Stewardship / Resistance Scan for Oct 03, 2019

News brief

Accelerate Diagnostics touts data on rapid diagnostic test

Accelerate Diagnostics presented three studies today at IDWeek 2019 in Washington, DC, that show promising results for its rapid phenotypic susceptibility test, according to a company press release.

In the RAPIDS-GN randomized controlled trial, conducted at Mayo Clinic and the University of California, Los Angeles, investigators reported that the Accelerate PhenoTest BC kit, when compared with legacy testing methods in gram-negative bacteremia patients, shortened reporting time to first gram-negative antibiotic change a full 24 hours sooner than legacy methods (17.4 vs 42.1 hours) and reporting time to any antibiotic change 6 hours sooner (8.6 vs 14.9 hours).

In a single-center study conducted by researchers at the University of Arkansas for Medical Sciences, use of the Accelerate Pheno system was associated with a statistically significant decrease in time on broad-spectrum gram-positive antibiotics of 23.3 hours and a decrease in time on broad-spectrum gram-negative antibiotics of 38.4 hours. Hospital length of stay was also reduced.

Data from a study conducted at the University of Iowa Hospitals and Clinics showed that implementation of Accelerate Pheno paired with antimicrobial stewardship team review resulted in early optimization of antibiotic therapy, with the highest impact seen in patients with resistant gram-negative infections.

"We are thrilled to see these data, which demonstrate conclusively that the Accelerate PhenoTest BC kit positively impacts clinical outcomes across a diverse set of institutions and patient populations," said Romney Humphries, PhD, Chief Scientific Officer of Accelerate Diagnostics. "The studies show an improvement in antibiotic use, a necessary factor for lowering the risk of multidrug-resistant infections and in preserving the patient's vital functions, while also improving the hospital's bottom line by reducing patient length of stay."
Oct 3 Accelerate Diagnostics press release

Data show promise for novel antibiotic against gram-negative pneumonia

Data presented today at IDWeek by Shionogi & Co researchers reveal that its investigational drug cefiderocol, a novel siderophore cephalosporin that has shown activity against a broad range of gram-negative bacteria, was non-inferior to meropenem in patients who had hospital-acquired pneumonia caused by gram-negative bacteria.

In the study, 148 patients were randomized to receive cefiderocol and 150 to meropenem. Illnesses were typically severe; 60% required mechanical ventilation, and a third had previous treatment failure. Patients received high doses (2 grams) of the drugs every 8 hours.

All-cause mortality at 14 days was similar for cefiderocol (12.4%) versus merpoenem (11.6%), as was clinical cure (64.8% vs 66.7%), and microbiological eradication (47.6% vs 48.0%).

Tsutae "Den" Nagata, MD, Shionogi's chief medical officer, in a company news release, said the findings "provide meaningful evidence that cefiderocol has the potential to be an effective treatment option for severely ill hospitalized patients with pneumonia….Recently, several new antibiotics have been introduced to address some carbapenem-resistant infections, but they do not address all resistant Gram-negative pathogens. Clinicians are in urgent need of novel therapeutic approaches to overcome the multiple resistance mechanisms that make these strains so difficult to treat."

The researchers recorded no unexpected safety issues with the new drug.

Cefiderocol—a cephalosporin—has a novel method of penetrating the tough outer membrane of gram-negative bacteria, including multidrug-resistant strains. It has been fast-tracked for assessment by the US Food and Drug Administration, which has assigned an action date of Nov 14 to the drug. It showed promising results against complicated urinary tract infections in a study published last year.
Oct 3 IDWeek abstract
Oct 2 Shionogi news release
Oct 26, 2018, CIDRAP News story "Fast-tracked antibiotic shows promise in phase 2 trial"

News Scan for Oct 03, 2019

News brief

Rockland County, NY, reports new measles case separate from earlier outbreak

Health officials in New York's Rockland County yesterday announced a new measles case, which involves an international traveler and is separate from a large outbreak that ended in September.

The patient visited a synagogue in Monsey, New York, possible exposing others from Sep 20 to Sep 21. Monsey is about 40 miles from New York City.

County Executive Ed Day emphasized in a statement that the case is new and isn't connected to the previous outbreak, which sickened 312 beginning in October 2018 and was declared over on Sep 25, decreasing the chance that the United States would lose its measles elimination status.

"As the disease continues to spread around the world, it is not surprising to see yet another imported case here in Rockland. Utilizing the strategies developed during our outbreak the Department of Health will continue to investigate this case and monitor anyone who may have been exposed to the measles," he said.

Health officials are urging residents to check their immunization status and to get vaccinated if they are underimmunized. Patricia Schnabel Ruppert, DO, MPH, county health commissioner, said, "By avoiding having pockets of susceptible individuals, we can prevent the measles from spreading further within our County. The MMR [measles, mumps, and rubella] vaccination remains the only safe and effective way to prevent the measles."
Oct 2 Rockland County press release

Study details first evidence of windborne mosquito migration in Africa

A study to probe why malaria persists in parts of Africa that are dry for 3 to 8 months of the year revealed the first evidence of windborne migration of some mosquito species that can spread the disease. Researchers from Mali, the United Kingdom, and the United States described their findings yesterday in a letter to Nature.

The investigators used aerial sampling to explore mosquito movements in the Sahel area of Mali, which has a long dry season and where mosquito populations surge much faster than expected after the rains return. Aerial sampling involved suspending sticky nets tied to helium balloons at different altitudes at night. Sampling took place at four villages for 10 consecutive nights over 22 to 32 months.

The team found ten species, including the primary malaria vector Anopheles coluzzii, among 235 anopheline captured during 617 aerial collections. Females made up 80% of the collected mosquitoes, and, of those, 90% had taken a blood meal before migration, hinting that malaria parasites are probably transported over long distances by migrating females. However, they did not find the parasite in any of the sampled mosquitoes, possibly owing to the small sample size.

Also, the researchers found that the likelihood of capturing Anopheles species increased with altitude and wet season, with little variation between years and locations. Trajectory simulations of mosquito flights suggest nightly displacements of 300 kilometers (186 miles) for 9-hour flight durations.

The group concluded that successful elimination of malaria may hinge on identifying and controlling the sources of migrant mosquito vectors.
Oct 2 Nature study
Oct 2 Nature news story