Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2018/06/stewardship-resistance-scan-jun-29-2018
Stewardship / Resistance Scan for Jun 29, 2018
FDA guidance for reporting animal antimicrobial sales; VIM-CRE in Indiana hospitals; Resistant bugs in meat; UTI prophylactic antibiotics and resistance
Filed Under:
Antimicrobial Stewardship; Healthcare-Associated Infections; Foodborne Disease
[h=3]FDA issues antimicrobial sales reporting guidance for animal-drug makers[/h] The US Food and Drug Administration (FDA) yesterday released guidance to help animal-drug makers meet requirements for reporting antimicrobial sales. The step follows the 2016 implementation of a final rule that revised annual reporting requirements for companies that sell or distribute antibiotics for use in food-producing animals.
Because antimicrobial use in animals contributes to emerging antimicrobial resistance that poses a threat to people, the federal government tracks annual sales of animal antimicrobials, including those that are important for use in human and veterinary medicine.
Steve Solomon, DVM, who directs the FDA Center for Veterinary Medicine, said in an FDA statement that the guidance will help ensure that the animal-drug sponsors understand their responsibilities and can comply with reporting requirements, designed to give the FDA an accurate picture of the volume of antimicrobial drugs that enter the marketplace. "Sales and distribution information are one piece of the overall picture related to antimicrobial resistance that can help to better our understanding of this critical public health issue."
Jun 28 FDA statement
[h=3]Testing suggests VIM-CRE in Indiana hospitals, possible regional emergence[/h] Enhanced surveillance for carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) in Indiana that began in December 2015 identified Verona integron-mediated metallo-beta-lactamase (VIM)?producing types that are frequently found in southern Europe and Southeast Asia, but are rare in the United States.
Between January 2016 and December 2017, tests identified 649 CP-CRE isolates across Indiana, including 9 VIM-CRE isolates from 7 patients. VIM was the most commonly identified carbapenemase after Klebsiella pneumoniae carbapenemase, authors from the Indiana State Department of Health and the US Centers for Disease Control and Prevention (CDC) reported today in Morbidity and Mortality Weekly Report. Seven different species were found in the nine VIM-producing isolates; one was from a patient colonized or infected with three different VIM-producing organisms over a 15-month period.
None of the patients had traveled overseas in the 6 months before specimens were collected, but all had stayed overnight in an Indiana hospital, suggesting VIM transmission within Indiana health facilities.
Investigators said that though VIM is still one of the least frequently reported carbapenemases among CRE in the United States, Indiana and its neighbors account for 29 (71%) of 41 VIM-CRE isolates reported to the CDC so far, hinting at the potential for regional emergence of the resistance mechanism.
Jun 29 MMWR note from the field
[h=3]Nonprofit group warns of resistant bacteria in meat, offers consumer tips[/h] The Environmental Working Group, a nonprofit group that works to protect health and the environment, issued a report yesterday warning that resistant bacteria are common in retail meat and poultry samples and offered consumer tips on avoiding such contamination.
Based on its own analysis of 2015 data from the National Antimicrobial Resistance Monitoring System (NARMS), the EWG said that bacteria with resistance to at least one antibiotic were found in 79% of retail turkey samples, 71% of pork chops, 62% of ground beef, and 36% of chicken breasts, wings, and thighs. The percentages refer to Enterococcus faecalis, a common gut bacterium that can indicate the presence of fecal contamination.
The report notes that resistant bacteria can pass their resistance genes to other bacteria, giving rise to resistant pathogens.
?Consumers need to know about potential contamination of the meat they eat, so they can be vigilant about food safety, especially when cooking for children, pregnant women, older adults or the immune-compromised,? Dawn Undurraga, MS, RD, EWG?s nutritionist and author of the report, said in a press release from the group.
The press release includes links to a tip sheet on how to avoid resistant bacteria in meat and to a ?label decoder? to help consumers understand labels on meat, dairy products, and eggs. The decoder explains the significance of labels such as ?American Grassfed Association,? ?Animal Welfare Approved,? ?Certified Humane,? ?USDA Organic,? and others.
The EWG also released a letter to the commissioner of the US Food and Drug Administration calling for more aggressive action to keep resistant bacteria out of food.
Jun 28 EWG press release and report
June 28 EWG letter to the FDA
Oct 23, 2017, CIDRAP News story on NARMS report based on 2015 sampling
[h=3]Studies find increased antimicrobial resistance with prophylaxis for UTIs[/h] Two new studies of antibiotic prophylaxis for urinary tract infections (UTIs) found an increased risk of drug resistance in recurrent infections, one involving adults who use clean intermittent self-catheterization (CISC) to empty their bladders and the other involving children who have a history of vesicoureteral reflux.
A team from Newcastle University in the United Kingdom, writing in The Lancet Infectious Diseases, reported on a randomized open-label superiority trial that compared once-daily antibiotic prophylaxis with no prophylaxis over a 12-month period to explore the benefits, drawbacks, and cost-effectiveness of low-dose treatment in adults. Between November 2013 and January 2016, researchers enrolled 404 participants, including 203 who received prophylaxis (nitrofurantroin, trimethoprim, or cotrimoxazole) and 201 who didn't.
Continuous treatment reduced UTI frequency in CISC users and was well tolerated, but there was increased resistance, not only to the drugs used for prophylaxis but also to other antibiotics commonly prescribed for UTI treatment.
"The severity of individual patient distress from repeated UTIs and local threats from antimicrobial resistance should simultaneously be considered when appraising and implementing this evidence of benefit of treatment," the authors wrote.
Jun 28 Lancet Infect Dis report
The other study is a meta-analysis of six randomized controlled trials of children age 18 or younger who had a history of vesicoureteral reflux and did or didn't receive continuous antibiotic prophylaxis. The international research team published its findings yesterday in Pediatrics.
The studies included 1,299 patients who had 224 UTIs. Patients who got prophylactic treatment were more likely to have a multidrug-resistant infection than those not treated (33% versus 6%, P< .001) and were more likely to receive broad-spectrum antibiotics (68% versus 49%, P< .004).
The group's analysis found that patients on prophylaxis had 6.4 times the odds of developing a multidrug-resistant infection and that one multidrug-resistant infection developed for every 21 patients treated with prophylaxis.
They concluded that the findings have important implications for weighing the risks and benefits of prophylaxis as a management strategy and for selecting empiric treatment for breakthrough infections in patients on antibiotic prophylaxis.
Jun 28 Pediatrics abstract
Stewardship / Resistance Scan for Jun 29, 2018
FDA guidance for reporting animal antimicrobial sales; VIM-CRE in Indiana hospitals; Resistant bugs in meat; UTI prophylactic antibiotics and resistance
Filed Under:
Antimicrobial Stewardship; Healthcare-Associated Infections; Foodborne Disease
[h=3]FDA issues antimicrobial sales reporting guidance for animal-drug makers[/h] The US Food and Drug Administration (FDA) yesterday released guidance to help animal-drug makers meet requirements for reporting antimicrobial sales. The step follows the 2016 implementation of a final rule that revised annual reporting requirements for companies that sell or distribute antibiotics for use in food-producing animals.
Because antimicrobial use in animals contributes to emerging antimicrobial resistance that poses a threat to people, the federal government tracks annual sales of animal antimicrobials, including those that are important for use in human and veterinary medicine.
Steve Solomon, DVM, who directs the FDA Center for Veterinary Medicine, said in an FDA statement that the guidance will help ensure that the animal-drug sponsors understand their responsibilities and can comply with reporting requirements, designed to give the FDA an accurate picture of the volume of antimicrobial drugs that enter the marketplace. "Sales and distribution information are one piece of the overall picture related to antimicrobial resistance that can help to better our understanding of this critical public health issue."
Jun 28 FDA statement
[h=3]Testing suggests VIM-CRE in Indiana hospitals, possible regional emergence[/h] Enhanced surveillance for carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) in Indiana that began in December 2015 identified Verona integron-mediated metallo-beta-lactamase (VIM)?producing types that are frequently found in southern Europe and Southeast Asia, but are rare in the United States.
Between January 2016 and December 2017, tests identified 649 CP-CRE isolates across Indiana, including 9 VIM-CRE isolates from 7 patients. VIM was the most commonly identified carbapenemase after Klebsiella pneumoniae carbapenemase, authors from the Indiana State Department of Health and the US Centers for Disease Control and Prevention (CDC) reported today in Morbidity and Mortality Weekly Report. Seven different species were found in the nine VIM-producing isolates; one was from a patient colonized or infected with three different VIM-producing organisms over a 15-month period.
None of the patients had traveled overseas in the 6 months before specimens were collected, but all had stayed overnight in an Indiana hospital, suggesting VIM transmission within Indiana health facilities.
Investigators said that though VIM is still one of the least frequently reported carbapenemases among CRE in the United States, Indiana and its neighbors account for 29 (71%) of 41 VIM-CRE isolates reported to the CDC so far, hinting at the potential for regional emergence of the resistance mechanism.
Jun 29 MMWR note from the field
[h=3]Nonprofit group warns of resistant bacteria in meat, offers consumer tips[/h] The Environmental Working Group, a nonprofit group that works to protect health and the environment, issued a report yesterday warning that resistant bacteria are common in retail meat and poultry samples and offered consumer tips on avoiding such contamination.
Based on its own analysis of 2015 data from the National Antimicrobial Resistance Monitoring System (NARMS), the EWG said that bacteria with resistance to at least one antibiotic were found in 79% of retail turkey samples, 71% of pork chops, 62% of ground beef, and 36% of chicken breasts, wings, and thighs. The percentages refer to Enterococcus faecalis, a common gut bacterium that can indicate the presence of fecal contamination.
The report notes that resistant bacteria can pass their resistance genes to other bacteria, giving rise to resistant pathogens.
?Consumers need to know about potential contamination of the meat they eat, so they can be vigilant about food safety, especially when cooking for children, pregnant women, older adults or the immune-compromised,? Dawn Undurraga, MS, RD, EWG?s nutritionist and author of the report, said in a press release from the group.
The press release includes links to a tip sheet on how to avoid resistant bacteria in meat and to a ?label decoder? to help consumers understand labels on meat, dairy products, and eggs. The decoder explains the significance of labels such as ?American Grassfed Association,? ?Animal Welfare Approved,? ?Certified Humane,? ?USDA Organic,? and others.
The EWG also released a letter to the commissioner of the US Food and Drug Administration calling for more aggressive action to keep resistant bacteria out of food.
Jun 28 EWG press release and report
June 28 EWG letter to the FDA
Oct 23, 2017, CIDRAP News story on NARMS report based on 2015 sampling
[h=3]Studies find increased antimicrobial resistance with prophylaxis for UTIs[/h] Two new studies of antibiotic prophylaxis for urinary tract infections (UTIs) found an increased risk of drug resistance in recurrent infections, one involving adults who use clean intermittent self-catheterization (CISC) to empty their bladders and the other involving children who have a history of vesicoureteral reflux.
A team from Newcastle University in the United Kingdom, writing in The Lancet Infectious Diseases, reported on a randomized open-label superiority trial that compared once-daily antibiotic prophylaxis with no prophylaxis over a 12-month period to explore the benefits, drawbacks, and cost-effectiveness of low-dose treatment in adults. Between November 2013 and January 2016, researchers enrolled 404 participants, including 203 who received prophylaxis (nitrofurantroin, trimethoprim, or cotrimoxazole) and 201 who didn't.
Continuous treatment reduced UTI frequency in CISC users and was well tolerated, but there was increased resistance, not only to the drugs used for prophylaxis but also to other antibiotics commonly prescribed for UTI treatment.
"The severity of individual patient distress from repeated UTIs and local threats from antimicrobial resistance should simultaneously be considered when appraising and implementing this evidence of benefit of treatment," the authors wrote.
Jun 28 Lancet Infect Dis report
The other study is a meta-analysis of six randomized controlled trials of children age 18 or younger who had a history of vesicoureteral reflux and did or didn't receive continuous antibiotic prophylaxis. The international research team published its findings yesterday in Pediatrics.
The studies included 1,299 patients who had 224 UTIs. Patients who got prophylactic treatment were more likely to have a multidrug-resistant infection than those not treated (33% versus 6%, P< .001) and were more likely to receive broad-spectrum antibiotics (68% versus 49%, P< .004).
The group's analysis found that patients on prophylaxis had 6.4 times the odds of developing a multidrug-resistant infection and that one multidrug-resistant infection developed for every 21 patients treated with prophylaxis.
They concluded that the findings have important implications for weighing the risks and benefits of prophylaxis as a management strategy and for selecting empiric treatment for breakthrough infections in patients on antibiotic prophylaxis.
Jun 28 Pediatrics abstract