May 14, 2018
Review of O’Neill’s Superbugs in Science. In a book review of Superbugs: An Arms Race Against Bacteria for Science, CDDEP Director Ramanan Laxminarayan reminds readers of a useful comparison between the global crises of antimicrobial resistance (AMR) and the problem of climate change: in both, a vital, shared global resource can be detrimentally affected by the actions of a single country. The new book, by Jim O’Neill, the economist who led the United Kingdom’s Review on Antimicrobial Resistance in 2014, and colleagues interprets the threat of AMR and the incentive challenges in solving this problem, for the lay public. [Science]
Korean antibiotic prescribing coincides with seasonal viral respiratory illness. Investigators in Korea collaborated with CDDEP Research Fellow Eili Klein to examine factors involved in antibiotic prescribing for acute respiratory-tract infections. The authors found that similar to a previous study in the United States by CDDEP researchers, antibiotic prescribing was highly correlated with cases of respiratory viruses in Korea (p<0.001). However, unlike other studies, the researchers demonstrated that antibiotic prescribing was only highly correlated with influenza virus activity and was not highly correlated with other respiratory viruses such as RSV, corona viruses, or adenoviruses. [Antimicrobial Resistance and Infection Control]
Phylogenetic analysis of colistin-resistant gene, mcr-1, points to origin in Chinese pigs. The efficacy of colistin, an antibiotic with relatively high toxicity to humans, has been compromised, by the emergence of mcr-1, a plasmid-mediated gene that codes for resistance to colistin. The largest phylogenic analysis of mcr-1 isolates to date has been published in a paper that traces the global distribution of mcr-1 to a single emergence in the mid 2000s, which likely occurred in China’s agricultural livestock (i.e., from pigs into humans). The resistance gene then spread rapidly, achieving its current distribution through multiple translocations that were likely driven by the global trade in livestock and meat, and the transcontinental travel of colonized or infected humans. [VOA News, Nature, University College London]
Study: Soil-transmitted intestinal worms could be reduced dramatically by treating adults as well as children. In Timor-Leste, where standard treatment for helminth infection consists of school-based deworming, a community intervention was tested and compared with standard treatment. Some communities received water, sanitation, and hygiene (WASH) programs in the schools, in addition to standard treatment, and other communities received standard treatment, WASH programming for the whole community, plus an expanded deworming program that included adults in addition to schoolchildren. In the latter communities, the odds of N. americanus infection at follow-up were 58% lower in the intervention arm compared to the control arm (OR 0.42, 95% CI 0.07–2.36). [PLOS Neglected Tropical Diseases, EurekAlert, EurekAlert]
Twenty percent of prescriptions written for gonorrhea are not consistent with CDC guidelines. In a study of provider adherence to recommendations for gonorrhea treatment, Centers for Disease Control and Prevention researchers investigated whether clinicians were using the most recent 2015 U.S. guidelines, which recommend a two-drug therapy designed for now-common drug-resistant infections. Patients with gonorrhea who were treated in a family planning or sexual health clinic had a 91% or 94% chance, respectively, of receiving the antibiotics recommended by CDC. Providers in other settings prescribed the recommended drugs 80% of the time. [Morbidity and Mortality Weekly Report, Healio]
US vectorborne infection reports tripled over 13 years. In a study released by the CDC, over 640,000 vectorborne diseases were reported in the United States and its territories between 2004 and 2016. Nine of the sixteen viruses on the list were reported for the first time on US soil during the study period. Tickborne pathogens accounted for 77% of all vectorborne infections; Lyme Disease made up 82% of the approximately 491,000 tickborne cases. Notably, the tickborne diseases increased gradually, compared to several mosquitoborne diseases that struck in epidemics: dengue affected 46,692 people over the thirteen-year period, with nearly two thirds of cases occurring in 2010 and 2012-13; Zika virus, accompanied by its unexpected teratogenic sequelae, affected 41,680 people in the US in 2016, including 36,000 in Puerto Rico.; and West Nile Virus was the third most reported mosquitoborne illness, with 31,919 cases total. The CDC estimates that for every serious (neuroinvasive) case of West Nile Virus, 30 to 70 mild cases go unreported. [Morbidity and Mortality Weekly Report, New York Times, Healio]
For urinary tract infection, five days of nitrofurantoin treatment is more effective than a single dose of fosfomycin. Researchers carried out a randomized trial in Poland, Israel, and Switzerland between October 2013 and April 2017, comparing the effectiveness of two first-line antibiotics recommended for the treatment of urinary tract infections (UTIs) in non-pregnant women. Results showed a statistically significant difference of 12 percentage points between the two treatment groups: 70% of UTIs were clinically resolved after treatment with oral nitrofurantoin (100 mg., 3 times a day for 5 days), while 58% of those treated with a single one-time 3 g. dose of oral fosfomycinwere clinically resolved. Microbiologic evidence of treatment success was also higher in the nitrofurantoingroup (74%) compared to the fosfomycingroup (63%). [JAMA, MedicalXPress]
Photo credit: Eneas De Troya from Mexico City, México (Epidemia de Pánico, Uploaded by Hello32020) [CC BY 2.0]
