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Antimicrobial resistance.

Antimicrobial resistance. Conference Panel Summaries Timothy Naimi,* Pascal Ringwald,† Richard Besser,‡ and Sharon Thompson§ *Minnesota Department of Health, Minneapolis, Minnesota, USA; †World Health Organization, Geneva, Switzerland; ‡Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and §Food and Drug Administration, Rockville, Maryland, USA This symposium highlights selected topics in antimicro- Dr. Richard Besser discussed efforts to reduce bial resistance: community-acquired methicillin-resistant inappropriate antibiotic prescribing for outpatient respirato- Staphylococcus aureus, malaria, reducing inappropriate ry infections in the United States. Over 40% of outpatient antimicrobial drug prescribing for outpatient respiratory antibiotic prescriptions are for viral illnesses, which are not infections, and addressing the human health impact of affected by antibiotics. CDC’s educational campaign, targeted antimicrobial drug use in food animals. to clinicians and patients, involves partnerships with health Dr. Timothy Naimi discussed community-acquired departments, health-care delivery organizations, health-care methicillin-resistant Staphylococcus aureus (CMRSA) infec- purchasers, medical societies, and others. Materials and tions, which have been reported in the Western Pacific and information are available at www.cdc.gov/drugresistance. North America with increasing frequency. Few incidence data Controlled trials of interventions demonstrated notable are available, but reports show a disproportionate reductions in antibiotic prescriptions written in Denver, distribution among racial minorities and groups with low central Wisconsin, and rural Alaska. socioeconomic status. CMRSA infections resembled commu- Successful interventions were multifaceted and directed nity-acquired methicillin-susceptible S. aureus infections at both clinicians and patients. Clinician interventions more than MRSA infections acquired in health-care facilities. included peer education using opinion leaders, improving Patients with CMRSA were young, healthy, and lacked diagnosis of acute otitis media, and feedback on group- risk factors for MRSA (recent hospitalization, dialysis, and prescribing practice. Patient interventions included educa- injection drug use), and they had predominantly skin and soft tion in the community (day care centers, health fairs), homes tissue infections; four deaths due to invasive CMRSA (reminder refrigerator magnets), and physician offices (videos infections were reported in the United States. Unlike in waiting rooms). CDC is expanding this campaign and nosocomial MRSA, CMRSA is sensitive to multiple non-beta- seeking to assess its impact in larger areas. lactam antibiotics. CMRSA isolates have the mec A gene and Dr. Sharon Thompson described Food and Drug distinct pulsed-field-gel electrophoresis patterns. CMRSA Administration (FDA) initiatives to address the human presents a clinical challenge because most community- health impact of antimicrobial drug use in food animals. acquired S. aureus infections are diagnosed without taking a These initiatives include regulatory changes, antimicrobial culture, and the patient is treated with beta-lactam drugs. resistance monitoring, risk assessment, promoting judicious Improved surveillance and efforts to define risk factors are drug use, and research. FDA has concluded that past under way. regulations are no longer adequate to preserve important Dr. Pascal Ringwald reviewed antimalarial drug antimicrobial drugs for human use when their use in food resistance, which greatly hinders malaria control since no animals may contribute to antimicrobial resistance. A vaccine will be available in the near future. Resistance of proposed framework would classify antimicrobial agents Plasmodium falciparum to chloroquine, the most frequently according to their importance in human medicine and the used antimalarial drug, is found in nearly all malaria- likelihood that human exposure to them from consuming food endemic countries. Resistance also affects all other animals containing them would create more resistant antimalarial drugs; cross-resistance occurs against drugs in bacteria. Preapproval studies would assess resistance the same group. development and pathogen load in treated animals. Specified In recent years, chloroquine-resistant P. vivax has been thresholds of resistance in human and animal isolates would reported in Southeast Asia and in South America. Drug provide risk management tools—as these thresholds were resistance increases illness and death, especially among approached, drug use in animals could be restricted. children. As the number of new antimalarial agents is FDA is currently finalizing a risk assessment of limited, the use of drug combinations is under evaluation. fluoroquinolone-resistant Campylobacter infection and its WHO supports national malaria control programs to monitor relationship to fluoroquinolone use in poultry and is antimalarial drug resistance in sentinel sites. Decisions to beginning an assessment of quinupristin/dalfopristin- change drug policy should be based on the results of resistant Enterococcus faecium and its relationship to monitoring in these sites. The establishment of a new policy virginiamycin use as a growth promotant. Visit the FDA must entail a rational use of drugs and improved compliance. website at www.fda.gov. Address for correspondence: David Bell, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop C12, Atlanta, Georgia 30333, USA; fax: 404-639-4197; e-mail: dbell@cdc.gov Emerging Infectious Diseases Vol. 7, No. 3 Supplement, June 2001 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Emerging Infectious Diseases Pubmed Central

Antimicrobial resistance.

Emerging Infectious Diseases , Volume 7 (3 Suppl) – Sep 1, 167

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Pubmed Central
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1080-6040
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1080-6059
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Abstract

Conference Panel Summaries Timothy Naimi,* Pascal Ringwald,† Richard Besser,‡ and Sharon Thompson§ *Minnesota Department of Health, Minneapolis, Minnesota, USA; †World Health Organization, Geneva, Switzerland; ‡Centers for Disease Control and Prevention, Atlanta, Georgia, USA; and §Food and Drug Administration, Rockville, Maryland, USA This symposium highlights selected topics in antimicro- Dr. Richard Besser discussed efforts to reduce bial resistance: community-acquired methicillin-resistant inappropriate antibiotic prescribing for outpatient respirato- Staphylococcus aureus, malaria, reducing inappropriate ry infections in the United States. Over 40% of outpatient antimicrobial drug prescribing for outpatient respiratory antibiotic prescriptions are for viral illnesses, which are not infections, and addressing the human health impact of affected by antibiotics. CDC’s educational campaign, targeted antimicrobial drug use in food animals. to clinicians and patients, involves partnerships with health Dr. Timothy Naimi discussed community-acquired departments, health-care delivery organizations, health-care methicillin-resistant Staphylococcus aureus (CMRSA) infec- purchasers, medical societies, and others. Materials and tions, which have been reported in the Western Pacific and information are available at www.cdc.gov/drugresistance. North America with increasing frequency. Few incidence data Controlled trials of interventions demonstrated notable are available, but reports show a disproportionate reductions in antibiotic prescriptions written in Denver, distribution among racial minorities and groups with low central Wisconsin, and rural Alaska. socioeconomic status. CMRSA infections resembled commu- Successful interventions were multifaceted and directed nity-acquired methicillin-susceptible S. aureus infections at both clinicians and patients. Clinician interventions more than MRSA infections acquired in health-care facilities. included peer education using opinion leaders, improving Patients with CMRSA were young, healthy, and lacked diagnosis of acute otitis media, and feedback on group- risk factors for MRSA (recent hospitalization, dialysis, and prescribing practice. Patient interventions included educa- injection drug use), and they had predominantly skin and soft tion in the community (day care centers, health fairs), homes tissue infections; four deaths due to invasive CMRSA (reminder refrigerator magnets), and physician offices (videos infections were reported in the United States. Unlike in waiting rooms). CDC is expanding this campaign and nosocomial MRSA, CMRSA is sensitive to multiple non-beta- seeking to assess its impact in larger areas. lactam antibiotics. CMRSA isolates have the mec A gene and Dr. Sharon Thompson described Food and Drug distinct pulsed-field-gel electrophoresis patterns. CMRSA Administration (FDA) initiatives to address the human presents a clinical challenge because most community- health impact of antimicrobial drug use in food animals. acquired S. aureus infections are diagnosed without taking a These initiatives include regulatory changes, antimicrobial culture, and the patient is treated with beta-lactam drugs. resistance monitoring, risk assessment, promoting judicious Improved surveillance and efforts to define risk factors are drug use, and research. FDA has concluded that past under way. regulations are no longer adequate to preserve important Dr. Pascal Ringwald reviewed antimalarial drug antimicrobial drugs for human use when their use in food resistance, which greatly hinders malaria control since no animals may contribute to antimicrobial resistance. A vaccine will be available in the near future. Resistance of proposed framework would classify antimicrobial agents Plasmodium falciparum to chloroquine, the most frequently according to their importance in human medicine and the used antimalarial drug, is found in nearly all malaria- likelihood that human exposure to them from consuming food endemic countries. Resistance also affects all other animals containing them would create more resistant antimalarial drugs; cross-resistance occurs against drugs in bacteria. Preapproval studies would assess resistance the same group. development and pathogen load in treated animals. Specified In recent years, chloroquine-resistant P. vivax has been thresholds of resistance in human and animal isolates would reported in Southeast Asia and in South America. Drug provide risk management tools—as these thresholds were resistance increases illness and death, especially among approached, drug use in animals could be restricted. children. As the number of new antimalarial agents is FDA is currently finalizing a risk assessment of limited, the use of drug combinations is under evaluation. fluoroquinolone-resistant Campylobacter infection and its WHO supports national malaria control programs to monitor relationship to fluoroquinolone use in poultry and is antimalarial drug resistance in sentinel sites. Decisions to beginning an assessment of quinupristin/dalfopristin- change drug policy should be based on the results of resistant Enterococcus faecium and its relationship to monitoring in these sites. The establishment of a new policy virginiamycin use as a growth promotant. Visit the FDA must entail a rational use of drugs and improved compliance. website at www.fda.gov. Address for correspondence: David Bell, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop C12, Atlanta, Georgia 30333, USA; fax: 404-639-4197; e-mail: dbell@cdc.gov Emerging Infectious Diseases Vol. 7, No. 3 Supplement, June 2001

Journal

Emerging Infectious DiseasesPubmed Central

Published: Sep 1, 167

There are no references for this article.