Inside Track: The White House Hosts a Forum

Antibiotic stewardship gets support in a top-level venue

At the beginning of June, the Obama Administration convened a special “White House Forum on Antibiotic Stewardship” as part of the administration’s ongoing effort to combat antibiotic resistance. The event brought together key human and animal health constituencies involved in antibiotic stewardship—the development, promotion, and implementation of activities to ensure the responsible use of antibiotics—and highlighted commitments from more than 150 food companies, retailers, and human and animal health stakeholders to implement changes over the next 5 years to slow the emergence of resistant bacteria and prevent the spread of resistant infections.

The forum was the latest among a number of activities the administration has undertaken to combat antibiotic resistance. In September 2014, President Obama signed an executive order prioritizing federal efforts to combat the rise in antibiotic-resistant bacteria. The administration also issued the National Strategy on Combating Antibiotic-Resistant Bacteria, and the President’s Council of Advisors on Science and Technology released a report with recommendations to address the crisis of the proliferation of antibiotic-resistant bacterial infections. In March 2015, the administration released the National Action Plan for Combating Antibiotic-Resistant Bacteria, a comprehensive plan that identifies critical actions for key federal departments and agencies to enhance diagnosis and treatment and limit the spread of antibiotic-resistant bacteria. In addition, the president’s FY 2016 budget proposed nearly doubling the amount of federal funding for combating and preventing antibiotic resistance to more than $1.2 billion.

Among the diagnostics-related initiatives announced at the forum, the Department of Health and Human Services released a request for input from the medical and scientific communities, industry, and the public on the parameters of the diagnostic tests that should be eligible for the $20 million prize competition previously announced by the department. The prize is to be awarded for the development of an in vitro diagnostic test for healthcare providers to use at the point of care to rapidly and effectively identify bacterial infections.

COMMITMENTS

A White House fact sheet about the forum ended with a call to action, noting that “there is more work to be done to strengthen nationwide antibiotic stewardship programs and tracking of antibiotic use, get faster and better tests to better tailor treatment, and understand the drivers of antibiotic resistance. Combating antibiotic resistance and improving antibiotic use requires commitments across a variety of sectors and disciplines.”

Following are some of the key commitments made by IVD manufacturers and other organizations in the clinical laboratory community, for antibiotic stewardship activities to be conducted over the coming 5 years.

• Accelerate Diagnostics will sponsor studies on the role of rapid diagnostics and early antimicrobial deescalation in hospitals, and will pursue the development and regulatory clearance of rapid diagnostic tests.

• AdvaMedDx will develop educational materials on the role of diagnostic tests in fighting antibiotic resistance; develop collaborative efforts to disseminate the materials to hospitals, clinicians, and public health professionals; and organize a Capitol Hill briefing to educate policymakers on how diagnostic tests fight antibiotic resistance.

• Alere will highlight the critical role that diagnostics play in effective antibiotic stewardship; publicly release educational materials on the use of rapid diagnostics in antimicrobial stewardship, including continuing medical education accredited webinars; and complete a study on the acceptability, feasibility, barriers, and challenges to use of specific, new, point-of-care tests in United States primary care settings.

• The American Society for Microbiology will promote comprehensive antimicrobial stewardship and clinical decision support for infected patients.

• BD Diagnostics will develop a test to rapidly detect carbapenem-resistant Enterobacteriaceae, deploy new antibiotic susceptibility testing platforms, support efforts to identify healthcare-associated infections (HAIs) through surrogate markers, and pioneer new ways to examine and reduce the risks of HAIs.

• BioMérieux will produce a real-time antibiotic surveillance system; collaborate to ensure next-generation sequence-based typing of pathogens to track patterns; create additional high-medical-value multiplex assays combining host resistance markers, pathogen detection, and antimicrobial resistance markers; and validate biomarkers that can differentiate bacterial from viral infections.

• CareFusion will develop electronic and clinical decision support tools to extend antimicrobial stewardship, expand the number of hospitals reporting antimicrobial use data to CDC, provide an electronic and interactive antimicrobial resistance map, and develop a pandemic sentinel system for persons monitored by public health.

• Cepheid is committed to developing and marketing products to optimize antimicrobial use in patients with gram-negative sepsis, ventilator-associated pneumonia, multiple types of multidrug-resistant bacterial infections, acute bacterial gastroenteritis, and bacterial vaginosis. The company will also work with academic, industry, and government partners to develop sound public policy regarding the promotion of antimicrobial stewardship programs.

• The Infectious Diseases Society of America will continue collaborations with CDC in support of antibiotic stewardship, and will promote research, development, and appropriate use of diagnostics to guide stewardship.

• OpGen will use rapid tools to enable healthcare facilities and public health organizations to identify, characterize, and track multidrug-resistant organism threats and infections; and will help form a public health surveillance network that identifies, tracks, and trends antibiotic resistance.

• The Society for Healthcare Epidemiology of America will continue collaborations with CDC to encourage routine use of diagnostics in clinical settings and expanded access to new diagnostic technologies for all patients.

QUOTABLE

Following is a sampling of comments relating to the use of diagnostics to identify antibiotic-resistant organisms, as presented or reported in conjunction with the recent White House forum.

“A world without effective antibiotics is a frightening prospect. But our greatest threat isn’t evolution of bacteria—it’s inaction from people. Through smart policies and cross-sector partnerships, we can make sure effective medicine is there when we need it. Together we will win this fight, because we must.”—Sylvia Mathews Burwell, HHS Secretary, and Tom Vilsack, USDA Secretary

“Diagnostic tests will be crucial in any strategy to help reduce the threat of antibiotic resistance. These innovative tests can be used to identify, monitor, track, and prevent resistance. Diagnostic test manufacturers are committed to continuing to develop and deploy the cutting-edge technologies that are on the front lines of the fight against antibiotic resistance.”—Andrew Fish, JD, executive director, AdvaMedDx

“A critical strategy for reducing the spread and impact of antibiotic resistance is using rapid diagnostics to identify when antibiotics are necessary, and when they should be withheld.”—Namal Nawana, president and CEO, Alere

“BD has a full range of expertise related to identification and prevention of antimicrobial resistance, from diagnosis and treatment information to electronic surveillance and prevention of healthcare associated infections. We are committed to being a key contributor to this collaborative effort to stop the rise of antibiotic resistant organisms.”—Vincent A. Forlenza, chairman, CEO, and president, BD

“As the critical first step in any strategy to combat resistance, we should accelerate the availability of appropriate diagnostics in all healthcare settings, particularly at the point of need. Primary care physicians need fast and accurate diagnostic information that differentiates viral from bacterial infections, so that they can prescribe more targeted antibiotic treatments against the right organisms to help slow the development of resistance.”—John Bishop, CEO, Cepheid; chair, AdvaMedD