The researchers identified 42,298 patients 65 and older who were prescribed nitrofurantoin, cefalexin, ciprofloxacin, or co-amoxiclav for a UTI. Compared with those receiving nitrofurantoin, patients prescribed cefalexin (OR, 0.85; 95% CI, 0.75 to 0.98), ciprofloxacin (OR, 0.48; 95% CI, 0.38 to 0.61), or co-amoxiclav (OR, 0.77; 95% CI 0.64 to 0.93) had lower risks of treatment failure. But patients prescribed cefalexin or ciprofloxacin had higher odds of hospitalization for sepsis (OR, 1.89; 95% CI, 1.03 to 3.47 for cefalexin; OR 3.21; 95% CI, 1.59 to 6.50 for ciprofloxacin), while patients prescribed cefalexin had higher odds of death (OR, 1.44; 95% CI, 1.12 to 1.85).
The authors of the study say the findings support further reductions in prescribing cefalexin, ciprofloxacin, and co-amoxiclav for UTIs, given their impact on antimicrobial resistance.
Jan 18 Open Forum Infect Dis abstract
'Super donors' may hold key to success of fecal transplants
Originally published by CIDRAP News Jan 22
A paper yesterday in Frontiers in Cellular and Infection Microbiology suggests that the efficacy of fecal microbiota transplantation (FMT) for inflammatory bowel disease (IBD) and other conditions may depend on "super donors" whose stool can provide the necessary bacteria to help restore the gut microbiome.
While a recent systematic review and meta-analysis of FMT for the treatment of recurrent C difficile infection (CDI) reported a cure rate of 92%, the efficacy of FMT for chronic diseases caused by intestinal dysbiosis, such as IBD, has been modest, with much higher variability in patient response. But in a review of FMT trials for IBD, researchers from the University of Auckland and the Broad Institute of MIT and Harvard found that success in IBD patients appeared to be donor-dependent and linked to donors with higher microbial diversity.
"The pattern of success in these trials demonstrates the existence of 'super-donors,' whose stool is particularly likely to influence the host gut and to lead to clinical improvement," senior study author Justin O'Sullivan of the University of Auckland said in a press release.
Further analysis of studies on the microbial profile of donors and recipients before and after FMT revealed specific microbial signatures linked to efficacy, including the presence of "keystone" bacterial species capable of restoring metabolic deficits in recipients. The investigators also found that how those keystone species interact with bacteria in the recipient's gut can influence FMT engraftment—the integration of donor-derived strains into the recipient's gut microbial community—and that underlying genetic differences between donor and recipient, diet, and subsequent antibiotic exposure can influence long-term efficacy.
Sullivan and his colleagues say further characterization of super donors could help standardize FMT therapy and reduce variability in patient response.
Jan 21 Front Cell Infect Microbiol review article
Jan 22 University of Auckland news release
Analysis shows high resistance rates in cholera bacteria in Ghana
Originally published by CIDRAP News Jan 22
Scientists in Ghana analyzed clinical and environmental isolates of Vibrio cholerae, the bacterium that causes cholera, from in and around the capital city of Accra and discovered that 97% are multidrug-resistant (MDR).
Writing yesterday in BMC Infectious Diseases, the investigators explain that they sampled water from 11 locations in four communities in Greater Accra from October 2015 to January 2016. They collected 244 samples from streams, shallow wells, storage containers, and spigots, and 33 of them (13.5%) tested positive for V cholerae.
Of those, they assessed 11 that were positive for the 01 serotype, as well as 40 clinical samples that were also positive for the 01 serotype, which is the strain most commonly circulating in the country. No tap water tested positive for the 01 strain, but 5.6% of samples (5 of 90) were positive for V cholerae.
All isolates were resistant to one or more of the eight antibiotics tested, and one—a clinical isolate—was resistant to all eight. Over 97% of the isolates were MDR, and 82% harbored the tcpA El torresistance gene. Only four of the clinical isolates were resistant to ciprofloxacin and six to doxycycline; the remainder were susceptible.
The authors conclude, "This study showed an increasing trend in multidrug resistant Vibrio choleraeO1 with pathogenic potential in domestic water sources."
Jan 21 BMC Infect Dis study
