Top Infectious Disease News of the Week—June 9, 2019

#5: Outpatient Antimicrobial Stewardship: Field of Dreams or Land of Opportunity for Pharmacists?

The critical importance of antimicrobial stewardship (AMS) to contain health care costs, combat antimicrobial resistance, and avoid unnecessary medication-related adverse events has become well accepted within the medical community. This widespread recognition has fostered the development of robust, outcome-driven, multidisciplinary AMS programs across a wide range of health care settings, from small, rural community hospitals to large, tertiary health care systems. Formal AMS programs have evolved and remained largely established within acute care hospitals given the prevalence of broad-spectrum antimicrobial use, higher rates of multidrug antimicrobial resistance, and risks of hospital-acquired infections.

Though the majority of AMS efforts have been directed toward inpatient practices, 60% of all antibiotic expenditures in the United States occur in the outpatient setting.¹ In the United States alone during 2013, 269 million antibiotic prescriptions were dispensed from outpatient pharmacies.² It has been estimated that up to 30% of outpatient antibiotic prescriptions may be inappropriate, based upon professional society endorsed national guidelines for infectious syndromes.³Further, the burden of community acquired Clostridioides difficile is significant, with up to 35% of adult and 70% of pediatric C difficile cases occurring in patients who had no recent overnight stay in a health care facility.^4,5 In response to the need for systematic outpatient AMS, the US Centers for Disease Control and Prevention (CDC) released the Core Elements of Outpatient Antibiotic Stewardship in 2016. The recommendations center around 4 cornerstone elements: commitment, action for policy and practice, tracking and reporting, and education and expertise.⁶

Read the June feature article.

#4: WHO: Meeting Global Goals for HIV, Hepatitis, STIs Requires Accelerated Effort

More action is needed to meet goals to eliminate HIV, viral hepatitis, and sexually transmitted infections by 2030, according to a recently released World Health Organization (WHO) progress report.

The report is a midterm look at progress WHO member states have made toward implementing strategies to guide actions from 2016-2021 aimed at eliminating the diseases by 2030. The report notes that HIV infections are declining, but not rapidly enough; global targets for reducing mortality from viral hepatitis B and C will require accelerating universal access to testing and treatment; and STIs are not declining globally and are increasing in some countries.

Jason Schafer, PharmD, associate professor of pharmacy practice at Thomas Jefferson University in Philadelphia and the HIV section editor for the Contagion^®print publication, emphasized the “sheer number of individuals impacted, the lives that are at risk, and those that could be saved if the targets are met.”

The 3 diseases highlighted in the report cause 2.8 million deaths each year, according to the WHO. Meeting targets could save 1.7 million lives and prevent 1.2 million people from developing cancer each year.

Read about the accelerated effort required for meeting WHO targets.

#3: 4 Sepsis Phenotypes Identified by Study Raise Hope for Targeted Treatment

Investigators at the University of Pittsburgh Medical Center used machine learning to identify 4 sepsis phenotypes in research aimed at developing targeted therapies for the condition.

The retrospective study, published in the Journal of the American Medication Association, involved more than 60,000 patients, and examined clinical outcomes and frequency of 4 distinct sepsis subtypes—α, β, γ, and δ.

“For over a decade, there have been no major breakthroughs in the treatment of sepsis; the largest improvements we’ve seen involve the enforcing of ‘one-size fits all’ protocols for prompt treatment,” lead author Christopher Seymour, MD, MSc, an associate professor in University of Pittsburgh’s Department of Critical Care Medicine, said in a statement. “But these protocols ignore that sepsis patients are not all the same. For a condition that kills more than 6 million people annually, that’s unacceptable. Hopefully, by seeing sepsis as several distinct conditions with varying clinical characteristics, we can discover and test therapies precisely tailored to the type of sepsis each patient has.”

The results of the study were presented at the American Thoracic Society’s Annual Meeting.

Read about 4 sepsis phenotypes.

#2: Achaogen—Canary in the Coal Mine or Developer of an Unwanted Product?

In April, the infectious diseases world received bad news when Achaogen, the developers of plazomicin (Zemdri), announced that they were filing for bankruptcy. The company’s demise serves notice that the recent boom in antibiotic development, which led to the incredible success of the Infectious Diseases Society of America’s 10 x ’20 drug development initiative, comes with a notorious asterisk.

I am still amazed by the success of the focus on the desperate need for new antimicrobials. The goal of “10 new antibiotics by 2020” was reached ahead of schedule, and the pipeline contains several new agents with possible approvals in 2019 and 2020. Push incentives, which encourage antibiotic development by helping to reduce research and development costs, have been effective in lowering barriers of entry to the market for new entities, such as plazomicin. With the abandonment of antibiotic development by nearly all large pharmaceutical companies, small companies such as Achaogen with limited resources are left as the driving forces of drug development. I am thankful for these small companies and their interest in creating new antibiotics, but they are vulnerable to setbacks and are dependent on venture capitalists in ways that more robust companies are not.

Read June’s Editor-in-Chief letter.

#1: Ebola Cases Confirmed in Uganda

The World Health Organization (WHO) in Uganda has announced on Twitter that a confirmed case of Ebola has been detected in Uganda. This case is the first confirmed case of Ebola that Uganda has detected during the ongoing outbreak in the neighboring Democratic Republic of the Congo (DRC).

According to the Twitter thread, the confirmed case is in a 5-year-old Congolese boy who traveled from the DRC into Uganda on June 9, 2019. The family entered the country through the Bwera Border post which is located along the Western border of Uganda which is shared with the DRC.

The child initially sought care at a hospital in Kagando hospital where health workers identified Ebola as a potential diagnosis. At that point the child was transferred to an Ebola Treatment Unit in Bwera.

In the treatment unit at Bwera the child was diagnosed with Ebola Virus Disease after confirmation was made by the Uganda Virus Institute. According to WHO Uganda and the Ugandan Ministry of Health, the child is under care and receiving supportive treatment at the facility.

In response to the confirmed case a rapid response team has been dispatched to Kasese to being contact tracing and “management of cases that are likely to occur.” The team will also being vaccination individuals who have been in contact with the ill child, including frontline health workers.

In a follow-up tweet posted on June 12, 2019, WHO Uganda confirmed that the 5-year-old boy died of his illness.

In an accompanying press release, the Ugandan Ministry of Health reported that 2 additional cases of Ebola have been confirmed in Uganda. The 2 new cases have been confirmed in the grandmother and 3-year-old brother of the deceased patient. According to the statement all patients are being treated at the Bwera Hospital Ebola Treatment Unit and presented with symptoms of vomiting blood, bloody diarrhea, muscle pain, headache, fatigue, and abdominal pain.

Read about Ebola in Uganda.