ISDA Infectious Diseases Society of America – Antimicrobial Resistance

December 21, 2009

Antimicrobial Resistance

http://www.idsociety.org/Content.aspx?id=6252

The development of antimicrobial agents (antibacterials, antivirals, antifungals and antiparasitics) to treat infections has been one of the most notable medical achievements of the past century.  These advances in medical care are threatened, however, by a natural phenomenon known as “antimicrobial resistance.” Antimicrobial resistance, whereby microbes mutate and become less susceptible to these “miracle drugs” over time, creates problems for infectious diseases physicians as they must work quickly to determine what drug will work on a patient’s infection.  Microbes’ ability to become resistant to antimicrobials not only impacts individual patients, but also can have devastating impacts on the general population as resistant microbes pass from one individual to another.

Worrisome recent examples of drug resistance include vancomycin-resistant Staphylococcus aureus (VRSA) and community-associated methicillin-resistant Staphylococcus aureus (MRSA). The emergence of VRSA is of great concern to clinicians and public health officials as vancomycin is typically the drug of last resort in treating S aureus and several other infections.  MRSA, in the recent past, only affected immune-compromised individuals and the elderly in hospital settings.  Now, it is occurring across the country in local communities—infecting healthy and strong individuals.

To preserve the effectiveness of antimicrobials, IDSA has adopted Principles and Strategies Intended to Limit the Impact of Antimicrobial Resistance.

Due to the increasing seriousness of this issue, IDSA also is working:

State-Specific Information on Antibiotic Resistance
Working with State Epidemiologists, IDSA has summarized information of the antibacterial drug resistance problem in all 50 U.S. states.

Policymakers and the public may view IDSA’s statements; relevant reports from the U.S. Public Health Service, General Accounting Office, Institute of Medicine and WHO/UN; and other useful policy documents, resources and links concerning antimicrobial resistance below.

IDSA Statements

New US/EU Transatlantic Task Force on Antimicrobial Resistance and IDSA’s “10 X ’20 Initiative: Two’s Path Forward 12/04/2009
Robert Guidos, JD, IDSA VP, Public Policy & Government Relations, outlines IDSA’s position in an invited guest column of the Center for Global Development’s newsletter.

Summary of Existing Policy on the Use of Antimicrobial Drugs in Food Animals 11/01/2009
IDSA has summarized its existing policies on food animal use of antimicrobials in this one-page fact sheet.

IDSA Testifies to FDA on the Need to Update Susceptibility Breakpoints 10/26/2009
At a recent FDA Anti-Infective Advisory Committee meeting, IDSA testified about its position on updating the Microbiology subsection of product labeling for systemic bacterial drug product labeling and provided recommendations on how FDA could accomplish this task.

IDSA Urges Senate to Boost ID Public Health in Economic Stimulus Plan 01/21/2009
IDSA submitted proposals to Senate leaders urging the stimulus plan include investments in public health infrastructure for infectious diseases. Two proposals emphasize the crises of antimicrobial resistance and emerging infections, and HIV / AIDS and tuberculosis.

IDSA Preliminary Statement on Antibiotic Home Stockpiling 06/18/2008�
At a meeting of the National Biodefense Science Board, IDSA delivered public comments raising concerns about an HHS intiative to inform the public about home stockpiling of doxycycline for use in a potential anthrax attack.

The Epidemic of Antimicrobial Resistant Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America, January 15, 2008 12/12/2007
Published in Clinical Infectious Diseases [CID 2008:46 (15 January)].

IDSA, HIVMA Call for Action on XDR-TB 03/19/2007
A fact sheet details the threat of Extensively Drug-Resistant Tuberculosis (XDR-TB) to the United States and the globe, and outlines urgent federal funding needs for FY08.

View all Statements

IDSA Letters

IDSA Supports FDA’s Preliminary Approach to Breakpoints Updates in a Response to U.S. Rep. DeLauro 11/17/2009
IDSA notes that FDA Appropriations Chairwoman appears to have received some faulty information when she took FDA to task on its plans to update antibacterial breakpoints on drug labeling (e.g., we disagree that the agency is “outsourcing” this essential function to the Clinical Laboratory Standards Institute).

IDSA Urges NIAID Clinical Trial Networks Expansion into New Areas 10/19/2009
NIAID officials are examining the possibility of expanding the Institute’s clinical trials networks to cover tuberculosis, hepatitis C, influenza research. IDSA supports this proposal and has requested that resistant bacterial infections also be considered.

IDSA Urges Obama Administration to Issue and Fund Updated Public Health Action Plan to Combat Antimicrobial Resistance 08/07/2009
In letters to the heads of agencies on the Interagency Task Force on Antimicrobial Resistance, IDSA urges quick issuance of a revised plan, the inclusion of meaningful benchmarks for action items, and funding for the Action Plan to be made a priority for the Administration.

IDSA Proposes Clinical Trials to NIAID That Aim to Improve Antimicrobial Stewardship 07/28/2009
IDSA proposes three, randomized, multi-centered controlled trials to NIAID that seek to optimize antimicrobial prescribing practices.

20 Organizations Support Obama Administration’s New Approach to Drug Approvals and Uses 07/24/2009
IDSA and other organizations applaud the Obama administration and U.S. Food and Drug Administration (FDA) for adopting an approach that demonstrates a clear commitment to sound and science-based polciy development.

IDSA and TFAH Support FDA’s New Thinking on the Use of Antimicrobial Drugs in Animal Agriculture 07/17/2009
On July 13th, FDA testified in support of phasing out the use of antimicrobials in animals for growth promotion/feed efficiency and requiring that all other uses of antimicrobials in animals be carried out under the supervision of a veterinarian and within the boundaries of a valid veterinarian-client-patient relationship.

View all Letters

IDSA Comments on Federal Agencies’ Actions

Comments on CMS Framework Document ‘8th Quality Improvement Organization Scope of Work’ 01/02/2004
IDSA recommends that CMS include activities to limit the spread of antimicrobial resistance, decrease inappropriate antimicrobial use and improve current infection control in its quality improvement efforts.

Commented on FDA’s Draft Guidance: Evaluating the Safety of Antimicrobial New Animal Drugs with Regard to Their Microbiological Effects on Bacteria on Human Health Concerns 11/01/2002
See final  FDA’s Guidance announced 10/23/03.

IDSA Supports FDA’s Review of the Use of Antimicrobial Agents in Animals 10/27/2000
Supported FDA’s review of the human health risks associated with the use of antimicroibial agents in animals in a statement. One drug company sponsor, Abbott, has agrreed to withdraw its product. A second company, Bayer, is challenging FDA’s decision. IDSA will continue to monitor this issue.

Comments on PHS Action Plan to Combat Antimicrobial Resistance 08/02/2000
(See the final “Action Plan” (01/18/2001) and follow up “Progress Reports” (06/01/2003) in “General Reports” section below.)

Institute of Medicine Reports

Microbial Threats to Health: Emergence, Detection, and Response 03/01/2003
IOM report provides a comprehensive study on the policy and infrastructure changes necessary to detect, prevent and respond to microbial threats to health.

Managed Care Systems and Emerging Infections: Challenges and Opportunities for Stregnthening Surveillance, Research, and Prevention, Workshop Summary 12/01/2000
IOM summary is the product of a workshop on how managed care has created both problems and opportunities in the fight against infectious diseases and highlights ways the managed care systems can aid research, develop clinical guidelines, manage the use of antibiotics, support public education efforts and monitor the spread of emerging infections and microbial resistance.

Antimicrobial Resistance: Issues and Options 12/01/1998
IOM summary is the product of a workshop to provide an opportunity for representatives of academia, industry, government and professional groups to examine and discuss scientific and policy dilemmas of common interest that are specifically related to research on and the prevention, detection and management of emerging infections.

Important Links

Antimicrobial (Antibiotic) Resistance
Information from the National Institutes of Allergy and Infectious Diseases

Antibiotic and Antimicrobial Drug Resistance
Resources from the Centers for Disease Control and Prevention

World Heath Organization (WHO) Global Patient Safety Challenge

World Health Organization (WHO) Global Strategy for Containment of Antimicrobial Resistance 08/01/2001
WHO Report

View all Important Links

Related Federal Websites

CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC)

PHS Interagency Task Force on Antimicrobial Resistance (includes federal report: A Public Health Action Plan to Combat Antimicrobial Resistance)

FDA’s Antimicrobial Resistance Webpage

FDA’s Patient Information on Appropriate Antibiotics Usage

 

Economics of Antibiotic Resistance

December 9, 2009

www.medscape.com

From Expert Review of Anti-Infective Therapy

Economics of Antibiotic Resistance

Oguz Resat Sipahi

Abstract and Introduction

Abstract

Antibiotics are developed to kill microorganisms; however, microorganisms develop and disseminate resistance as a reaction to antimicrobials in accordance with the laws of evolution and natural selection. Resistant and multidrugresistant bacterial infections comprise a great problem in both the community and hospital setting. Increasing values of health expenditures, including antibiotics, is a global problem.

Antibiotic resistance is not always, but usually, associated with significant morbidity, longer hospitalization, excess costs and mortality. Excess costs associated with resistant microorganisms may be due to: obligation to use more expensive antibiotics, longer hospital stay, higher mortality, delayed appropriate antibiotic therapy or a necessity to perform surgery.

Optimal use of existing antimicrobial agents, using alternative treatment options (where possible), reducing the need for antimicrobials by increasing immunity, reducing the use of antimicrobials without providing an alternative form of treatment through education of health professionals and patients, antibiotic policies (including antibiotic stewardship and regulations for restricted use), implementation of infection control measures (e.g., hand washing, screening and isolation) are the strategies aimed at prevention of emergence and spread of antibiotic resistance.

Posted:

09/30/2008;

http://www.medscape.com/viewarticle/580479_print

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Microbiology Australia, Nov 2007

November 13, 2009

Journal available for download:

Microbiology Australia, November 2007

ASM Antimicrobial Susceptibility Textbook Now Available

November 4, 2009

EDITOR’S INTRODUCTION

This handbook has been produced as a response to requests to updated information from antimicrobial special interest group members of the Australian Society for Microbiology. It was funded by the NSW Sub-branch of the Australian Society for Microbiology.

As the title suggests “Antimicrobial Susceptibility Testing: Methods and Practices in Australia” is an evolving science. The handbook focuses on standardized methods and some which are non-standardized that are useful for detecting antimicrobial resistance during susceptibility testing for the bench microbiologist. It provides updated information from different authors who are currently working or had experiences in specific areas which have proven to be problematic. While it is not a complete textbook, our aim is to update information and topics every two years.

Antimicrobial resistance is an issue of great significance for public health at the local, national and global level. It has become increasingly important to monitor patterns of resistance as the antimicrobial susceptibility of bacterial pathogens escalates. Two major areas covered in this handbook are beta-lactam resistance in Gram-negatives and resistance seen in Gram-positives bacteria such as penicillin in pneumococci and methicillin/oxacillin and vancomycin resistance in staphylococci and enterococci. Fastidious organisms such as Neisseria species and Haemophilus influenzae are also covered by the “National Neisseria Network of Australia” and scientists who are currently working with such organisms. A mycobacterial susceptibility section has also been included with current methods with an Australian perspective. The handbook provides an updated concise chapter on CDS susceptibility testing from the CDS Users group for 2004.

The handbook also covers specialized areas of laboratory testing such as antiviral drug resistance and resistance to parasites with information on current state of testing. Authors of those sections have gone to great lengths in gathering and providing updated information on such testing, which was never previously included in past issues of antimicrobial updates. Antifungal resistance is also an increasing problem and an updated section on referenced methods for such testing and materials available in Australia has also been included from experts in the field. New method developments in antimicrobial combination testing for cystic fibrosis patients are also included in the text.

Susceptibility testing in microbiology is a challenging, continuing, educational science and I hope the microbiologists on the bench find the material useful. The reader should complement the information in the text with tables and guidelines provided by standardized groups such as CDS, NCCLS, BSAC and Etest working party, it is not meant to replace such text material and references are continuously made to updated published tables and guidelines.

Finally I would like to thank the AB BIODISK, Etest from Sweden and the British Society for Chemotherapy committee in UK who gave permission to reproduce material previously published which has been referenced for further reading throughout the text. Also thank you to all those reviewers who took time to comment and review documents. The Antimicrobial Special Interest Group also acknowledges the support of the current Standing Committee on Clinical Microbiology of the Australian Society for Microbiology for this publication.

I hope you find that the information in the handbook provides a stimulus for thought and discussion for the practicing microbiologist carrying out susceptibility testing at the bench.

Dr. John Merlino – Editor in Chief
National Antimicrobial Special Interest Convenor 2004
Contact: JMerlino@med.usy.edu.au
Australian Society for Microbiology

Index

Chapter 1:
Introduction – Antimicrobial Susceptibility: Concepts, Definitions and Practices
By: John Merlino

Chapter 2:
Antibiotic Susceptibility Testing by the CDS Method: A Manual for Medical and Veterinary Laboratories 2004
By: Bell SM, Gatus BJ, Pham JN, Rafferty DL.

Chapter 3:
Clinical Relevance of Antimicrobial Susceptibility Testing
By: Richard A. V. Benn

Chapter 4:
Gram-positive Bacteria – Resistance and Multidrug Resistance
By: John Merlino

Chapter 5:
Beta-lactam resistance in Gram-negative Bacteria
By: Jubelle Valenzuela, Lee Thomas and Jon Iredell

Chapter 6:
Combination Antimicrobial Testing Applications for Cystic Fibrosis
By: D. Hill, B. Rose, W. Ferris, S. Aaron and C. Harbour

Chapter 7:
Haemophilus influenzae and Antimicrobial Susceptibility
By: Stephen Tristram
Pages

Chapter 8:
Antimicrobial testing and applications in Pathogenic Neisseria
By: John Tapsall and members of the National Neisseria Network of Australia

Chapter 9:
Recommendations for the Drug Susceptibility Testing of Mycobacteria
By: Richard Lumb

Chapter 10:
Antifungal Susceptibility Testing
By: David Ellis and Rosie Handke

Chapter 11:
Resistance in Parasites: The Current State of Testing
By: Harsha Sheorey

Chapter 12:
Laboratory Testing for Antiviral Drug Resistance
By: Catherine Pitman and Dominic E. Dwyer

Chapter 13:
Antibiotic Susceptibility of Veterinary Isolates
By: Mary D. Barton

Chapter 14:
Chemical Disinfectants and Strerilising Agents
By: John Merlino

Chapter 15:
Appendices
Appendix 15.1
Factors Influencing Zone Size in Antibiotic Testing
Appendix 15.2
Troubleshooting Guide for Disc Diffusion Test in Antibiotic Susceptibility Testing
Appendix 15.3
Detection of Phenotype and Resistance Mechanisms using Disc Susceptibility Testing
Appendix 15.4
Summary of performance, Interpretative Criteria and Quality Control Ranges Using Etest for MIC Determination
Appendix 15.5
Etest Reading Guide
Appendix 15.6
Etest Media, Inoculum and Incubation Guide
Appendix 15.7
Direct Susceptibility from Specimens
Appendix 15.8
A summary check list when performing Quality Control Procedures in Antibiotic Susceptibility Testing
Pages