Stewardship / Resistance Scan for Apr 03, 2018

News brief

Surveillance network finds more evidence for global spread of MCR gene

Tests on clinical samples collected from a large global antimicrobial resistance surveillance network confirmed the worldwide spread of the colistin-resistance gene MCR, a research team based at the International Health Management Associates in Schaumberg, Ill., reported yesterday in PLoS One.

The samples are from the International Network for Optimal Resistance Monitoring (INFORM), which monitors antimicrobial resistance to pathogens isolated from a number of anatomic sites. From 2014 to 2016 the system collected 44,407 Enterobacteriaceae isolates from 39 countries in Europe, the Asia-Pacific region, Latin America, the Middle East, Africa, and the United States.

The group screened a subset of 908 colistin-resistant Enterobacteriaceae isolates for MCR-1, MCR-2, MCR-3, MCR-4, and MCR-5 genes, which came from 15 different countries. Of the collection, 3.2% (29) were positive for MCR: 27 Escherichia coli, 1 Klebsiella pneumoniae, and 1 Enterobacter cloacae. Of the group, 24 had the MCR-1 gene, with 1 containing MCR-1.2 and 1 containing MCR-1.5. The researchers found MCR-3 genes in 4 isolates from Thailand, 3 that contained MCR-3.1 and 1 that contained MCR-3.2. And finally, they found the newly identified MCR-5 gene in an E coli sample isolated from a patient in Colombia who had a urinary tract infection, expanding its known host and geographic range.

They didn't find any coexistence of MCR with any carbapenemase genes. Testing of the full group against a set of microbial agents found that ceftazidime-avibactam and tigecycline showed the highest antimicrobial activity.
Apr 2 PLoS One study

CARB-X awards $1.7 million for drug-resistance rapid test for blood

In an effort to change the way drug-resistant infections in the blood are diagnosed and treated, CARB-X today awarded California-based Specific Diagnostics up to $1.7 million to develop its antibiotic susceptibility testing (AST) system, with an option of $1.7 million more if the company meets certain milestones. CARB-X, a public-private collaboration that supports companies to combat antimicrobial resistance, announced the award in a news release.

Specific's system is designed to quickly detect volatile molecules that are the first sign of bacterial growth in blood, then determine which antibiotic to use. According to the statement, the test can determine susceptibility and identify resistant organisms within 4 hours of a positive blood sample.

Kevin Outterson, JD, executive director of CARB-X, said in the statement that Specific Diagnostic's project is an example of cutting-edge technology that could speed up and change the way life-threatening infections are diagnosed.

Paul Rhodes, PhD, chief executive officer of Specific, said his company is honored by the CARB-X award. "Our new instrument determines phenotypic antibiotic susceptibility with[in] hours of blood infection, and CARB-X's support affirms the importance of that capability and helps us bring it to clinics around the globe for evaluation in 2018."

The latest CARB-X award is the fourth targeted to a diagnostic testing product. So far, CARB-X—with funding from Wellcome Trust and the US government—has announced support for 29 projects in seven countries totaling $75.6 million, plus $90.7 million more if companies meet their milestones.
Apr 3 CARB-X news release

Antibiotics, acid suppressors early in life may increase kids' allergies

The use of antibiotics or acid-suppressing drugs in the first 6 months of life was associated with an increased risk of developing allergies later in childhood, according to a large study published yesterday in JAMA Pediatrics.

Researchers with the Uniformed Services University of the Health Sciences in Bethesda, Md., analyzed data on 792,130 children born from October 2001 through September 2013 who were enrolled in the U.S. military health system until at least 1 year old.

The scientists determined that, for infants 6 months old and younger who were prescribed antibiotics, the adjusted hazard ratios (aHRs) later in childhood were 2.09 for asthma, 1.74 for allergic rhinitis, 1.51 for anaphylaxis, and 1.42 for allergic conjunctivitis. This means the risk was raised from 42% for allergic conjunctivitis—and it more than doubled the risk of asthma—compared with children who hadn't been prescribed antibiotics early in life.

For two common acid-suppressing medications, aHRs were 2.18 and 2.59 for food allergy, 1.70 and 1.84 for medication allergy, 1.51 and 1.45 for anaphylaxis, 1.50 and 1.44 for allergic rhinitis, and 1.25 and 1.41 for asthma.

It is possible that antibiotics or acid-suppressing medicines were prescribed to infants for allergic diseases that were misdiagnosed, although the authors said they doubt this can explain all their findings, according to a JAMA Pediatrics news release. The authors conclude in the study, "Acid-suppressive medications and antibiotics should be used during infancy only in situations of clear clinical benefit."
Apr 2 JAMA Pediatr study
Apr 2 JAMA Pediatr news release

News Scan for Apr 03, 2018

News brief

Monkeypox outbreak recorded in Central African Republic

The Central African Republic (CAR) declared an outbreak of monkeypox in Bambari district, according to the latest weekly World Health Organization (WHO) African regional office bulletin, dated Mar 30 but posted yesterday.

From Mar 2 to Mar 25, CAR health officials identified eight case-patients, three of whom have been hospitalized. There have been no deaths, and all cases have occurred in people over the age of 5. Four patients are male and four female.

Researchers at the Institut Pasteur in Bangui confirmed monkeypox in six of eight patient samples. Last fall, Nigeria reported one of the largest monkeypox outbreaks in African history, with 68 cases.
Mar 30 WHO African regional office bulletin

Spanish study shows early use of antivirals during flu may reduce death

A new study conducted by Spanish investigators shows that patients with severe influenza who took neuraminidase inhibitors within 5 days of symptom onset were less likely to die. The study was published yesterday in Epidemiology & Infection.

Researchers based in Catalonia looked at the use of neuraminidase inhibitors (NAIs) in 1,727 hospitalized patients, of whom 1,577 (91.3%) received NAI treatment for flu from 2010 to 2016.

Patients who received treatment within 48 hours after symptom onset had the greatest reduction in death (adjusted odds ratio [aOR], 0.37; 95% confidence interval [CI], 0.22-0.63), followed by patients given the antivirals up to 3 days after symptoms appeared (aOR, 0.49; 95% CI, 0.30-0.79). Patients who received antivirals 5 days or more after symptom onset had no reduction in death rates.

Intensive care unit patients who received NAIs also had lower fatality rates.

The authors conclude that this study confirms the use of NAIs in the treatment of severe flu. Early treatment, even before laboratory confirmation of the virus can be helpful for patients at risk for severe complications from infection.
Apr 2 Epidemiol Infect study