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Stewardship / Resistance Scan for May 19, 2021

Stewardship / Resistance Scan for May 19, 2021

CARB-X funds development of novel antibiotic for gram-negative infections

CARB-X announced today that it is awarding Swiss drug maker Basilea Pharmaceutica International up to $2.7 million to develop a novel class of antibiotics to treat gram-negative bacterial infections.

The award from CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) will help Basilea develop small-molecule inhibitors of the DXR enzyme, which is essential for the survival of many gram-negative pathogens, including carbapenem-resistant Enterobacterales and Acinetobacter baumannii and multidrug-resistant Pseudomonas aeruginosa.

“The Basilea project is in the early stages of development, with a novel chemical class working with a novel mechanism of inhibition of bacterial growth,” CARB-X Research and Development Chief Erin Duffy, PhD, said in a CARB-X press release.

“Together, these offer a potential advantage where the development of resistance is concerned and—as such—offer great promise for a new therapy to treat serious hospital infections.”
May 19 CARB-X press release


Hospital stewardship linked to reduced MDR pathogen colonization

A systematic review and meta-analysis of more than 60 studies found that antimicrobial stewardship programs (ASPs) were associated with reduced multidrug-resistant Enterobacterales (MDR-E) colonization in hospital patients, researchers reported last week in the Journal of Infection.

The aim of the study, conducted by scientists from Israel, Germany, and Spain, was to evaluate the comparative effectiveness and safety of different interventions for the prevention of MDR-E colonization and infections in hospitalized patients. The co-primary outcomes were reduction in mortality and infections caused by MDR-E, and secondary outcomes included colonization with MDR-E.

A total of 63 studies were included, with 23 that assessed ASPs as the main intervention. Meta-analysis of those studies found no significant difference between ASPs and control groups for all-cause mortality (relative risk [RR], 1.o; 95% confidence interval [CI], 0.95 to 1.07), intensive care unit mortality (RR, 1.01; 95% CI, 0.93 to 1.10), or MDR-E infection (incidence ratio [IR], 0.88; 95% CI, 0.71 to 1.10). But significantly reduced MDR-E colonization was observed with ASPs (IR, 0.69; 95% CI, 0.57 to 0.82).

Seventeen studies examining decolonization strategies found no significant differences in any outcomes. Few other intervention strategies were studied.

The authors say that the finding of reduced colonization is noteworthy, since roughly one-third of patients with MDR-E colonization will develop an infection.

“Though effect on infection was not demonstrated in our meta-analysis, it is possible that additional future studies and a larger sample size would demonstrate a significant difference,” they wrote.
May 14 J Infect abstract


VHA survey finds stewardship programs reliant on pharmacists

Interviews conducted at Veterans Health Administration (VHA) hospitals without on-site infectious diseases (ID) support found that ASPs are largely a pharmacy-driven process, researchers reported this week in Infection Control & Hospital Epidemiology.

 A team led by researchers with the Iowa City Veterans’ Affairs Health Care System found that four themes emerged from site visits (two conducted virtually because of the pandemic) and interviews with 42 ASP team members at seven VHA hospitals lacking on-site ID support.

The first was that the ASP pharmacy champion wears many hats and fills many roles, and was consistently recognized as the leader of the ASP. The second was that ASP pharmacy champions had to build rapport with clinicians in order to get support for stewardship recommendations, a task that was difficult at hospitals that relied heavily on contract physicians.

The third theme that emerged was that access to an off-site ID specialist via electronic consultation helped give credibility to both the ASP pharmacists’ recommendations and to any stewardship initiatives the ASP team was trying to move forward. Finally, most ASP pharmacy champions spoke of the difficulty of gaining institutional buy-in and funding for their efforts.

The authors say the findings have broader implications, since a large proportion of US hospitals lack an on-site ID support but are still required to have an ASP.

“Given the ongoing need to improve antibiotic use and expand the implementation of ASPs across the spectrum of healthcare, our findings could inform future work on ASP implementation in these settings,” they wrote.
May 17 Infect Control Hosp Epidemiol abstract

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