APUA Highlights: June/July 2014
APUA Chapter News
News and Publications of Note
Upcoming Events & Opportunities
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APUA is currently soliciting nominations for the 2014 APUA Leadership and Chapter Awards. The Leadership Award honors an individual or organization for extraordinary leadership in promoting the prudent use of antibiotics as a means to contain antibiotic resistance. The Chapter Award honors a chapter for its leadership in promoting the prudent use of antibiotics in its country and containing antibiotic resistance. APUA seek nominees active in the fields of science, medicine, and policy from around the world. Please submit your nominations before August 15, 2014 via email to APUA@tufts.edu.
On June 24, 2014, APUA president Dr. Stuart Levy delivered the opening address Antibiotic Stewardship: More Action, Less Resistance at the Global Respiratory Infection Partnership (GRIP) summit in London.
On June 18, APUA participated in a CDC-led Twitter talk regarding hospital-acquired infections and antibiotic resistance. Moderated by CDC’s Dr. Tom Frieden, using the handle #SafeCareChat, many doctors, advocates, and patients submitted comments and statistics regarding antibiotic use, misuse, and infection surveillance. Highlights of the discussion included: advocating for one’s own health as a patient; reducing resistant infections and increasing patient safety is one of the best ways to save lives and money; and successful stewardship programs should include hospital commitment, physician and pharmacy leadership, real-time information and feedback, and specific programs about antibiotics.
In May, APUA hosted an international meeting of key opinion leaders concerning the utility of biomarkers to guide antibiotic therapy and reduce antibiotic overuse. The Boston-based May 21 summit meeting, titled Improving antimicrobial stewardship in outpatients: Potential for CRP and other biomarkers, explored how biomarkers such as C-Reactive Protein (CRP) can be used at the point-of-care (POC) from finger-stick blood samples, thereby providing additional information to guide the physician in antibiotic decision-making and reducing diagnostic uncertainty in community healthcare settings. This practice is now common in some northern European countries, which are well known for prudent antibiotic use and low levels of resistance. As a rapid, point-of-care CRP test is not currently approved in the US, there are multiple barriers to its implementation, including physician and patient uptake, cost issues and federal approval. A consensus evolved among attendees that US-based studies to evaluate and clarify the utility and outcomes of CRP are needed in order to augment the dearth of sometimes conflicting data—most of which are based in Europe at present. A summary manuscript of the meeting outcomes is currently in preparation and projected for submission to a primary health care journal in July.
Dr. Stuart Levy, along with author/commentator Maryn McKenna and Dr. Michael Bell of the CDC, were guests of the National Public Radio show On Point with Tom Ashbrook, which featured a discussion of the recent WHO release —Antimicrobial resistance: global report on surveillance 2014. Dr. Levy commented how antibiotic stewardship programs are unifying the efforts of pharmaceutical industries, consumers, and prescribers. The conversation explored the consequences of patient expectations for antibiotics, the overuse of antibiotics in food animals and agriculture and the implications of antibacterials in soaps and household products. While explaining that, “Antibiotics work against bacteria, but not viruses”, he highlighted the need for a paradigm shift in public and consumer behavior to reduce the broad overuse of antibiotics in multiple arenas.
APUA Chapter News
The APUA-Italy chapter conducted a one-day symposium on "Containing the spread of multi-resistant bacteria," hosted at the University of Verona on May 30, 2014 and co-sponsored by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). The symposium stressed how controlling the unrelenting emergence of multidrug-resistant bacteria in major human infections is a public health priority, and how this control must be based on appropriate and cost-effective screening, accurate and reliable identification, and strict infection control measures. The event included lectures on the topics of screening of MDR bacteria, detection of ESBLs and carbapenemases, therapy of carbapenem-resistant isolates, containment of gram-negative infections, hospital MRSA, and new antibiotics for MRSA. Approximately one hundred attendees participated, including microbiologists, clinicians and Public Health Officers.
Submitted by: Giuseppe Cornaglia, MD, APUA-Italy President
On November 28-30, 2013 APUA-Bulgaria, together with Bulgarian microbiologists, the Ministry of Health and WHO representatives, attended the Meeting of the Focal Points of the South-Eastern Europe Health Network (SEEHN) – Regional Health Development Center for Antibiotic Resistance, which was hosted by the National Center for Infectious and Parasitic Diseases (NCPD) in Sofia. Topics of discussion included: policy development, updates on legislation networking, establishment of inter-sectorial coordination mechanisms, rational use of antibiotics, quality assessment systems, training of professionals, and development of guidelines. The work of Bulgarian microbiologists on the issues of rational antibiotic policies was also presented, in which they noted a national antibiotic consumption rate of 22.5 - 24.6 DDD/1000 population/day during 2008-2010.
In September 2013 APUA-Bulgaria participated in the VIIth National Meeting, “Initiatives for Health and Vaccination” at the Council of Ministers. Representatives from the state, NGOs and private sector from Albania, Bulgaria, Hungary, Macedonia, Romania, Serbia and Slovakia took part. The Bulgarian delegation presented its experience in coping with health challenges among minority groups.
APUA-Bulgaria participated in European Antibiotic day, November 18, 2013, during which lectures in mass media and educational materials for public/patient populations were presented.
APUA-Bulgaria also attended the 12th National Congress on Clinical Microbiology and Infection, held on 24 – 26 April, 2014 at the National Congress of Culture, Sofia. Important presentations focused on: improvement of epidemiological and laboratory surveillance of vaccine-preventable infections; new infections and biohazards management; vector-borne infections in Bulgaria; transmitted drug resistance in newly diagnosed HIV-1 patients; antimicrobial susceptibility of human extra-intestinal non-typhoid salmonella; common genotypes of multi-drug resistant Mycobacterium tuberculosis; rapid detection of Gram-positive and Gram-negative bacteria and resistant determinants from positive blood-cultures using micro-array-based technology; and molecular characterization and clonal spread of carbapenem- resistant Acinetobacter baumannii in Bulgarian hospitals.
Among the current activities of the hospital microbiologists in Bulgaria are their efforts in antimicrobial resistance surveillance, antibiotic stewardship, guidelines development, and work on infection control.
Submitted by: Emma Keuleyan, MD, PhD, APUA Bulgaria coordinator
During the previous decade, there has been a noticeable upward trend, especially in larger cities, in the use of broad- spectrum antibiotics for community-acquired abdominal infections. This increase is most likely unnecessary and believed to contribute to the notorious rise in antibiotic resistance. Thus, four months ago, APUA-Argentina planned and initiated a multi-centric prospective study, involving many cities country-wide, to conduct surveillance of antibiotic resistance among these community pathogens. Patient enrollment, now at 100, will continue through 2014. It is hoped that the study outcomes, anticipated for publication in 2015, will help influence antibiotic stewardship efforts and lead to more appropriate antibiotic use in Argentina.
Submitted by: Maria Jose Lopez Furst, MD, APUA-Argentina
In its ongoing efforts to monitor antimicrobial resistance and promote better antimicrobial stewardship, APUA-Georgia is collecting antimicrobial resistance data from the network of bacterial laboratories established by the Service of Antimicrobial Chemotherapies. Based on its regular data analysis, the Chapter updates its recommendations for empirical antimicrobial therapies. Resistance data for 2011-12 were presented during a US-based antimicrobial resistance workshop in February 2013. A poster, titled “Prevalence of ESBL-producing E. coli and K. pneumoniae in Georgia 2011-2012” was also presented at the ECCMID 2014 conference in Barcelona, Spain.
The APUA-Georgia Chapter actively participates in the Study for Monitoring Antimicrobial Resistance Trends (SMART), conducted by International Health Management Associates, Inc. (IHMA). SMART sends gram-negative clinical isolates originating from intra-abdominal and urinary tract infections to its Epalinges, Switzerland laboratory for identification and susceptibility testing.
APUA-Georgia continues its educational activities with physicians by publishing newsletters and holding workshops about the prudent use of antimicrobials. Future Chapter activities include projects on antibiotic consumption in primary care and hospitals, and participation in the government program, “National strategic action plan against antimicrobial resistance.”
Submitted by: Nino Jashiashvili, APUA-Georgia
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News and Publications of Note
The Longitude Prize competition has identified six challenges as the biggest scientific problems of our time and the public has voted to award the £10m prize to antibiotic resistance prevention and research. The antibiotic challenge will be to create a cheap, accurate, rapid, and simple test for infection that will allow medical professionals to better target their treatments - administering the right antibiotics at the right time. Lord Martin Rees, chair of the Longitude Committee and Astronomer Royal, hopes the prize will "speed up progress towards meeting the challenge of resistance to antibiotics by stimulating invention and innovation - especially 'out of the box' thinking".
On June 20, the World Alliance Against Antibiotic Resistance (WAAAR) launched its declaration and ten recommendations to safeguard antibiotic effectiveness. The WAAAR alliance, which consists of 700 individuals from 55 different countries representing physicians, veterinarians, microbiologists, surgeons, pharmacists, nurses, evolutionary biologists, ecologists, environmentalists and patient advocacy groups, was formed two years ago by Dr. Jean Carlet to increase awareness regarding the imminent risk of antibiotic resistance. WAAAR advocates for: 1) the promotion of awareness of the threat by all stakeholders, 2) organization of a financed national plan for the containment of antibiotic resistance, 3) continuous access to antibiotics of assured quality, 4) integrated surveillance of antibiotic resistance and antibiotic use, 5) use of diagnostic tests, 6) antibiotic stewardship, 7)educational efforts for change, 8)containment of bacterial transmission and prevention of infection, 9) research and development of new antibiotics, and 10) a request for UNESCO to include the “concept of antibiotic” in the list of intangible cultural heritage. The Alliance urges all to “promote wiser use of antibiotics in animal and human health, and the necessary accompanying political actions to support better education, integrated surveillance for public health action, and research.”
Canadian researchers have identified carbapenem-resistant Pseudomonas fluorescens in raw squid, reportedly originating from S. Korea. The carbapenems are last-resort antibiotics, reserved for the most highly resistant “superbugs.” The presence of resistant bacteria in food significantly increases the risk of exposure in the general public–beyond people who have been hospitalized or traveling. Finding resistant microbes in “niche-market meat products” and imported foods is becoming more common as the resistance genes are present in the environment.
New Zealand researcher Professor Nigel French believes the increasing use of antibiotics in animals may be contributing to the global issue of antimicrobial resistance. Concerned over an increase in the incidence of two particular types of antibiotic-resistant bacteria that commonly cause urinary tract infections, he and his team will embark on a $1.1m project funded by New Zealand’s Health Research Council to examine the risks posed by household pets in the transmission of resistant bacteria that can potentially spread to humans via contact with fluids and feces.
In APUA’s most recent Newsletter, representative Kathleen Young reviewed advances in Cuba’s health system, which has generated indicators reportedly on par with those of the US. In May, Cuba was acknowledged for its public health system and honored to chair for the first time the 67th World Health Assembly. Some topics on the Assembly’s agenda include the impact of climate change on health and universal health coverage, in which Cuba has been an example for many years.
A recent study shows that fecal micro biota transplantation (FMT) restores healthy bacteria and functioning of the gut. A patient suffering from Clostridium difficile (C. diff) infection receives stool bacteria from a healthy donor during a FMT, replacing the needed micro flora and restoring gut homeostasis. The study showed that types of bacteria among donor and post-transplant patients were similar to each other, contributing to the 90% success rate among transplant patients. Compared to their pre-transplant profile, the bacterial communities in transplant patients showed a reduced amount of Proteobacteria, including a variety of infectious agents, and an increased amount of Firmicutes and Bacteroidetes typically found in healthy individuals. With C. diff infections increasing over the past decade due to antibiotic overuse, 500,000 cases resulting in $1.3 to 3.4 billion in health care costs, and a 40% patient recurrence, FMT has the potential for significant treatment impact once the specific microorganisms that promote resistance of bacterial colonization and growth are further identified.
A recent New England Journal of Medicine study reports that a single intravenous dose of a new antibiotic Oritavancin, is as effective as the twice daily, 10-day regimen of antibiotics used to treat patients with serious bacterial skin infections, including methicillin-resistant Staphylococcus aureus (MRSA). The advantage of a single dose antibiotic is patient adherence and reduced amount of time spent in the hospital, which could potentially prevent hospital-acquired infections. The drug, which is under a special FDA fast-track process, may be approved as early as August 2014.
July 6-9, 2014: The Australian Society for Infectious Diseases (ASID) Annual Scientific Meeting, Melbourne, Australia
Pullman Melbourne Albert Park will host Australia’s largest and most prestigious annual scientific meeting and trade exhibition. Expected to attract 600 microbiologists, allied professionals, researchers and academics from across the country and around the world, the conference will feature extensive workshops, the launch of the Nancy Millis Student Mentoring Program, and feature presentations from Anne Dell, Brett Finaly, Sheila Lukehart, Patrick McGovern, Gustav Nossal, Vincent Racaniello, Rino Rappuoli, and Roy Robins-Browne. Register here.