WAAAR wins third Prize in European Union global competition of NGOs on AMR
On Feb.6, WAAAR President Jean Carlet attended the EU ceremony delivering the Prizes on AMR: the one for NGOs, and the Horizon Prize for discoveries from industry. Vytenis Andriukaitis, Commissioner for Health and Food Safety, awarded the EU Health Award for NGOs fighting Antimicrobial Resistance – a prize which aims to reward outstanding initiatives by NGOs which have significantly reduced the threat of antimicrobial resistance (AMR) to human health.
For 'best of' NGOs, we are happy to report that WAAAR won the Third Prize for its campaign for the "Preservation of Antibiotics".
Dr Jean Carlet campaigned and published in international scientific journals and conferences for many years on the subject of antibiotic resistance and the threat it posed to patients and medical practice. Then, in 2011, Dr Carlet endeavored to take the next step which was to create an NGO ACdeBMR, headquartered in Paris, combining patients groups and experts with physicians and scientific researchers. With The Paris Declaration, the group took on the name of WAAAR and arose as an international organisation with over 700 members and over a 100 scientific societies, endorsing the Paris Declaration.
The NGO ACdeBMR/WAAAR publishes a yearly publication for decision makers "AMR Control."
The first and second prizes on AMR went to NGOs engaged in consumer information vis à vis antibiotic resistance via the food chain: BEUC, the European Consumer Organisation, for their campaign "From Farm to You, and the second prize to the Alliance to save our Antibiotics, Compassion in World Farming and the Soil Association for their campaign to end the routine prophylactic mass-medication of farm animals.
More in our March edition. Below is a report on the Diagnostics Horizon prize selection by the EU
Australian think tank proposes a very challenging approach to AMR decision making
AMR in the context of "A framework for making implicit assumptions explicit when modelling risk and uncertainty." The newly published outcome of an Australian think tank seminar addresses AMR with a novative and challenging approach, of great interest for decision-makers.
An Interdisciplinary Approach to: Living In a Risky World Recommendations from the 2016 Theo Murphy High Flyers Think Tank. The challenge is well introduced by the Australian Academy of Science. "Risk is as much about opportunity as it is about avoiding bad things: uncertainty is as much a signpost towards new discovery and understanding as it is about simply not knowing. Carefully considering both can help us make decisions that will secure the best possible outcomes." Pr Andrew Holmes, President Australian Academy of Science. The task of the think tank seminar was notably to 'develop a better understanding of how uncertainty affects decision-making.'
In the chapter on AMR, the participants recommended interdisciplinary research, including socio-cultural and behavioural research, and noted that "A knowledge gap exists surrounding the impact of gene reservoirs in the environment and research is required to guide processes for waste management." and that "antimicrobial use should be incorporated into food labelling to support public awareness."
AMR-Times noted with great interest that the group called for "contributions from both scientists and decision-makers that describe how scientific uncertainty of all forms is considered within decision-making scenarios. Among the major tasks was to "facilitate improved communication of risk and uncertainty between scientists, decision-makers and the general public.
A set of guidelines for reporting risk and uncertainty could be co-created in these networks with an aim of reaching a common language that can be understood by all, irrespective of their background."
A table (figure one) lays out: A framework for making implicit assumptions explicit when modeling risk and uncertainty.
The report, while succinct, is truly appetite whettering after so many years where common 'scientific' publications hide rather than highlight the risks and uncertainties. The chapter on the environment notes that "There is great uncertainty regarding disruptive technologies (including but not limited to robotics, artificial intelligence, biotechnology, nanomaterials, 3D printing, ...).
The chapter on AMR notes that the drivers are 'multifaceted and interconnected': use and misuse of antimicrobials, exacerbated by inadequate governance and fragmented and siloed regulation around antimicrobial use.
AMR, bound to increase due to population growth and notably increase in food production, is a 'complex' decision making issue and 'a wicked problem', such that no single action in any single sector will be sufficient and any action will have unavoidable negative outcomes for one or more stakeholders. Accordingly, AMR must be treated as 'One Health' and "framing AMR in terms of risk can emphasise its One Health relevance.
The Australian think tank's recommendations suggest to the Australian authorities to open up to interdisciplinary research. It proposes to "Evaluate the impact of antimicrobials and resistance gene reservoirs in the wider environment" ... Since "Environmental 'hotspots' of AMR are suspected to play a major but largely unexplored role in the AMR challenge. AMR microorganisms and their genes are present and persistent in major environmental waste streams such as municipal wastewater (mixed household, hospital, industrial and commercial waste water). Antimicrobial residues are also present in these systems because they are only semi-metabolised in their human/animal recipients and incompletely removed in conventional waste treatment processes.
A genetic link between AMR and pollutant-associated genes for other chemical pollutants (e.g. heavy metal resistance) results in a complex interplay of selection and co-selection of AMR microorganisms in polluted environments that may increase the risk of transfer into human environments through direct contact or the food chain.
Much remain to be understood...
For the AMR chapter: Chair, Dr Deborah Williamson, Rapporteurs: Dr Maurizio Labbate, Dr Roìsìn McMahon
Web=link: https://www.science.org.au/files/userfiles/events/documents/think-tank-risk-recommendations.pdf
AMR in the News
The €1 million Horizon Prize of the European Union for AMR diagnostic tools
MINICARE HNL won the first prize for "a finger prick test that can diagnose in less than ten minutes a bacterial infection and identify if a patient can be treated safely without antibiotics. The easy-to-use test is expected to be available for patients by 2018. (P&M Venge AB from Sweden and PHILIPS Electronics). The two other finalists were: ImmunoPoc who developed a finger prick test that can differentiate between bacterial and viral infections within fifteen minutes and Pulmocheck with a device that reacts within 2-6 minutes to body fluids derived from a bacterial infection. Considering that the overuse and misuse of antibiotics is intimately linked with the low availability of diagnostic tools, the EU €1 million Horizon Prize was a welcomed initiative.
AMR-Times comments: we also hope that policymakers will support legislations and reimbursement mechanisms supporting physicians enhanced used of diagnostics, in an economic austerity framework situation in Europe, where proper diagnostic is often ignored or underfunded. And that an international effort will be mounted to render available diagnostics in low income countries, an urgent necessity. We were very interested to learn that: The Pulmocheck system uses "available fluids such as sputum, nasal secretion or swabs from the affected tissue and is considered minimally invasive." This a decisive advantage in view of the fact that all blood-based tests are more invasive in a world where infection prevention and control is lacking worldwide and proper equipment is often lacking.
Web-Links: https://ec.europa.eu/research/horizonprize/index.cfm?prize=better-use-antibiotics&pg=finalists
Cassandra Quave: Brazilian peppertree weed of use against MRSA, better than to fight the weed with glyphosates...!
Cassandra Quave, ethnobotanist, Assistant Professor at Emory University made headlines in research on Methicillin-resistant Staphylococcus aureus (MRSA) again, by finding that a common weed found in the Southern part of the USA, the Brazilian peppertree – used by traditional healers in the Amazon for hundreds of years – works against MRSA in mice.
Quave and her team found that their compound, which they are describing as a “quorum quencher,” contains a complex mix of plant chemicals that shut down the activity of a set of genes that direct cell communication.
The report in Nature's Scientific Reports says that: Brazilian peppertree "is included in the Brazilian Pharmacopoeia and has served as a staple in Brazilian traditional medicine for its anti-septic and anti-inflammatory qualities in the treatment of wounds and ulcers as well as for urinary and respiratory infections. Bark extracts have demonstrated antibacterial activity against several pathogens, including S. aureus, Pseudomonas aeruginosa, and Aspergillus species. Bark extracts were also found to be active against Pseudomonas aeruginosa and were effective against peritonitis when injected into the abdominal cavity of rats."
Quave et all write that "while many studies have focused on growth inhibitory, anti-inflammatory, and wound-healing properties of this plant, none have examined its potential as a source of anti-virulence drugs." Hence this is what the group researched and they found that extracts were efficient on quorum-sensing, disturbing the bacteria's communication system.
In conclusion: "Due to its long-standing use as a traditional medicine, a chemically complex preparation of the refined extract would be eligible for consideration of Food and Drug Administration (FDA) approval via the Botanical Drug Regulatory Pathway. These findings support the translational potential for products of this exotic pest plant, and could provide an alternative avenue for use of this natural resource in place of eradication efforts, which resort to toxic herbicides, including glyphosates. Thus, future research will also address alternative management and use strategies for this species as a wild-crafted medicinal plant and potential botanical ingredient in future anti-virulence therapies. "
National Geography writes: "Also known as Christmas berry for its brilliant fuchsia fruit and glossy green leaves, Schinus terebinthifolius can tower up to 30 feet. It colonizes land and water rapidly, and its branches grow so densely that it blocks light for other plants and for fish. It was imported, at first, to be grown for ornamental cuttings, but now it is so out of control that it is illegal to sell or move one in Florida. “It’s hated down there,” says Quave. “But in Brazil, there are accounts of it being used as a medication that goes back hundreds of years.” (...) In the peppertree’s fleshy fruit, Quave and her collaborators at Emory and the University of Iowa found a compound that has an unusual and valuable property. Instead of destroying bacteria—which most antibiotics do, and which most bacteria have evolved protections against—the extract prevents bacteria from talking to each other."
Cassandra Quave, an Emory University scientist who studies how indigenous people use plants in healing practices, said researchers pulled apart the chemical ingredients of the berries and tested them in mice infected with these superbug strains. The mice got injections containing the bacteria with or without the plant extracts. Those that didn't receive the extracts developed skin lesions. But in the other mice, the extracts -- a mixture of 27 chemicals -- prevented skin lesions from forming.
Web=links: http://www.nature.com/articles/srep42275
http://news.nationalgeographic.com/2017/02/superbugs-antibiotics-infections-weed-florida-peppertree-health-science/
https://www.washingtonpost.com/news/to-your-health/wp/2017/02/10/common-weed-could-help-fight-deadly-superbug-study-finds/ postshare=9661486764972368&tid=ss_tw&utm_term=.d1b4a37d8503
http://resistancecontrol.info/rd-innovation/antibiotics-from-nature-traditional-medicine-as-a-source-of-new-solutions-for-combating-antimicrobial-resistance/ (An overview on traditional medicine and AMR by Pr Quave in AMR CONTROL 2016)
AB stewardship in hospitals: decreases duration of AB treatment with better outcomes, says Cochrane
Authors' conclusions, "We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing the duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces the length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions." (...) Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation." The Cochrane authors conclude that "More research is required on unintended consequences of restrictive interventions."
AMR-Times comments: We think that indeed more comprehensive studies are needed in low-resource countries, notably with the added load of children with combined viral and bacterial infections, as pointed out by Pr Jacques Acar, in the case of measles (AMR-Times Interview)
Web=links: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003543.pub4/full
EN FRANCAIS http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003543.pub4/full
JPIAMR held a workshop in Paris this January, the topic was
Early discovery of new antibiotics
Web=link: http://www.jpiamr.eu/wp-content/uploads/2017/01/JPIAMR_-PARIS-Workshop_Agenda.pdf
Elections are coming up at the WHO
Three candidates were selected by the Executive Board of the WHO two weeks ago, and the finalist will come out of a vote at the May World Health Assembly (one country one vote for the first time). The three top choices are: David Nabarro (UK), Tedros Adhanom Ghebreyesus (Ethiopia) and Sania Nishtar (Pakistan)
AMR Times had the opportunity to know both Nabarro, since his early years with Gro Harlem Bruntland, and Sania Dishtar, (for her NGO leadership in Heartfile).
We've sent questions to all three and are (hoping) for responses.
Elections are also coming up end of February for the Global Fund, the GFATM
The three candidates for the post of director are: Dr. Muhammad Ali Pate, former health minister of Nigeria; Subhanu Saxena, a former drug companies executive and Helen Clark, formerly running the United Nations Development Program. Their website announces that: The Global Fund’s next Executive Director will oversee and guide the implementation of the 2017-2022 Strategy, “Investing to End Epidemics,” a title we find very political, typical marketing agency slogan.
Note: At the present time HIV infection rates are rising, the tuberculosis pandemic is nowhere near in sight (latest figures show 2 million more cases than previously published in India) and malaria certainly not an epidemic of the past, and all three are increasingly drug resistant.
Now and more in the coming years, AMR will be a major burden on the GFATM: rise in resistance to antiretroviral drugs to treat HIV (17% of new HIV infections in the South African Republic), often related to : PLWAs patients difficulties in sticking to treatment because of terrible side effects (insufficiently publicized as many lay people believe that 'cures' now exist for HIV), because of insufficient procurement capacities and health centers capacities: very frequent breaks in ARV supplies in many countries on the African continent, as well as lackadisiac attention to infection prevention and control in health care systems worldwide: which means an acceleration of ARV-resistant HIV transmission to naive patients. A real concern with drug-resistant tuberculosis, finally the UN has listened to the South African minister's plea for high level action against this main killer: ordinary TB which can be well treated before it becomes drug resistant, and a Ministerial meeting will also take place in Moscow next November (announced by Russia at the WHO EB this January, in the context of the discussion on AMR). We can remember Stephen Lewis at last summer international AIDS conference in Durban: "However, stunned turned out to be as nothing when I received, this morning, a copy of UNAIDS latest report, just released, titled “90-90-90: On the Right Track Towards the Global Target”. In 54 pages of text, TB is mentioned three times, entirely in passing, as though it were utterly inconsequential. I verged on cardiac arrest. What was I missing? Isn’t it accepted knowledge, everywhere, that you can’t get to 90-90-90 without defeating tuberculosis?"
Web=link: http://www.aidspan.org/node/4094?pk_campaign=email-attrib-Word-PDF-download&pk_kwd=gfo-issue-305&utm_source=IHP+Newsletter&utm_campaign=9936be39db-
EMAIL_CAMPAIGN_2017_02_17&utm_medium=email&utm_term=0_14504ce43d-9936be39db-298053621
Stephen Lewis at last summer's AIDS conference: http://www.aidsfreeworld.org/Publications-Multimedia/Speeches/Stephen-Lewis-at-TB-2016.aspx
Laurie Garrett on the future of the WHO
In a column on global health financing, Laurie highlights that in her opinion:
"Powerful Republicans in the U.S. House of Representatives and officials in the American Chemistry Council (ACC)—the powerful organization representing the likes of Dow Chemical, Monsanto, and Dupont—are already setting their sights on WHO. The manufacturers are more than a little angry with WHO and its International Agency for Research on Cancer (IARC), which designates carcinogens. IARC routinely issues monographs that designate such things as pesticides, food coloring, herbicides, and other chemical products with various risk levels. Chemical manufacturers do not like seeing their products labeled “human carcinogens” and want the IARC either reformed or destroyed. In 2011, the IARC declared cell phones a potential source of brain cancer, creating a firestorm of criticism, though the U.S. National Cancer Institute lent quiet support to IARC’s concern about radio frequency radiation and neurological disorders. The FDA filed IARC’s concerns in its registry but took no action against the phone industry. For its part, WHO released, retracted, and rereleased statements in a manner that seemed to invite scrutiny and undermine credibility.
The ACC has powerful friends in Congress who vow to hold hearings soon to interrogate the credibility of WHO. The UN agency is vulnerable, in part because IARC operates out of Lyon in a semi-autonomous fashion not directly under the DG’s control. And because Chan is leading an organization that is battling its own demons in Geneva and regional offices...."
Web=link: http://www.cfr.org/about/newsletters/archive/newsletter/n4308
AMR at the EB 140 Jan 2017
The EU group declaration on AMR at the EB140
"In 2016 we formally acknowledged the aim of the global action plan to develop national plans, with the adoption of EU council conclusions that all EU Member States strive to meet the deadline. Moreover, the EU and its Members States have initiated a Joint Action on antimicrobial resistance and healthcare-associated infection that will support the development and review of national action plans including use of the self-assessment tool."
Colistin-resistant E. coli carrying MCR-1 reported in Brazilian chicken meat
MCR-1-carrying Ecoli found in chicken meat in Brazil, the world's second producer: "A new study in Antimicrobial Agents and Chemotherapy reports that colistin-resistant Escherichia coli isolates carrying the MCR-1 gene have been identified in commercial chicken meat in Brazil.
As part of a local investigation into the presence of colistin-resistant bacteria, researchers collected 41 chicken samples from markets in Sao Paulo and tested them for susceptibility to polymixin B and colistin and for the presence of the MCR-1 gene, which confers resistance to the last-resort antibiotic. They found eight clonally unrelated colistin-resistant E coli isolates carrying MCR-1.
The authors report that most of the E coli isolates exhibited a multidrug-resistant phenotype and carried additional genes conferring resistance to aminoglycosides, quinolones, sulphonamide, and tetracyclines. In addition, they found the presence of IncX4-type plasmids, which have been implicated in the global dissemination of the gene, in five of the isolates. (...)
"In summary, these results highlight that commercial chicken meat can be an important reservoir of mcr-1-carrying E coli, which is a cause for public health concern, since this could contribute to the acceleration of the spread of the mcr-1 gene," the authors write.
Brazil has become the world’s second largest producer, according to data from the United States Department of Agriculture (USDA), cited by the Brazilian Association of Animal Protein (ABPA) Feb 1rst. Brazilian poultry producers last year produced 13.146 million tons of chicken meat, an annual increase of 3.58 percent, while China, according to the USDA, produced 13.025 million tons.
Backgrounds on Colistin in humans and animals: Reminder in April 2016 : "Silent dissemination of colistin-resistant Escherichia coli in South America could contribute to the global spread of the mcr-1 gene." During a Brazilian multicentric antimicrobial resistance surveillance study, colistin resistance was investigated in 4,620 Enterobacteriaceae isolated from human, animal, food and environmental samples collected from 2000 to 2016. (...) mcr-1 positive Escherichia coli has been emerging in South America since at least 2012, supporting a previous report on the possible acquisition of mcr-1 harbouring E. Coli by European travellers visiting Latin American countries.
And the European Medicine Agency (EMA) 2016 report on Europe: The more frequent isolation of the mcr-1 gene in veterinary isolates compared to human isolates up until the present time, together with the much higher use of colistin in livestock compared to human medicine and the finding of the mcr-1 gene, along with genetic determinants typically seen in animal environments, has been considered suggestive of a flow from animals to humans.
The report further noted that: There is a wide variation between European Union (EU) Member States (MS) in the extent of veterinary use of colistin. From the data available the variation cannot be directly linked to the predominance of specific animal species, a category or husbandry system in an individual MS, with some MS having a low level or no use of the substance, suggesting that there is scope to decrease the overall use of colistin within the EU. There are wide variations in the use of colistin adjusted for the biomass under exposure (kg livestock, expressed as population correction unit (PCU) between countries and these are largely unexplained. Countries with intensive livestock production can have a level of usage below 1 mg/PCU (e.g. Denmark and the UK) or much higher, up to 20 to 25 mg/PCU (Italy and Spain). Considering the rapidly increasing importance of colistin for treatment of critically ill human patients, all countries should strive to reduce the use of polymyxins as much as possible. For the current "high and moderate consumers" the target and desirable levels are set at 5 mg/PCU and 1 or below 1 mg/PCU, respectively, based on the observations on the level of use in other countries. Meanwhile, more information should be gathered to determine the minimum level of colistin use that can be achieved while maintaining animal welfare and preventing the increased use of other Critically Important Antimicrobials(CIAs).
Web=links: http://www.ema.europa.eu/docs/en_GB/document_library/Scientific_guideline/2016/07/WC500211080.pdf
http://www.eurosurveillance.org/images/dynamic/EE/V21N17/art22458.pdf
Doctors prescribe more antibiotics when they expect the patients 'want' them...
A study published by the American Psychological Association (and commented in the Science Daily)
AMR-Times comments: Doctors often look down on patients, feel superior, but say they were 'influenced' when caught in bad behavior...!
Web=links: https://www.sciencedaily.com/releases/2017/02/170216103910.htm
EU Consultation on AMR from 27 January 2017 to 28 April 2017
Open Public Consultation on possible activities under a 'Commission Communication on a One Health Action Plan to support Member States in the fights against Antimicrobial Resistance (AMR)'
All citizens, administrations, associations and other organisations with an interest in animal and human health policy, animal health, public health, healthcare and/or the environment in Europe are welcome to contribute to this consultation.
Web=links: http://ec.europa.eu/dgs/health_food-safety/amr/consultations/consultation_20170123_amr-new-action-plan_en.htm
ECMID reports on Sepsis Excellence Award
Sepsis expert Thierry Calanda receives the 2017 Excellence Award. Thierry Calandra, professor of medicine and head of the Infectious Diseases Service at the Centre Hospitalier Universitaire Vaudois (CHUV) in Lausanne, Switzerland, is the winner of the 2017 ESCMID Excellence Award. Calandra will hold his keynote lecture Sepsis: making progress, but not yet there! at ECCMID 2017 on Sunday, 23 April 2017 at 14:30 (see agenda)
