scholarly journals Impact of existing vaccines in reducing antibiotic resistance: Primary and secondary effects

2018 ◽  
Vol 115 (51) ◽  
pp. 12896-12901 ◽  
Author(s):  
Keith P. Klugman ◽  
Steven Black
Keyword(s):  
Antibiotic Resistance ◽  
Influenza Vaccination ◽  
Direct Reduction ◽  
Antibiotic Use ◽  
The United States ◽  
Antibiotic Usage ◽  
Secondary Effect ◽  
Antibiotic Resistant ◽  
Vaccination Programs ◽  
The Impact

Vaccines impact antibiotic-resistant infections in two ways: through a direct reduction in the organisms and strains carrying resistant genes that are specifically targeted by the vaccine and also via a secondary effect through a reduction in febrile illnesses that often lead to the use of antibiotics. We review here the impact of pneumococcal conjugate vaccines (PCVs) on the prevalence of antibiotic-resistant disease and antibiotic usage as an example of the direct effect of vaccines on antibiotic resistance and the impact of influenza vaccination on antibiotic usage as an example of a secondary effect. A prelicensure study of a PCV in Africa demonstrated 67% fewer penicillin-resistant invasive disease episodes in the PCV group compared with controls. Similar studies in the United States and Europe demonstrated reductions in antibiotic use consistent with the vaccines’ impact on the risk of otitis media infections in children. Postlicensure reductions in the circulation of antibiotic-resistant strains targeted by the vaccines have been dramatic, with virtual elimination of these strains in children following vaccine introduction. In terms of a secondary effect, following influenza vaccination reductions of 13–50% have been observed in the use of antibiotics by individuals receiving influenza vaccine compared with controls. With the demonstrated effectiveness of vaccination programs in impacting the risk of antibiotic-resistant infections and the increasing threat to public health that these infections represent, more attention needs to be given to development and utilization of vaccines to address antibiotic resistance.

scholarly journals 2742. The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S965-S966
Author(s):  
Eili Klein ◽  
Emily Schueller ◽  
Katie K Tseng ◽  
Arindam Nandi
Keyword(s):  
United States ◽  
Antibiotic Resistance ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Seasonal Influenza ◽  
Antibiotic Use ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Coverage Rates ◽  
The Impact

Abstract Background Antibiotic resistance is a cause of morbidity and mortality driven by inappropriate prescribing. In the United States, a third of all outpatient antibiotic prescriptions may be inappropriate. Seasonal influenza rates are significantly associated with antibiotic prescribing rates. The impact of influenza vaccination coverage on antibiotic prescribing is unknown. Methods We conducted a retrospective analysis of state-level vaccination coverage and antibiotic prescribing rates from 2010 to 2017. We used fixed effects regression to analyze the relationship between cumulative vaccine coverage rates for a season and the per capita number of prescriptions for systemic antibiotics for the corresponding season (January–March) controlling for temperature, poverty, healthcare infrastructure, population structure, and vaccine effectiveness. Results Rates of vaccination coverage ranged from 33% in Nevada to 52% in Rhode Island for the 2016–2017 season, while antibiotic use rates ranged from 25 prescriptions per 1,000 inhabitants in Alaska to 377 prescriptions per 1,000 inhabitants in West Virginia (Figure 1). Vaccination coverage rates were highly correlated with reduced prescribing rates, and controlling for other factors, we found that a one percent increase in the influenza vaccination rate was associated with 1.40 (95% CI: 2.22–0.57, P < 0.01) fewer antibiotic prescriptions per 1,000 inhabitants (Table 1). Increases in the vaccination coverage rate in the pediatric population (aged 0–18) had the strongest effect, followed by the elderly (aged 65+). Conclusion Vaccination can reduce morbidity and mortality from seasonal influenza. Though coverage rates are far below levels necessary to generate herd immunity, we found that higher coverage rates in a state were associated with lower antibiotic prescribing rates. While the effectiveness of the vaccine varies from year to year and the factors that drive antibiotic prescribing rates are multi-factorial, these results suggest that increased vaccination coverage for influenza would have significant benefit in terms of reducing antibiotic overuse and correspondingly antibiotic resistance. Disclosures All authors: No reported disclosures.

scholarly journals Estimating the proportion of bystander selection for antibiotic resistance among potentially pathogenic bacterial flora

2018 ◽  
Vol 115 (51) ◽  
pp. E11988-E11995 ◽  
Author(s):  
Christine Tedijanto ◽  
Scott W. Olesen ◽  
Yonatan H. Grad ◽  
Marc Lipsitch
Keyword(s):  
Antibiotic Resistance ◽  
Medical Care ◽  
Bacterial Species ◽  
Bacterial Flora ◽  
The United States ◽  
Vaccination Programs ◽  
Care Survey ◽  
Selection For ◽  
Ambulatory Medical Care ◽  
The Impact

Bystander selection—the selective pressure for resistance exerted by antibiotics on microbes that are not the target pathogen of treatment—is critical to understanding the total impact of broad-spectrum antibiotic use on pathogenic bacterial species that are often carried asymptomatically. However, to our knowledge, this effect has never been quantified. We quantify bystander selection for resistance for a range of clinically relevant antibiotic–species pairs as the proportion of all antibiotic exposures received by a species for conditions in which that species was not the causative pathogen (“proportion of bystander exposures”). Data sources include the 2010–2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, the Human Microbiome Project, and additional carriage and etiological data from existing literature. For outpatient prescribing in the United States, we find that this proportion over all included antibiotic classes is over 80% for eight of nine organisms of interest. Low proportions of bystander exposure are often associated with infrequent bacterial carriage or concentrated prescribing of a particular antibiotic for conditions caused by the species of interest. Applying our results, we roughly estimate that pneumococcal conjugate vaccination programs result in nearly the same proportional reduction in total antibiotic exposures of Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli, despite the latter two organisms not being targeted by the vaccine. These results underscore the importance of considering antibiotic exposures of bystanders, in addition to the target pathogen, in measuring the impact of antibiotic resistance interventions.

scholarly journals Competition and diversity determine vaccine impact on antibiotic resistance evolution

2019 ◽  
Author(s):  
Nicholas G. Davies ◽  
Stefan Flasche ◽  
Mark Jit ◽  
Katherine E. Atkins
Keyword(s):  
Antibiotic Resistance ◽  
Pneumococcal Vaccination ◽  
Antibiotic Use ◽  
Relative Strength ◽  
Antibiotic Resistant ◽  
Resistance Evolution ◽  
Pneumococcal Carriage ◽  
Bacterial Transmission ◽  
Vaccine Impact ◽  
The Impact

Bacterial vaccines can protect recipients from contracting potentially antibiotic-resistant infections. But by altering the selective balance between sensitive and resistant strains, vaccines may also help suppress—or spread—antibiotic resistance among unvaccinated individuals. Predicting the outcome requires knowing the drivers of resistance evolution. Using mathematical modelling, we identify competition and diversity as key mediators of resistance evolution. Specifically, we show that the frequency of penicillin resistance in Streptococcus pneumoniae (pneumococcus) across 27 European countries can be explained by between-host diversity in antibiotic use, heritable diversity in pneumococcal carriage duration, or within-host competition. We use our calibrated model to predict the impact of universal pneumococcal vaccination upon the prevalence of carriage, incidence of disease, and frequency of resistance for S. pneumoniae. The relative strength and directionality of competition between resistant and sensitive pneumococcal strains determines whether vaccination promotes, inhibits, or has little effect on the evolution of antibiotic resistance. Finally, we find that differences in overall bacterial transmission and carriage alter predictions, suggesting that evidence-based policies for managing resistance with vaccines must be tailored to both pathogen and setting.One sentence summaryCompetition and diversity are key to antibiotic resistance evolution and determine whether vaccines will prevent or increase resistant infections.

scholarly journals 2062. Improving Antibiotic Prescribing in the Ambulatory Care Setting—Stewardship through Influenza Vaccination, US Flu VE Network 2013–2014 Through 2017–2018

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S695-S695
Author(s):  
Emily Smith ◽  
Alicia M. Fry ◽  
Lauri Hicks ◽  
Katherine E Fleming-Dutra ◽  
Emily T Martin ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Vaccine Coverage ◽  
Improve Patient Safety ◽  
Respiratory Illness ◽  
Antibiotic Use ◽  
The United States ◽  
Antibiotic Prescribing ◽  
Ambulatory Care Setting

Abstract Background Improving antibiotic use is a key strategy to combat antibiotic resistance and improve patient safety. Acute respiratory illness (ARI) is a common cause of outpatient visits and accounts for ~41% of antibiotics used in the United States. We sought to determine the proportion of antibiotic prescriptions (Rx) prescribed among outpatients with ARI that can be potentially averted through influenza vaccination. Methods From 2013–2014 through 2017–2018 influenza seasons, we enrolled patients aged ≥6 months with ARI in the US Influenza Vaccine Effectiveness (VE) Network of >50 outpatient clinics. Antibiotic Rx and diagnosis codes were collected from medical records. Study influenza test results were not available to treating clinicians at most sites, and clinical influenza testing was infrequently performed (a), prevalence of influenza among unvaccinated ARI patients (b), prevalence of antibiotic Rx among unvaccinated influenza-positive ARI patients (c) and prevalence of antibiotic Rx among ARI patients overall (d), we derived estimates of the proportion of ARI antibiotic Rx that can be averted by influenza vaccination [(a × b × c)/d]. Results Among 37487 outpatients with ARI, 13,316 (36%) were prescribed an antibiotic and 9,689 (26%) tested positive for influenza. Of those positive, 2,496 (26%) were prescribed an antibiotic. Adjusted VE against influenza-associated ARI was 35% (95% confidence interval (CI), 32 to 39). Among unvaccinated patients with ARI, 30% were influenza-positive and 24% received antibiotics. Based on these estimates, we determined that influenza vaccination may prevent 10.6% of all ARI syndromes and may avert 1 in 14 or 7.3% of antibiotic Rx among ARI patients. Conclusion By preventing influenza-associated ARI syndromes, influenza vaccination may substantially reduce antibiotic prescribing. Increasing influenza vaccine coverage and improving protection may facilitate national goals to improve antibiotic use and reduce the global threat of antibiotic resistance. Disclosures All authors: No reported disclosures.

scholarly journals Estimating the proportion of bystander selection for antibiotic resistance in the US

2018 ◽  
Author(s):  
Christine Tedijanto ◽  
Scott Olesen ◽  
Yonatan Grad ◽  
Marc Lipsitch
Keyword(s):  
Antibiotic Resistance ◽  
Medical Care ◽  
Antibiotic Use ◽  
The United States ◽  
Microbial Flora ◽  
Antibiotic Prescribing ◽  
Care Survey ◽  
Selection For ◽  
Ambulatory Medical Care ◽  
The Impact

AbstractBystander selection -- the selective pressures exerted by antibiotics on microbial flora that are not the target pathogen of treatment -- is critical to understanding the total impact of broad-spectrum antibiotic use; however, to our knowledge, this effect has never been quantified. Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS), the Human Microbiome Project, and additional carriage and etiological data from existing literature, we estimate the magnitude of bystander selection for a range of clinically relevant antibiotic-species pairs as the proportion of all exposures of an antibiotic experienced by a species for conditions in which that species was not the causative pathogen (“proportion of bystander exposures”). For outpatient prescribing in the United States, we find that this proportion over all included antibiotics is over 80% for 8 out of 9 organisms of interest. Low proportions of bystander exposure are often associated with infrequent bacterial carriage or a high proportion of antibiotic prescribing focused on conditions caused by the species of interest. Using the proportion of bystander exposures, we roughly estimate that S. aureus and E. coli may benefit from 90.7% and 99.7%, respectively, of the estimated reduction in antibiotic use due to pneumococcal conjugate vaccination, despite not being the pathogen targeted by the vaccine. These results underscore the importance of considering antibiotic exposures to bystanders, in addition to the targeted pathogen, in measuring the impact of antibiotic resistance interventions.Significance StatementThe forces that contribute to changing population prevalence of antibiotic resistance are not well understood. Bystander selection -- the inadvertent pressures imposed by antibiotics on the microbial flora other than the pathogen targeted by treatment -- is hypothesized to be a major factor in the propagation of antibiotic resistance, but its extent has not been characterized. We estimate the proportion of bystander exposures across a range of antibiotics and organisms and describe factors driving variability of these proportions. Impact estimates for antibiotic resistance interventions, including vaccination, are often limited to effects on a target pathogen. However, the reduction of antibiotic treatment for illnesses caused by the target pathogen may have the broader potential to decrease bystander selection pressures for resistance on many other organisms.

scholarly journals Reducing Antibiotic Use in Ambulatory Care Through Influenza Vaccination

2020 ◽  
Vol 71 (11) ◽  
pp. e726-e734
Author(s):  
Emily R Smith ◽  
Alicia M Fry ◽  
Lauri A Hicks ◽  
Katherine E Fleming-Dutra ◽  
Brendan Flannery ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Influenza Vaccination ◽  
Clinical Decision Making ◽  
Respiratory Illness ◽  
Clinical Decision ◽  
Antibiotic Use ◽  
The United States ◽  
Diagnostic Code ◽  
Upper Respiratory Tract ◽  
Global Threat

Abstract Background Improving appropriate antibiotic use is crucial for combating antibiotic resistance and unnecessary adverse drug reactions. Acute respiratory illness (ARI) commonly causes outpatient visits and accounts for ~41% of antibiotics used in the United States. We examined the influence of influenza vaccination on reducing antibiotic prescriptions among outpatients with ARI. Methods We enrolled outpatients aged ≥6 months with ARI from 50–60 US clinics during 5 winters (2013–2018) and tested for influenza with RT-PCR; results were unavailable for clinical decision making and clinical influenza testing was infrequent. We collected antibiotic prescriptions and diagnosis codes for ARI syndromes. We calculated vaccine effectiveness (VE) by comparing vaccination odds among influenza-positive cases with test-negative controls. We estimated ARI visits and antibiotic prescriptions averted by influenza vaccination using estimates of VE, coverage, and prevalence of antibiotic prescriptions and influenza. Results Among 37 487 ARI outpatients, 9659 (26%) were influenza positive. Overall, 36% of ARI and 26% of influenza-positive patients were prescribed antibiotics. The top 3 prevalent ARI syndromes included: viral upper respiratory tract infection (47%), pharyngitis (18%), and allergy or asthma (11%). Among patients testing positive for influenza, 77% did not receive an ICD-CM diagnostic code for influenza. Overall, VE against influenza-associated ARI was 35% (95% CI, 32–39%). Vaccination prevented 5.6% of all ARI syndromes, ranging from 2.8% (sinusitis) to 11% (clinical influenza). Influenza vaccination averted 1 in 25 (3.8%; 95% CI, 3.6–4.1%) antibiotic prescriptions among ARI outpatients during influenza seasons. Conclusions Vaccination and accurate influenza diagnosis may curb unnecessary antibiotic use and reduce the global threat of antibiotic resistance.

The Future of Antibiotics and Meat

2016 ◽  
pp. 178-200 ◽  
Author(s):  
Talia Raphaely ◽  
Dora Marinova ◽  
Mira Marinova
Keyword(s):  
Antibiotic Resistance ◽  
Food Chain ◽  
Animal Husbandry ◽  
Meat Consumption ◽  
Antibiotic Use ◽  
Meat Production ◽  
Livestock Industry ◽  
Antibiotic Resistant ◽  
New Challenges ◽  
Food Animals

This chapter discusses antibiotic use in the livestock industry and potential ramifications for human health. Antibiotics are routinely administered to food animals, primarily at sub-therapeutic levels. The extensive use of antibiotics in global animal husbandry in quantities greater than used for humans is creating antibiotic resistance. There is evidence that antibiotic resistant organisms emerging in food animals transfer to humans through the food chain, environmental contamination, direct association with animals or through mobile resistant genetic elements resulting in co-resistance to other antibiotics. No new classes of antibiotics have been developed since the 1980s. Intensifying use of existing antibiotics for meat production poses new challenges for treating humans, needs to be taken seriously and dealt with urgently. This chapter argues that reduced meat consumption is an under-considered but essential part in any suite of solutions aimed at preserving the use of antibiotics for human treatment.

scholarly journals Estimating the Number of Agricultural Fatal Injuries Prevented by Agricultural Engineering Developments in the United States

Safety ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. 63
Author(s):  
Salah F. Issa ◽  
Kiana Patrick ◽  
Steven Thomson ◽  
Bradley Rein
Keyword(s):  
United States ◽  
Direct Reduction ◽  
Demographic Data ◽  
The United States ◽  
Current Status ◽  
United States Bureau ◽  
Agricultural Engineering ◽  
Agricultural Safety ◽  
The Impact ◽  
Fatal Injuries

Agriculture has been consistently marked as one of the deadliest industries by the United States Bureau of Labor Statistics (BLS). While this statistic is widely used in promoting agricultural safety and health, it does not paint a complete picture on the current status of agricultural safety and the advances that have been made in the last century. For example, even with a stagnant rate of injury, the BLS has reported that fatal incidents decreased from a high of 855 incidents in 1993 to a low of 500 incidents in 2013. The purpose of this study was to analyze the impact that agricultural engineering developments had on reducing fatal injuries. Agricultural engineering developments are defined as any agricultural improvement that results in a direct reduction in the amount of labor needed. This study uses existing federal agricultural statistical, injury and demographic data to calculate the impact that engineering, in contrast to yield improvements and safety enhancements, contributed to a reduction in the number of fatal incidents. The study found that engineering developments could have contributed to the reduction in the number of fatal injuries by about 170 incidents from 1992 to 2015. This represents 63% of the total reduction in the number of fatal injuries. In conclusion, agricultural engineering developments play a substantial role in reducing the number of fatal incidents by removing and reducing labor exposure to hazardous environments.

scholarly journals Comparison of different approaches to antibiotic restriction in food-producing animals: stratified results from a systematic review and meta-analysis

2019 ◽  
Vol 4 (4) ◽  
pp. e001710 ◽  
Author(s):  
Karen L Tang ◽  
Niamh P Caffrey ◽  
Diego B Nóbrega ◽  
Susan C Cork ◽  
Paul E Ronksley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Antibiotic Resistance ◽  
Meta Analysis ◽  
Antibiotic Use ◽  
Growth Promoter ◽  
Antibiotic Resistant ◽  
Random Effects Models ◽  
Differential Effectiveness ◽  
Different Types ◽  
Meta Analyses

BackgroundWe have previously reported, in a systematic review of 181 studies, that restriction of antibiotic use in food-producing animals is associated with a reduction in antibiotic-resistant bacterial isolates. While informative, that report did not concretely specify whether different types of restriction are associated with differential effectiveness in reducing resistance. We undertook a sub-analysis of the systematic review to address this question.MethodsWe created a classification scheme of different approaches to antibiotic restriction: (1) complete restriction; (2) single antibiotic-class restriction; (3) single antibiotic restriction; (4) all non-therapeutic use restriction; (5) growth promoter and prophylaxis restriction; (6) growth promoter restriction and (7) other/undetermined. All studies in the original systematic review that were amenable to meta-analysis were included into this substudy and coded by intervention type. Meta-analyses were conducted using random effects models, stratified by intervention type.ResultsA total of 127 studies were included. The most frequently studied intervention type was complete restriction (n=51), followed by restriction of non-therapeutic (n=33) and growth promoter (n=19) indications. None examined growth promoter and prophylaxis restrictions together. Three and seven studies examined single antibiotic-class and single antibiotic restrictions, respectively; these two intervention types were not significantly associated with reductions in antibiotic resistance. Though complete restrictions were associated with a 15% reduction in antibiotic resistance, less prohibitive approaches also demonstrated reduction in antibiotic resistance of 9%–30%.ConclusionBroad interventions that restrict global antibiotic use appear to be more effective in reducing antibiotic resistance compared with restrictions that narrowly target one specific antibiotic or antibiotic class. Importantly, interventions that allow for therapeutic antibiotic use appear similarly effective compared with those that restrict all uses of antibiotics, suggesting that complete bans are not necessary. These findings directly inform the creation of specific policies to restrict antibiotic use in food-producing animals.

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