Vaccines for common pathogens could help fight antimicrobial resistance
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NATIONAL HARBOR, Maryland — Vaccines against common health care-associated, resistant pathogens could be a key in the fight against antimicrobial resistance, according to data presented at the World Anti-Microbial Resistance Congress.
“Antimicrobial resistance (AMR) is a major public health threat globally and in the United States,” Shelley S. Magill, MD, PhD, a medical officer in the CDC’s Division of Healthcare Quality Promotion, said during her presentation. “Many of you are probably familiar with the recent publication from the Institute of Health Metrics and Evaluation on the global burden of AMR showing that there were an estimated 4.95 million deaths worldwide associated with AMR pathogens and about 1.3 million deaths attributed to these pathogens in 2019.”
According to Magill, the pathogens most associated with AMR infections are Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae, although many other contribute to the high burden.
During her presentation, Magill explained that before the COVID-19 pandemic, the U.S. was making headway against AMR. However, once the pandemic began, antibiotic use was greatly impacted, essentially reversing recent AMR prevention success. Between March and October of 2020, almost 80% of patients hospitalized with COVID-19 received an antibiotic, she said.
Data showed that resistant hospital-onset infections and deaths both increased at least 15% during the first year of pandemic. More than 29,400 people died from AMR infections commonly associated with health care during the first year of the pandemic, of which 40% of patients contracted the infection while in the hospital.
Magill said that although efforts are being made across many platforms using different methods and technologies, vaccines may hold promise as a tool to prevent AMR.
“Real-world evidence already exists for vaccines directed against community-associated pathogens,” she said, although more work is needed to develop them.
Phase 3 clinical trial data presented by Magill during World Anti-Microbial Resistance Congress showed that an investigational Clostridioides difficile vaccine being developed by Pfizer was well tolerated and successful to a point. According to the study, the vaccine was tested in adults aged 50 years and younger who were at high risk for C. difficile as part of the CLOVER trial.
They were given doses at the start of the trial, 1 month and 6 months in. Researchers found that the vaccine efficacy was 31% (96.4% CI, –38.7 to 66.6) after the third dose and 28.6% (96.4% CI, –28.6 to 61) after the second but noted that during initial analyses of two secondary endpoints, vaccinated patients had reduced duration of C. difficile infection compared with unvaccinated patients (1 day vs. 4 days), as well as less severe disease.
Another vaccine being investigated is an extraintestinal pathogenic E. coli candidate from Janssen. In a phase 3 trial, the 9-valent vaccine candidate was given to adults aged 60 years and older with a history of UTIs in the past 2 years. No data are currently available, but the study is estimated to be completed by May 2027.
“We need vaccines that protect against pathogens that we think of as being health care associated or for which there are emerging resistance phenotypes that pose major treatment challenges,” Magill said. “Vaccines that can actually move the needle on antibiotic use and potentially reduce antibiotic pressure are already available, and we need better implementation of programs.”
She added, “It is essential to have networks and infrastructure in place to be able to monitor and evaluate the impact of newly available vaccines directed against important air pathogens, as well as against pathogens that are major drivers of antibiotic use.”
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Magill SS. The role of vaccines in reducing antimicrobial resistance. Presented at: World AMR Congress; Sept. 7-8, 2022; National Harbor, Maryland
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