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Source: http://www.cidrap.umn.edu/news-persp...an-nov-15-2019
Stewardship / Resistance Scan for Nov 15, 2019
Dental antibiotic stewardship; Host-response diagnostic tests; Antibiotic use, resistance in Europe; Pakistan and typhoid vaccine
Filed Under:
Typhoid; Antimicrobial Stewardship
Paper calls for more engagement on dental antibiotic stewardship
A paper today in Clinical Infectious Diseases calls for more engagement between antibiotic stewardship programs (ASPs), dentists, and orthopedic surgeons to curb unnecessary dental antibiotic prophylaxis.
Nationwide, dentists are the top specialty prescriber of antibiotics, accounting for 10% of all antibiotic prescriptions in the United States. Most of these prescriptions are given prior to dental procedures to prevent infections in patients with cardiac conditions and prosthetic joints. But recent research has found that more than 80% of these prescriptions are unnecessary.
One reason is that guidelines for prophylactic dental antibiotic prescribing in the patients have changed over the years. In particular, recent guidelines from the American Academy of Orthopedic Surgeons have stopped recommending antibiotic prophylaxis for patients with prosthetic joints, while guidelines from the American Dental Association and American Heart Association have limited the types of cardiac patients who should receive antibiotics before dental procedures.
But as researchers from the Ohio State University write in the paper, despite the new recommendations, orthopedic surgeons still see high value and low risk in antibiotic prophylaxis, and dentists are put in a tough position when patients ask for antibiotics on the advice of their orthopedic surgeon. They also note, based on feedback from a recent town hall forum they held with orthopedic surgeons and dentists, that many consider dental antibiotic prophylaxis to be a form of defensive medicine.
Based on their review of guidelines and findings from the forum, the authors of the paper recommend that ASP coordinators should meet with local orthopedic and dental societies to address guidelines and controversies and to improve knowledge gaps about adverse drug reactions, and should provide education to dentists and orthopedic surgeons via webinars. They also suggest that dentists and orthopedic surgeons in the same communities work together to build consensus on antibiotic prophylaxis.
"Similar to the current US opioid crisis, which has greatly impacted dentists and OS [orthopedic surgeons] to reconsider every opioid dose and duration, we believe community based dental stewardship must advocate for both dentists and OS to rethink any AP [antibiotic prophylaxis] prescribed with a goal towards far less," the authors write.
Nov 15 Clin Infect Dis abstract
HHS funds 3 host-response rapid tests to diagnose viral, bacterial illnesses
The US Department of Health and Human Services (HHS) will provide an initial $6 million over 14 months to Inflammatix, of Burlingame, California, for developing three point-of-care host-response diagnostic tests to distinguish viral infections from bacterial ones, HHS said in a news release yesterday.
The tests—HostDx Fever, HostDx Sepsis, and HostDx FeverFlu—involve diagnostics technology that reads gene expression patterns in the immune system to distinguish bacterial from viral infections and determines the severity within 20 to 30 minutes. HostDx Fever is designed for ambulatory care settings, HostDx Sepsis is geared toward hospital patients, and HostDx FeverFlu is designed for both outpatient and inpatient settings.
Funds will be provided by the Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response. The contract could grow to as much as $64.9 million through 2027 for Inflammatix to complete the additional work needed to apply for Food and Drug Administration approval.
Determining quickly whether an illness is caused by a virus or a bacterium is crucial in knowing whether antibiotics are needed. "Rapid diagnostics are a cornerstone of our strategy to protect Americans from many bacterial and viral infections; earlier diagnosis can empower patients to take action to reduce disease transmission," said BARDA Director Rick Bright, PhD. "Diagnostics that can provide rapid results to patients and doctors will support stewardship of antibiotics and save lives."
Nov 14 HHS news release
European data show antibiotic use, resistance dropping or stable
Antibiotic use for and antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae across Europe have decreased or stabilized in recent years, according to a report yesterday in Eurosurveillance.
To examine trends, European researchers analyzed population-weighted data across the European Union/European Economic Area from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2001 through 2018. They studied trends in consumption of third-generation cephalosporins, fluoroquinolones, and carbapenems and for AMR in E coli and K pneumoniae.
The authors found that consumption of third-generation antibiotics rose slightly in the earlier years of the study but then declined in the community and held steady in the hospital sector. Resistance to third-generation cephalosporins rose steadily till about 2013 then plateaued.
Fluoroquinolone use held fairly steady throughout the study period, while resistance to the drug followed a pattern similar to third-generation cephalosporins, though fluoroquinolone resistance in hospital samples plateaued earlier, in 2006. Carbapenem consumption climbed more dramatically than for the other drugs until 2013, then declined in each subsequent year, while resistance to that antibiotic class rose sharply till 2013 and has been fairly stable since.
The authors write that their results indicate that recent public health efforts promoting prudent antibiotic use are showing results. "Nevertheless," they add, "percentages of AMR reported here were comparatively much higher in 2018 than in 2002/06 and trends appear to stabilise or slow down rather than decrease in recent years."
Nov 14 Eurosurveill study
Pakistan to launch typhoid vaccine campaign to fight 'superbug' strain
Pakistan has become the first country to routinely use the typhoid conjugate vaccine as it combats an outbreak of multidrug-resistant typhoid, according to Reuters. The vaccination campaign will be funded by GAVI, the vaccine alliance.
The "superbug" strain of typhoid has sickened about 11,000 Pakistanis since 2016. Children between the ages of 9 months and 15 years will be targeted in the vaccination campaign, and the vaccine affords up to 5 years of protection from the disease. The campaign will launch in Sindh province.
Children are most at risk for contracting typhoid, which is caused by Salmonella enterica serotype Typhi bacteria and transmitted through contaminated food and water. The disease most commonly causes fever, nausea, and stomach pain, and in severe cases can be fatal.
The case-fatality rate for Pakistan's current outbreak is around 1%, but experts say that number could jump to 20% if the strain becomes resistant to the last remaining antibiotic that can kill it. There is also the risk of the strain spreading internationally, as travelers to Pakistan from the United States, Australia, Britain, Canada, Denmark, and Taiwan have already contracted the disease.
Nov 15 Reuters story
Stewardship / Resistance Scan for Nov 15, 2019
Dental antibiotic stewardship; Host-response diagnostic tests; Antibiotic use, resistance in Europe; Pakistan and typhoid vaccine
Filed Under:
Typhoid; Antimicrobial Stewardship
Paper calls for more engagement on dental antibiotic stewardship
A paper today in Clinical Infectious Diseases calls for more engagement between antibiotic stewardship programs (ASPs), dentists, and orthopedic surgeons to curb unnecessary dental antibiotic prophylaxis.
Nationwide, dentists are the top specialty prescriber of antibiotics, accounting for 10% of all antibiotic prescriptions in the United States. Most of these prescriptions are given prior to dental procedures to prevent infections in patients with cardiac conditions and prosthetic joints. But recent research has found that more than 80% of these prescriptions are unnecessary.
One reason is that guidelines for prophylactic dental antibiotic prescribing in the patients have changed over the years. In particular, recent guidelines from the American Academy of Orthopedic Surgeons have stopped recommending antibiotic prophylaxis for patients with prosthetic joints, while guidelines from the American Dental Association and American Heart Association have limited the types of cardiac patients who should receive antibiotics before dental procedures.
But as researchers from the Ohio State University write in the paper, despite the new recommendations, orthopedic surgeons still see high value and low risk in antibiotic prophylaxis, and dentists are put in a tough position when patients ask for antibiotics on the advice of their orthopedic surgeon. They also note, based on feedback from a recent town hall forum they held with orthopedic surgeons and dentists, that many consider dental antibiotic prophylaxis to be a form of defensive medicine.
Based on their review of guidelines and findings from the forum, the authors of the paper recommend that ASP coordinators should meet with local orthopedic and dental societies to address guidelines and controversies and to improve knowledge gaps about adverse drug reactions, and should provide education to dentists and orthopedic surgeons via webinars. They also suggest that dentists and orthopedic surgeons in the same communities work together to build consensus on antibiotic prophylaxis.
"Similar to the current US opioid crisis, which has greatly impacted dentists and OS [orthopedic surgeons] to reconsider every opioid dose and duration, we believe community based dental stewardship must advocate for both dentists and OS to rethink any AP [antibiotic prophylaxis] prescribed with a goal towards far less," the authors write.
Nov 15 Clin Infect Dis abstract
HHS funds 3 host-response rapid tests to diagnose viral, bacterial illnesses
The US Department of Health and Human Services (HHS) will provide an initial $6 million over 14 months to Inflammatix, of Burlingame, California, for developing three point-of-care host-response diagnostic tests to distinguish viral infections from bacterial ones, HHS said in a news release yesterday.
The tests—HostDx Fever, HostDx Sepsis, and HostDx FeverFlu—involve diagnostics technology that reads gene expression patterns in the immune system to distinguish bacterial from viral infections and determines the severity within 20 to 30 minutes. HostDx Fever is designed for ambulatory care settings, HostDx Sepsis is geared toward hospital patients, and HostDx FeverFlu is designed for both outpatient and inpatient settings.
Funds will be provided by the Biomedical Advanced Research and Development Authority (BARDA), part of the HHS Office of the Assistant Secretary for Preparedness and Response. The contract could grow to as much as $64.9 million through 2027 for Inflammatix to complete the additional work needed to apply for Food and Drug Administration approval.
Determining quickly whether an illness is caused by a virus or a bacterium is crucial in knowing whether antibiotics are needed. "Rapid diagnostics are a cornerstone of our strategy to protect Americans from many bacterial and viral infections; earlier diagnosis can empower patients to take action to reduce disease transmission," said BARDA Director Rick Bright, PhD. "Diagnostics that can provide rapid results to patients and doctors will support stewardship of antibiotics and save lives."
Nov 14 HHS news release
European data show antibiotic use, resistance dropping or stable
Antibiotic use for and antimicrobial resistance (AMR) in Escherichia coli and Klebsiella pneumoniae across Europe have decreased or stabilized in recent years, according to a report yesterday in Eurosurveillance.
To examine trends, European researchers analyzed population-weighted data across the European Union/European Economic Area from the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) and the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2001 through 2018. They studied trends in consumption of third-generation cephalosporins, fluoroquinolones, and carbapenems and for AMR in E coli and K pneumoniae.
The authors found that consumption of third-generation antibiotics rose slightly in the earlier years of the study but then declined in the community and held steady in the hospital sector. Resistance to third-generation cephalosporins rose steadily till about 2013 then plateaued.
Fluoroquinolone use held fairly steady throughout the study period, while resistance to the drug followed a pattern similar to third-generation cephalosporins, though fluoroquinolone resistance in hospital samples plateaued earlier, in 2006. Carbapenem consumption climbed more dramatically than for the other drugs until 2013, then declined in each subsequent year, while resistance to that antibiotic class rose sharply till 2013 and has been fairly stable since.
The authors write that their results indicate that recent public health efforts promoting prudent antibiotic use are showing results. "Nevertheless," they add, "percentages of AMR reported here were comparatively much higher in 2018 than in 2002/06 and trends appear to stabilise or slow down rather than decrease in recent years."
Nov 14 Eurosurveill study
Pakistan to launch typhoid vaccine campaign to fight 'superbug' strain
Pakistan has become the first country to routinely use the typhoid conjugate vaccine as it combats an outbreak of multidrug-resistant typhoid, according to Reuters. The vaccination campaign will be funded by GAVI, the vaccine alliance.
The "superbug" strain of typhoid has sickened about 11,000 Pakistanis since 2016. Children between the ages of 9 months and 15 years will be targeted in the vaccination campaign, and the vaccine affords up to 5 years of protection from the disease. The campaign will launch in Sindh province.
Children are most at risk for contracting typhoid, which is caused by Salmonella enterica serotype Typhi bacteria and transmitted through contaminated food and water. The disease most commonly causes fever, nausea, and stomach pain, and in severe cases can be fatal.
The case-fatality rate for Pakistan's current outbreak is around 1%, but experts say that number could jump to 20% if the strain becomes resistant to the last remaining antibiotic that can kill it. There is also the risk of the strain spreading internationally, as travelers to Pakistan from the United States, Australia, Britain, Canada, Denmark, and Taiwan have already contracted the disease.
Nov 15 Reuters story