Stewardship / Resistance Scan for Mar 01, 2021

News brief

CARB-X to fund vaccines for group A Streptococcus, Salmonella enterica

CARB-X announced today that it is awarding more than $10 million to GSK to develop vaccines to prevent serious infections caused by common bacterial pathogens that pose a significant health threat in the developing world.

Under the award from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), GSK Biologicals and the GSK Vaccines Institute for Global Health (GVGH) will receive $8.2 million for a vaccine targeting group A Streptococcus and $2.2 million for a vaccine targeting Salmonella enterica infections. If both projects meet certain milestones, they could be eligible for an additional $8.2 million.

Group A Streptococcus causes strep throat, which affects an estimated 600 million people a year globally, but it can also cause more serious infections, like acute rheumatic fever, and pose more of a health threat in immunocompromised people. Salmonella enterica causes invasive nontyphoidal salmonellosis (iNTS) and typhoid fever, both of which are significant causes of morbidity and mortality in sub-Saharan Africa and low- and middle-income countries in other parts of the world.

The aim of the group A Streptococcus vaccine is to reduce the incidence and severity of strep A infections and autoimmune sequelae. The Salmonella enterica vaccine, which combines a recently licensed Typhoid Conjugate Vaccine with key antigens from other Salmonella strains that cause iNTS, aims to prevent deaths and contribute to reduced antibiotic consumption.

"As part of GSK's overall Global Health approach, GVGH is dedicated to working with partners to develop effective and affordable vaccines that protect vulnerable communities against some of the most prevalent diseases causing high morbidity and mortality in developing countries," GVGH Director Francesco Berlanda Scorza said in a CARB-X press release. "Thanks to CARB-X support, we have the opportunity to study and advance innovative vaccines against Salmonellosis and Group A Streptococcus, and contribute to the fight against antimicrobial resistance."

Since its launch in 2016, CARB-X has awarded nearly $300 million for early-stage development of new antibiotic, vaccines, diagnostics, and other products that target drug-resistant bacteria.
Mar 1 CARB-X press release

VA study finds varying susceptibility in pneumonia-causing bacteria

A nationwide cumulative antibiogram for common bacterial isolates obtained from sputum samples shows some notable trends in susceptibility and resistance among pathogens that cause pneumonia, researchers in New York reported today in the American Journal of Infection Control.

To create the antibiogram, researchers from the Veterans Affairs (VA) Western New York Healthcare System obtained sputum culture data from patients treated at VA hospitals nationwide from 2009 to 2019. They calculated susceptibility percentages by dividing the total number of susceptible isolates of a particular bacterial species by the total number of reported isolates of that same bacterial species. Sputum and bronchial cultures from an average 10,345 VA patients per year were analyzed.

The results showed that the susceptibility of Streptococcus pneumoniae to third-generation cephalosporins rose from 92.2% to 95% over the study period, but azithromycin susceptibility fell from 56.8% in 2009 to 51.7% in 2018, and reduced susceptibility to erythromycin (59% to 46.2) and tetracycline (76.2% to 72.3%) was also observed.

Haemophilus influenzae maintained high levels of susceptibility to third-generation cephalosporins (99.7% to 97.2%), while third-generation susceptibility among Klebsiella pneumoniae trended upward (79.1% to 86.4%). Fluoroquinolone susceptibility among Escherichia coli remained low but stable (58% for ciprofloxacin and 57% for levofloxacin).

The authors say the findings suggest that, among VA patients, avoidance of macrolides (azithromycin and clarithromycin) for empiric treatment of community-associated pneumonia and avoidance of fluoroquinolones for empiric treatment of hospital-acquired or ventilator-associated pneumonia may be warranted based on the observed trends.

"Information obtained from this study can be used to help guide and improve empiric prescribing of antibiotics, which may in turn help reduce the development of antimicrobial resistance and lead to faster appropriate treatment of patients," they write.
Mar 1 Am J Infect Control abstract

News Scan for Mar 01, 2021

News brief

High vaccine uptake in Israel tied to fewer severe COVID cases in elderly

Israel's national COVID-19 vaccine rollout, which saw 84% of people 70 and older fully vaccinated by Feb 9 , was associated with less need for mechanical ventilation in the elderly. The finding could show that COVID-19 vaccine rollouts help prevent severe cases at the national level, according to a study in Morbidity and Mortality Weekly Report.

The ratio of Israeli residents 70 and above who needed mechanical ventilation compared with those less than 50 declined 67% from Quarter 4 of 2020 to February 2021. The researchers noted the decline began about 1 week after the vaccination program began Dec 20, 2020, rose briefly at the beginning of January before the country's third stay-at-home order (Jan 8-Feb 7), and then resumed its decrease after Jan 10, the day administration of the second vaccine dose began.

Israel's vaccination program began by targeting those 60 and above, healthcare workers, and those with chronic conditions that could worsen COVID-19 infection or severity. Currently, only the Pfizer/BioNTech COVID-19 vaccine is authorized in the country.

By Feb 9, about 3.6 million people had received the first vaccine dose, and 61.6% of those had received the second. Two-dose vaccine coverage was 84.3% among those 70 and older and 9.9% among those less than 50.

"The findings from this study provide preliminary but important evidence of the effectiveness of vaccines in preventing severe cases of COVID-19 at the national level in Israel," the researchers write. "Receipt of COVID-19 vaccines by eligible persons can help limit spread of disease and potentially reduce the occurrence of severe disease."
Feb 26 MMWR study

Preceding statin use associated with lower in-hospital COVID mortality

Patients who used statins prior to COVID-19 hospitalization were almost 50% less likely to experience 30-day in-hospital mortality compared with those that didn't, according to a retrospective study published late last week in Nature Communications.

Statins are drugs meant to reduce blood fat for conditions such as high cholesterol, and, as such, they have anti-inflammatory and anti-clotting properties.

The researchers matched 648 patients who used statins and were hospitalized with COVID-19 and 648 who did not but were also hospitalized for COVID-19 during the first 18 weeks of the pandemic in Manhattan at New York-Presbyterian Hospital sites. Almost 15% (14.8%) of statin users died in-hospital within 30 days of admission, compared with 26.5% of those who did not, resulting in a 0.47 odds ratio (95% confidence interval [CI], 0.36 to 0.62). Overall, 17.2% of statin users died while hospitalized, compared with 31.0%.

The need for invasive mechanical ventilations, days on a ventilator, or length of hospital stay were not statistically significantly different between the groups. Those who took statins, however, had on average lower levels of C-reactive protein upon admission (100.0 milligrams per liter vs 120.7), which can indicate less inflammation.

Out of all 2,626 patients hospitalized with COVID-19 in the hospital system, 36.2% used statins prior to admission. Statin users were more likely to be older (median age 70 vs 62), have Medicare or Medicaid versus a commercial insurer (63.0% vs 53.6%), and have comorbidities such as hypertension, diabetes, coronary artery disease, and chronic kidney disease (ranging from 5.4 to 30.7 percentage points in difference).

"If their beneficial effect bears out in randomized clinical trials, statins could potentially prove to be a low-cost and effective therapeutic strategy for COVID-19," said co-lead author Mahesh Madhavan, MD, in a Columbia University Irving Medical Center press release.
Feb 26 Nat Commun study
Feb 26 Columbia University press release

Officials confirm new MERS case in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) reported another new MERS-CoV case in a man from the nation's capital, Riyadh. Last month, the ministry recorded four cases across the country.

The MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 77-year-old man who had contact with camels, a known exposure to the virus. He has since recovered from his infection.

Earlier this month, the World Health Organization (WHO) said in a snapshot of MERS activity that, since 2012 through 2020, 2,566 cases have been reported in humans, at least 882 of them fatal (34.4%).
Saudi MOH epi week 7 report