Top Infectious Disease News of the Week—January 27, 2019

#5: A Look at Atrium Health's Efforts to Tackle Antibiotic Resistance: Public Health Watch

Investigators recently discovered genes linked with antibiotic resistance in a remote region of the Arctic, highlighting the truly global scope of the threat of infections unsusceptible to currently available drugs.

And yet, recent data suggest that nearly 1 in 4 health care institutions in the United States have yet to implement an antibiotic stewardship program as called on to do by the US Centers for Disease Control and Prevention (CDC) by 2020, Contagion® reported last November.

But is it more complicated than that?

“One of the greatest struggles for most hospital systems is lack of resources, in terms of personnel,” Lisa Davidson, MD, medical director of the Antimicrobial Support Network at Atrium Health, told Contagion®. “A lot of the hospital systems that reach out to us seeking advice are loathe to allocate resources, including physician and pharmacy time, to stewardship programs, because they won’t see immediate returns on the investment.”

Read about Atrium’s efforts to tackle antibiotic resistance.

#4 A New Discovery Could Help Prevent Future Ebola Transmission

As the Ebola outbreak in the Democratic Republic of the Congo enters its sixth consecutive month, a new discovery in Liberia is revealing more about how bats serve as a reservoir for Ebola and other filoviruses.

Investigators have announced that genetic material and antibodies from the Zaire ebolavirus strain were detected in a Greater Long-fingered bat in Liberia’s northeastern Nimba District. This discovery marks the first identification of Ebola virus in a bat in West Africa, the location of the 2013-2016 epidemic during which roughly 30,000 individuals were infected with the Zaire strain of Ebola.

The discovery was announced by the Liberian government who worked alongside investigators with the Center for Infection and Immunity at the Columbia University Mailman School of Public Health and EcoHealth Alliance.

“This discovery is a major step forward in understanding how Ebola outbreaks happen,” Jonathan Epstein, DVM, EcoHealth Alliance Vice President for Science and Outreach, said in a statement. “The West African Ebola epidemic was devastating, and it began with a single transmission from an animal to a person. It’s critical that we identify which animals naturally carry Ebola and related viruses—without knowing that, we can’t truly understand and reduce the risk of another outbreak occurring in the region.”

Read about a discovery that could help prevent Ebola transmission.

#3: PrEP Users Credit 6 Strategies for High Level of Adherence

A new study has identified 6 strategies used by individuals taking HIV pre-exposure prophylaxis (PrEP) medications to promote adherence to the daily regimen. Investigators say these strategies may assist health care providers treating patients who take PrEP.

According to the US Centers for Disease Control and Prevention (CDC), people who are at high risk of HIV infection can reduce their risk by 92% with consistent daily use of PrEP, but the pill is much less effective if not taken consistently. Only an estimated 10% of adults at risk of HIV infection currently take PrEP.

“Adding a daily pill for prevention can be challenging for some,” Christian Grov, PhD, MPH, chair of the Department of Community Health and Social Sciences at the City University of New York School of Public Health and a co-author of the study, told Contagion® in an interview. “In our study, we identified several easily adapted strategies that can help people to remember to take their medication at roughly the same time every day. Providers working with patients who are struggling with or concerned about adherence could recommend to their patients any number of the strategies we identified in our study.”

Read about strategies for PrEP for adherence.

#2: Can Lefamulin Decrease the Burden of Community-Acquired Pneumonia?

A diagnosis of community-acquired pneumonia is associated with high costs and significant morbidity and mortality, yet currently available treatment options have high levels of failure and associated adverse event risks.

In fact, according to an analysis published in 2016, pneumonia ranks as the eighth most expensive condition treated in US hospitals with an estimated annual cost of $16 billion.

Each year there are between 5 and 6 million cases of community-acquired pneumonia, accounting for about $10 billion in inpatient treatment costs, with the remainder being spent on the outpatient side. Mortality rates fluctuate between 12% for patients admitted to the hospital and 30% for those who require ICU admission, making community-acquired pneumonia the eighth leading cause of death in the United States.

“If there is interest in reducing the economic burden of patients with pneumonia, the single most important thing to do is deflect hospitalizations in appropriate patients,” Thomas Lodise, PharmD, PhD, professor of pharmacy practice at Albany College of Pharmacy and Health Sciences, told Contagion® in an interview.

Read about Lefamulin for the treatment of pneumonia.

#1: In Race to Cure HIV, Gene Editing Has Potential and Pitfalls

Years ago, when HIV was still an untreatable death sentence, the phones at Jacob P. Lalezari’s, MD, San Francisco research clinic rang constantly.

“We get used to get phone calls every day from around the world,” he said.

Calls came from as far away as Australia, India, and Africa—desperate patients hoping for a chance at a cure. They were willing to do what had to be done, to endure side effects and disappointment, if it would mean a cure for HIV.

One of the most famous studies Dr. Lalezari participated in was gene editing therapy for Sangamo Therapeutics. The idea was to remove a patient’s own CD4-T cells, modify them in a lab using a zinc-finger nuclease to render the cells’ CCR5 gene defective, and then reinfuse the modified cells back into the patient.

Pablo Tebas, MD, who runs the AIDS clinical trial unit at the University of Pennsylvania’s Perelman School of Medicine, said when you handicap CCR5, HIV can’t replicate.

“If you don’t have CCR5, the virus can’t enter the cell,” he told Contagion®.

If it worked, it would amount to a “functional” cure for HIV. For a chance at that, study participants were willing to risk side effects, including the strange possibility that the therapy would give them an odor reminiscent of garlic or spoiled cream corn.

The results of the Sangamo study, published in the New England Journal of Medicine in 2014, were mixed. The data showed improved T cell counts in patients, but many participants experienced side effects and none of them were cured. Though the study met its primary endpoint of demonstrating safety, the results weren’t good enough, said Dr. Lalezari.

“The company was never able to show a consistent effect on viral metrics and that really is the whole shooting match,” he said.

Read about the potential and pitfalls for gene editing.