Inclusion, diversity, access, and equity in antimicrobial stewardship: where we are and where we are headed.

PURPOSE OF REVIEW: This review summarizes existing data on health inequities in antimicrobial stewardship, identifies data gaps and barriers, and reflects on mitigating factors for achieving inclusion, diversity, access, and equity in antimicrobial stewardship. RECENT FINDINGS: Studies show variable antimicrobial prescribing patterns and adverse events according to race/ethnicity, rurality, socioeconomic status, and other factors. Most studies demonstrating these inequities typically do not address their upstream drivers or interventions to mitigate them. SUMMARY: Approaching antimicrobial stewardship through a lens of equity can allow antimicrobial stewardship programs (ASPs) opportunities to reach a wider population, and in doing so reduce health inequities. These opportunities include expanding ASPs beyond highly resourced institutions, educational outreach efforts, equity monitoring tools, incentivized equity metrics, and leadership diversification. Clinical research in this area also needs to address drivers of inequities and innovative approaches to mitigating and reducing them.

Role of Evolutionary Selection Acting on Vaccine Antigens in the Re-Emergence of Bordetella Pertussis.

Pertussis ("whooping cough") is a re-emerging disease with increasing incidence among fully vaccinated individuals. We explored the genetic diversity of five Bordetella pertussis proteins used to generate the subunit vaccine across ancestral and newly emergent strains using immunoinformatics and evolutionary selection measurements. The five subunits of pertussis toxin (Ptx1⁻Ptx5) were highly conserved with regard to sequence, predicted structure, predicted antigenicity, and were under purifying selection. In contrast, the adhesin proteins pertactin (Prn) and filamentous hemagglutinin (FHA) were under statistically significant (p < 0.01) diversifying selection. Most heavily diversified sites of each protein fell within antigenic epitopes, and the functional adhesin motifs were conserved. Protein secondary structure was conserved despite sequence diversity for FHA but was changeable in Prn. These findings suggest that subunit vaccine-derived immunity does not impact Ptx1⁻Ptx5 but may apply evolutionary pressure to Prn and FHA to undergo diversifying selection. These findings offer further insight into the emergence of vaccine-resistant strains of B. pertussis.

Inhibition of Toxic IAPP Amyloid by Extracts of Common Fruits.

The aggregation of the 37-amino acid polypeptide islet amyloid polypeptide (IAPP, amylin), as either insoluble amyloid or as small oligomers, appears to play a direct role in the death of pancreatic ß-islet cells in type 2 diabetes. It is believed that inhibiting the aggregation of IAPP may slow down, if not prevent entirely, the progression of this disease. Extracts of thirteen different common fruits were analyzed for their ability to prevent the aggregation of amyloidogenic IAPP. Thioflavin T binding, immuno-detection and circular dichroism assays were performed to test the in vitro inhibitory potential of each extract. Atomic force microscopy was used to visualize the formation of amyloid fibrils with and without each fruit extract. Finally, extracts were tested for their ability to protect living mammalian cells from the toxic effects of amyloid IAPP. Several fruits showed substantial ability to inhibit IAPP aggregation and protect living cells from toxic IAPP amyloid.