Vaccines could aid in the fight against antimicrobial resistance

Contributed by Dr. Tamhankar & Siddarth David

 

The latest report from the Review on Antimicrobial Resistance (AMR) says that improved utilization of existing vaccines could reduce the use of antibiotics and consequently antimicrobial resistance. The report points out that if vaccination coverage was improved it could be a critical step in reducing antimicrobial dependence for infectious diseases.

The report says that the nearly 800,000 deaths due to bacterial Pneumonia could be reduced as well as nearly 11.4million days of antimicrobial could be reduced by providing universal pneumococcal vaccination. While discussing the significance of the findings, the report says " Tackling antimicrobial resistance requires a wide range of approaches and developing alternatives to antibiotics, in humans and animals, is critical to the fight. Vaccines have a vital role to play in combating drug resistance, by preventing infections in the first place."

The AMR Review was commissioned by the UK Prime Minister and is hosted by the Wellcome Trust to recommend series of measures to deal with the challenge of antibiotic resistance. However, widely effective the vaccine approach maybe it is clear that using the existing methods to address antimicrobial infections such as hand washing, etc. maybe the way ahead in antimicrobial resistance. The report is therefore another reinforcement that the solutions to the problem of antibiotic resistance may very well be there with us. In India where we still have yet to achieve universal coverage for immunization this could be another reason to accelerate the process as we have an emerging public health burden related to antibiotic resistance in the country.

New Toolkit developed for monitoring antibiotic resistance especially among physicians and nurses

Contributed by Siddarth David & Dr. Tamhankar

The Royal College of Nursing in the UK, last week launched a infection control and antibiotic resistance management toolkit. It especially looks at sepsis in two main causes of infections in hospitals pneumonia and urinary tract infections.

The toolkit seeks to highlight organisational approaches to infection  prevention and control across primary, secondary and social healthcare settings. It also provides guidelines to address the hospital acquired infections in the health facility especially at the level of nurses and general physicians. It also lays down indicators to evaluate the steps taken to reduce hospital infection rates and antibiotic use.

The toolkit though not mandatory is the way forward in addressing antibiotic resistance. It can be easily replicated with appropriate contextualization in other national and regional settings.  

Pharmaceutical Companies Sign Declaration to Act Against Antibiotics

Contributed by Siddarth D & Dr. Tamhankar

In a first of its kind step, drug makers have pledged  joined hands with governments and other bodies working on addressing the problem of antibiotic resistance. Declaration on Combating Antimicrobial Resistance was signed by 85 phrama, bio-tech and drug companies including GlaxoSmithKline, Johnson & Johnson, Novartis and Pfizer as well as Cipla from India, to adhere to a common set of protocols keeping in mind antibiotic conservation.

The declaration was launched as part of the World Economic Forum in Davos, Switzerland, and outlines several key measures the government and industry must take to increase antibiotic effectiveness worldwide. This was done in collaboration the Review on Antimicrobial Resistance, a group commissioned by the UK Prime Minister for the purpose of raising awareness for the economic issues surrounding antimicrobial resistance (AMR).

This 21st January declaration, has broadened the scope of involving all the stakeholders in the process of tackling antibiotic resistance. Drug companies have been criticised for not doing enough to control the market forces that impeded unregulated production and sale of antibiotics. Rather than working in silos, it is only when policy makers, field workers, researchers and drug companies are on the same page, that effective steps can be taken to rationalize the use of antibiotics.  It is hoped that more drug makers sign the declaration and are part of the solution rather than the problem to antibiotic resistance.

Gene that makes superbugs found in Canada

Contributed by Siddarth D & Dr. Tamhankar

The MCR-1 gene that makes E. coli and some other species of bacteria resistant to colistin, an antibiotic considered the drug of last resort for infectious diseases has been found by scientists in samples in Canada. Moreover, the MCR-1 gene was found on a free-floating  bit of DNA: the plasmid allowing it to be transferred easily to other micro-organisms.

Public Health Agency of Canada's National Microbiology Laboratory had launched a nation-wide campaign to test samples for the presence of antimicrobial resistance. The three cases in Canada were reported in Canadian woman returning from Egypt and two from beef samples in Ottawa. This adds to the confirmed cases of the presence of the MCR-1 gene which was first reported in China and shared in this blog. Since then, scientists in other countries, including Britain, Denmark and Laos, have had similar findings.

This finding has reiterated the need to address the phenomenon of antimicrobial resistance at the global level with better stewardship and appropriate use. 

Gene that resists last resort antibiotics discovered

Contributed by Siddarth David & Dr. Tamhankar

Scientists in China have found increased levels of resistance to an antimicrobial drug colistin a polymyxin used when other drugs have failed, according to a report in the journal Lancet Infectious Diseases. The study analyzed various samples taken from patients who had presented infections in two hospitals.

The researchers found that colistin resistance was caused by a gene called MCR-1. This gene was found on a piece of bacterial DNA that can be transferred between bacteria. The study found the MCR-1 gene in E. coli collected from 15% of raw meat samples and 21% of animals tested from 2011-14. The gene was also found in E. coli from 1% of hospital inpatients in China.

The study recommends that the use of polymixin should be restricted in agriculture, as we could end up with a situation where doctors are forced to say, "Sorry, there is nothing I can do to cure your infection". This finding critically underscores the need for better surveillance, strategies for judicious use of antibiotic and development of national antibiotic protocols across countries. 

Contributed by Siddarth David & Dr. Tamhankar

A study published in the published in the Journal of the Paediatric Infectious Diseases Society has shown rising rate of infections, particularly prevalent among children between under the age of 5. After analysing a nationwide data base of reports from microbiology laboratories from 1991-2011, the study showed the increase of prevalence of "extended-spectrum beta-lactamase" (ESBL) producing bacteria and resistance to third-generation cephalosporins was highest among children under 5 years.

This means treatment with last-resort antibiotics such as carbapenems translating to longer hospital stays, higher health care costs, and increased mortality. The Centres for Disease Control (CDC) in the US, had called for stronger steps to counter ESBL-producing bacteria in 2013, given the significant threat they pose to public health in the US. The study also calls for more research into defining the risk factors for these infections in children, their prevalence in different settings, and their molecular epidemiology. 

New Blood Test to potentially identify Antibiotic resistant infection in an Hour

Contributed by Siddarth David and Dr. Tamhankar

Given that identifying and treating blood infections that are antibiotic resistant takes up to three days, researchers Brigham Young University, Utah, USA are in the process of  developing a speedier blood test to detect such infections. 

Working on a fund from the National Institutes of Health, of the US Department of Health and Human Services, the researchers have developed an opto-fluidic microchip. The device is still in  design but will first filter out a sample's blood cells to isolate bacteria and DNA from the bacteria will be extracted, sequenced and scanned for matches with known sequences of drug-resistant strains. Potentially harmful bacteria DNA will get flagged with fluorescing molecules.

After perfecting and testing the technology it should be available in the next few years, this can significantly reduce the time for detecting antibiotic-resistant infections and mortality associated with it. 

Plain Soaps as effective as Antibacterial Soaps: Study

Contributed by Siddarth David and Dr. Tamhankar

A study conducted by researchers in the College of Life Sciences and Biotechnology, Korea University, Seoul  has shown that there was no significant difference (p > 0.05) between washing hands with plain soap and antibacterial soaps. The study published in the Journal of Antimicrobial Chemotherapy showed that when 20 strains of bacteria, including Streptococcus, Staphylococcus, Listeria and MRSA were exposed to one soap of regular formation and one containing 0.3 percent triclosan for the recommended 20 seconds of hand washing, there was no difference in the amount of bacteria killed by the two varieties.

The study reported significant difference in killing more germs in the triclosan soap only after nine hours, which was a rather long period for washing of hands said the study. The study was also was experimented with 16 participants using both the soaps and again no difference was found.

The study does raise questions on the effectiveness of the use antibacterials in soaps, and if further research validates the finding of the Korean study, shifting to the traditional and cheaper soap and water for hand washing could reduce unnecessary antibacterial use in daily life.  

UK drafts Guidelines for changing public behaviour to reduce antibiotic resistance

Contributed by Siddarth David and Dr. Tamhankar

The National Institute for Health and Care Excellence (NICE) in the UK last week released its draft guidelines aimed at the general population in order to address the challenge on antimicrobial resistance in the country. The statutory body has drafted these guidelines complimenting the guidelines on antibiotic stewardship which were published last month to be implemented in the UK.

The draft guidelines which are open for public consultation, emphasize the need for public awareness to reduce risk-related behaviours among the general public. It reports that basic hygiene guidance such as hand-washing can reduce majority of infectious diseases like cough and cold which account for one-fifth of the days lost at work in the UK rather than depend on antibiotics for treatment. 

The draft guidelines also state that when people seek medical advice for self-limiting conditions, they should be told how they could treat their symptoms themselves and explained why they are not being prescribed antibiotics. The draft guidelines are commendable in having recognized that the patient and the public at large also have an important role to play in tackling antibiotic resistance. Once finalized it could be used as advocacy tool for other countries across the world to push for robust policies on the issue. 

South-Asian countries assess progress of Antimicrobial strategies in the region

Contributed by Dr. Tamhankar and Siddarth David

Health ministers of 11 countries in South Asia are meeting from today in Dili, Timor-Leste for the 68th WHO Regional Committee for South East Asia. An important agenda is the implementation of action plan for antimicrobial resistance by the 11 countries in the region.

The meeting conducted by the highest policy making body of the WHO in the region meets once a year to discuss, deliberate and plan health priorities and action policies for the entire region. Given the critical global challenge posed by antibiotic resistance, it features high in the agenda of this year's Regional Committee Meeting. 

It will be especially significant as it would be an opportunity to review the commitments and progress made by the 11 countries on the resolution passed in the May 2015 World Health Assembly in Geneva that every member country would have to develop and implement national action plans for  controlling antibiotic resistance in their respective countries by May 2017.