CARB-X to fund Group A Strep vaccine candidate
CARB-X today announced an award of more than $1.6 million to biopharmaceutical company SutroVax of Foster City, Calif., to develop a vaccine to prevent infections caused by Group A Streptococcus.
The Group A Streptococcus (GAS) bacterium can cause a variety of infections that range from minor illnesses such as pharyngitis (strep throat)—a major source of antibiotic prescriptions worldwide—to more severe and deadly infections like necrotizing fasciitis. It can also cause post-infectious immune-mediated rheumatic heart disease, which is a leading cause of mortality in the developing world. There is currently no vaccine for GAS.
According to a press release from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), SutroVax's vaccine candidate consists of a GAS carbohydrate antigen combined with an immunogenic protein carrier, and has been modified to avoid triggering an immune response that can adversely affect human cardiac or brain tissue.
"The SutroVax project is in the early stages of development but if successful and approved for use in patients, it could save lives, improve public health and strengthen health security worldwide," said CARB-X executive director Kevin Outterson, JD.
SutroVax could receive an addition $13.4 million in funding if certain project milestones are met.
Sep 3 CARB-X press release
Study highlights drawbacks of pre-operative urine testing
A study by Boston-area researchers indicates pre-operative urine screening and identification of pyuria increases antibiotic exposure but does not improve post-operative outcomes.
In the study, which was published in Clinical Infectious Diseases, researchers from the Veterans Administration (VA) Boston Healthcare System, Boston University School of Medicine, and Harvard Medical School analyzed a cohort of pre-operative patients within the national VA system who had a urinalysis performed during the 30-day pre-operative period. The primary exposure of interest was the presence of pyuria, which is frequently treated with antibiotics, even when patients are asymptomatic. The primary outcome was antibiotic initiation. Secondary outcomes included post-operative surgical site infections (SSIs), urinary tract infections (UTIs), and Clostridioides difficile infections.
Of the 70,277 patients who underwent surgical procedures at the VA during the study period (October 2008 through September 2013), 41,373 patients had a urinalysis performed in the 30-day window prior to surgery, and 3,617 had varying degrees of pyuria detected (43.8% low, 21.9% moderate, and 34% high). In patients with any degree of pyuria, 887 (24.5%) received antimicrobials, and the odds of receiving antimicrobials increased as the degree of pyuria increased (low pyuria, 14.7%, moderate pyuria, 24.0%, high pyuria, 37.4%).
Pre-operative pyuria was associated with post-operative C difficile infections (adjusted odds ratio [aOR], 1.7; 95% confidence interval [CI], 1.2 to 2.4), but the risk was higher in patients who received antimicrobials (aOR 2.4; 95% CI, 1.7 to 3.4). Pyuria was not associated with SSI but was associated with increases in UTI after orthopedic (aOR, 1.5; 95%, 1.1 to 2.1) and vascular procedures (aOR, 2.5; 95% CI, 1.4 to 4.5). However, antimicrobial therapy did not significantly change this association.
The researchers say the study highlights the importance of diagnostic stewardship and avoiding low-value tests.
"These findings underscore the need to avoid testing in asymptomatic patients to reduce unnecessary and excessive antimicrobial treatment in patients who will not benefit from the intervention," the authors of the study write. "Once something is seen in clinical medicine, it cannot be unseen; thus, the best strategy is to not perform tests that do not have a clinical indication."
Aug 30 Clin Infect Dis abstract
More ASP training for medical residents linked to better prescribing
A study conducted at a small community teaching hospital in Michigan has found that adding antibiotic stewardship-focused educational training sessions for medical residents was associated with better adherence to antibiotic prescribing guidelines, researchers reported yesterday in Infection Control and Hospital Epidemiology.
The retrospective cohort study looked at antibiotic prescribing practices for three common infections (pneumonia, cellulitis, and UTI) among three physician services at the hospital—the family medicine (FM) resident service, the internal medicine (IM) resident service, and the hospitalist service. While all three services receive daily audit and feedback on antibiotic prescribing and baseline antimicrobial stewardship program (ASP) training, the FM residents also receive bi-weekly stewardship-focused rounding and education sessions with an ASP physician and a clinical pharmacist. The aim of the study was to compare guideline-concordant therapy among the three groups, based on the hospital's ASP guidelines.
Of 1,572 patients discharged from the hospital from July 2016 through June 2017 with diagnoses of pneumonia, cellulitis, or UTI, 295 were eligible for inclusion; 96 were treated by the FM group, 69 by the IM group, and 130 by the hospitalist group. The percentage of patients receiving guideline-concordant antibiotic selection empirically was similar between groups for all diagnoses (FM, 87.5%; IM, 87%; hospitalist, 83.8%; P = .702), and no differences were observed in appropriate definitive antibiotic selection among groups (FM, 92.4%; IM, 89.1%; hospitalist, 89.9%; P = .746). But the FM resident service was more likely to prescribe a guideline-concordant duration of therapy across all diagnoses (FM, 74%; IM, 56.5%; hospitalist, 44.6%; P < .001).
"The FM team overall prescribed more appropriate durations of therapy than the IM and hospitalist services when all disease states were considered, which may reflect the added benefit of consistent biweekly presence of the ASP team during patient care rounds on top of routine audit and feedback," the authors of the study write. "These results suggest that more frequent and multifaceted interactions with the ASP team may positively impact guideline-concordant prescribing habits."
Sep 2 Infect Control Hosp Epidemiol abstract