Weekly Digest: Colistin-resistance genes spreading, proliferating; Stewardship efforts urgently need human resources estimates and funding

4 Aug 2017
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A weekly roundup of news on drug resistance and other topics in global health.

Human resource estimates and associated funding needed to support antibiotic stewardship. Standards for staffing antibiotic stewardship teams and associated funding estimates have been developed in only a handful of countries, all high-income, and only for hospitals. In an Expert Commentary in Clinical Microbiology & Infection, CDDEP Director Ramanan Laxminarayan and colleagues make the case that these standards are required to support global estimates of the resource needs for stewardship efforts.  They also point to a need to broaden stewardship to the community and nursing facilities, where most antibiotics are prescribed. The authors call for international staffing standards and a sustainable source of funding for antimicrobial stewardship teams. [Clinical Microbiology & Infection, CIDRAP]

Economic impact of reporting emerging infectious diseases. Globalization has accelerated the rate at which microbes travel around the world, leading to increasing numbers of infectious disease outbreaks, such as SARS, Ebola, and Zika. In the latest edition of The Milken Review, CDDEP Director Ramanan Laxminarayan writes in “Preparing for Pandemics,” that incentives to protect against pandemics are not nearly strong enough. He suggests a global audit agency as a way to keep countries honest about their pandemic risk preparedness, and a global insurance fund, with national premiums tagged to the threat level, as possible remedies. [The Milken Review]

CDC will invest more than $200 million to combat infectious diseases. The U.S. Centers for Disease Control and Prevention (CDC) will spend more than $200 million to help states respond to infectious disease threats, including $77 million directly to state health departments to support CDC’s Antibiotic Resistance (AR) Solutions Initiative. The investment will enhance the AR Lab Network, which monitors known and emerging antimicrobial resistance threats. Enhancements include increased testing nationwide for Candida fungal infection, enhanced detection of drug-resistant gonorrhea, and a new national tuberculosis (TB) center, equipped to perform whole genome sequencing for all TB isolates in the United States. The efforts will also build on activities established last year, including enhancements to PulseNet, the national laboratory network that connects foodborne illness cases to help identify foodborne outbreaks. [CDC, PulseNet]

Colistin-resistance mcr genes spread, proliferate. A new colistin-resistance gene, mcr-4, has been identified in a 2013 pig sample from Italy, and found subsequently in samples from pigs in Spain and Belgium. Colistin, a last-resort antibiotic, is critical in human medicine. mcr-3 from E. coli has been reported for the first time outside of Asia, in cattle samples from Spain and Denmark. In Spain, mcr-3 was found in Salmonella enterica isolated from pigs. Both mcr-1 and mcr-3 have now been reported in single human and animal isolates. The findings are reported in four studies in Eurosurveillance. [CIDRAP, Eurosurvillance MCR-4 study on pigs, study on MCR-1 and MCR-3 in cattle, study on MCR-3 in human Salmonella isolates, study on MCR-3 in human E coli isolates]

Newest TB drugs effective for MDR- and XDR-TB.  Three small studies in difficult-to-treat multidrug-resistant and extensively drug-resistant tuberculosis (MDR- and XDR-TB) reported encouraging results in Emerging Infectious Diseases. Studies of the two individual drugs, bedaquiline and delamanid, were led by Medicins sans Frontiere in eastern and central Europe, Swaziland and South Africa.  The third study, of five XDR-TB patients, used the drugs in combination, providing some of the first evidence of safety and efficacy.  [EID study on bedaquiline, EID study on combination drug therapy, CIDRAP]

Vaccine linked to sharp drop in rotavirus in children. Since introduction of the rotavirus vaccine Rotarix in 2006 in the United States and 2015 in Swaziland, hospitalization for diarrhea-related disease dropped dramatically in both countries, according to separate studies in Vaccine. The U.S. study documents an impressive five-fold decrease in rotavirus incidence in both fully and partially-vaccinated children, and significant savings in healthcare costs in the vaccinated cohort. In Swaziland, researchers tested nearly 600 stool samples of children younger than five years between 2013 and 2016, finding a near halving of positive tests for rotavirus, from 51 percent in 2013 to 29 percent in 2016. [Vaccine U.S. Study, Vaccine Swaziland Study, CIDRAP]

Image via oliver.dodd (CC BY 2.0)