Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/08/stewardship-resistance-scan-aug-27-2019
Stewardship / Resistance Scan for Aug 27, 2019
Antibiotic pollution initiative; Carbapenem-resistant Klebsiella spread
Filed Under:
Antimicrobial Stewardship
[h=3]New initiative aims to clean up antibiotics manufacturing[/h] The United Nations Development Programme (UNDP) yesterday announced a joint initiative with environmental and industry groups to reduce the amount of antibiotic discharge from pharmaceutical manufacturing facilities.
The REAP (Reducing Emissions from Antibiotics Production) project will bring together organizations on the supply and demand side of antibiotics manufacturing to advocate for technologies, incentives, and policies that help the pharmaceutical industry shift to more sustainable production practices. Partners in the initiative include the Stockholm International Water Institute, Centrient Pharmaceuticals, and contract manufacturer Recipharm.
The release of antibiotic residues into waterways by pharmaceutical manufacturing plants is considered one of the factors that contribute to antimicrobial resistance (AMR). Once in the water, the antibiotic residues interact with natural bacterial communities and with human and animal bacteria, and can exert selective pressure that promotes the development of AMR. Studies in parts of India where pharmaceutical manufacturing is concentrated have found high concentrations of antibiotic residues and an abundance of AMR genes in local waterways.
"The UN purchases large volumes of antibiotics. Developing a Sustainable Procurement Index for Health is a way for us to promote more sustainable manufacturing and procurement," Rosemary Kumwenda, MD, UNDP's regional team leader for HIV, Health, and Development, said in a press release from the UN's Sustainable Procurement in the Health Sector (SPHS) task force. "Through REAP, we can engage with manufacturers and suppliers and in the long run, incentivise a more sustainable production and procurement system."
The initiative was announced at World Water Week 2019.
Aug 26 SPHS press release
[h=3]Study highlights regional spread of carbapenem-resistant Klebsiella[/h] A genomic study of clinical isolates from long-term acute care hospitals (LTACHs) in the United States indicates patient transfer is driving regional proliferation of carbapenem-resistant Klebsiella pneumoniae (CRKP), researchers reported yesterday in Antimicrobial Agents and Chemotherapy.
To better understand the epidemiology of CRKP in LTACHs, which are increasingly recognized as reservoirs of multidrug-resistant organisms (MDROs) because of their critically ill patient population, the researchers performed whole-genome sequencing (WGS) on a collection of 451 CRKP isolates from LTACH patients in four geographic regions. The vast majority of the isolates (395, 87.6%) were from 11 facilities in the Los Angeles area. Patients with CRKP had a high rate of multiple comorbidities, and indwelling device and broad-spectrum antibiotic use was common.
Analysis of the sequence types revealed that more than 90% of the isolates belonged to ST258, an epidemic K pneumoniae lineage that has accounted for most of the carbapenem-resistant Enterobacteriaceae infections in US hospitals, and phylogenetic reconstruction showed that dissemination of the lineage started in Los Angeles?area LTACHs with a small number of introductions in 2012, then spread among the facilities via patient transfers.
A transmission map constructed from 363 isolates indicated that CRKP transmission was associated with rates of patient flow between LTACHs, with higher transmission frequencies found between geographically proximate facilities. But the CRKP prevalence at each LTACH was associated with intra-facility transmission rates, which varied according to the clinical characteristics of patients.
The researchers say the study illustrates how WGS and patient-level clinical meta-data can help identify pathways and drivers of MDRO transmission in regional healthcare networks, which could aid development of targeted interventions. "The ability to tease apart the relative contributions of inter- and intra-facility transmission across regional healthcare facilities, and to identify drivers of these processes, is a critical first step in the development of effective regional interventions to control the spread of MDROs," they write.
Aug 26 Antimicrob Agents Chemother abstract
Stewardship / Resistance Scan for Aug 27, 2019
Antibiotic pollution initiative; Carbapenem-resistant Klebsiella spread
Filed Under:
Antimicrobial Stewardship
[h=3]New initiative aims to clean up antibiotics manufacturing[/h] The United Nations Development Programme (UNDP) yesterday announced a joint initiative with environmental and industry groups to reduce the amount of antibiotic discharge from pharmaceutical manufacturing facilities.
The REAP (Reducing Emissions from Antibiotics Production) project will bring together organizations on the supply and demand side of antibiotics manufacturing to advocate for technologies, incentives, and policies that help the pharmaceutical industry shift to more sustainable production practices. Partners in the initiative include the Stockholm International Water Institute, Centrient Pharmaceuticals, and contract manufacturer Recipharm.
The release of antibiotic residues into waterways by pharmaceutical manufacturing plants is considered one of the factors that contribute to antimicrobial resistance (AMR). Once in the water, the antibiotic residues interact with natural bacterial communities and with human and animal bacteria, and can exert selective pressure that promotes the development of AMR. Studies in parts of India where pharmaceutical manufacturing is concentrated have found high concentrations of antibiotic residues and an abundance of AMR genes in local waterways.
"The UN purchases large volumes of antibiotics. Developing a Sustainable Procurement Index for Health is a way for us to promote more sustainable manufacturing and procurement," Rosemary Kumwenda, MD, UNDP's regional team leader for HIV, Health, and Development, said in a press release from the UN's Sustainable Procurement in the Health Sector (SPHS) task force. "Through REAP, we can engage with manufacturers and suppliers and in the long run, incentivise a more sustainable production and procurement system."
The initiative was announced at World Water Week 2019.
Aug 26 SPHS press release
[h=3]Study highlights regional spread of carbapenem-resistant Klebsiella[/h] A genomic study of clinical isolates from long-term acute care hospitals (LTACHs) in the United States indicates patient transfer is driving regional proliferation of carbapenem-resistant Klebsiella pneumoniae (CRKP), researchers reported yesterday in Antimicrobial Agents and Chemotherapy.
To better understand the epidemiology of CRKP in LTACHs, which are increasingly recognized as reservoirs of multidrug-resistant organisms (MDROs) because of their critically ill patient population, the researchers performed whole-genome sequencing (WGS) on a collection of 451 CRKP isolates from LTACH patients in four geographic regions. The vast majority of the isolates (395, 87.6%) were from 11 facilities in the Los Angeles area. Patients with CRKP had a high rate of multiple comorbidities, and indwelling device and broad-spectrum antibiotic use was common.
Analysis of the sequence types revealed that more than 90% of the isolates belonged to ST258, an epidemic K pneumoniae lineage that has accounted for most of the carbapenem-resistant Enterobacteriaceae infections in US hospitals, and phylogenetic reconstruction showed that dissemination of the lineage started in Los Angeles?area LTACHs with a small number of introductions in 2012, then spread among the facilities via patient transfers.
A transmission map constructed from 363 isolates indicated that CRKP transmission was associated with rates of patient flow between LTACHs, with higher transmission frequencies found between geographically proximate facilities. But the CRKP prevalence at each LTACH was associated with intra-facility transmission rates, which varied according to the clinical characteristics of patients.
The researchers say the study illustrates how WGS and patient-level clinical meta-data can help identify pathways and drivers of MDRO transmission in regional healthcare networks, which could aid development of targeted interventions. "The ability to tease apart the relative contributions of inter- and intra-facility transmission across regional healthcare facilities, and to identify drivers of these processes, is a critical first step in the development of effective regional interventions to control the spread of MDROs," they write.
Aug 26 Antimicrob Agents Chemother abstract