CIDRAP Antimicrobial Stewardship Project Newsletter – Aug 8, 2019


In this week's issue:

  • What's new at CIDRAP-ASP?
  • AMR educational leadership from children in India
  • Oral versus IV antibiotics for bone and joint infection
  • Antibiotic audit in England
  • Gonorrhea diagnoses and resistance in Northern Ireland
  • Diagnostic stewardship podcast series
  • AMR and stewardship on US farms and ranches
  • One Health AMR action plan in Madhya Pradesh
  • C auris candidemia in South Africa
  • New peer-reviewed journal on phage research
  • Urine-specific antibiogram in the US
  • AMR and typhoid in Pakistan




[Weigh In] Take our August quiz to gauge your understanding of highly resistant malaria in Southeast Asia. And to learn more, read a recent CIDRAP News story on resistance tracking and treatment failure for Plasmodium falciparum in the region.


[Connect] On "MIC'ed Up," a podcast miniseries from the Society of Infectious Diseases Pharmacists, CIDRAP-ASP Advisory Committee member Elizabeth Dodds Ashley, PharmD, MHS, along with Lisa Dumkow, PharmD, Jamie Kisgen, PharmD, and moderator Erin McCreary, PharmD, describe leadership and advocacy in antimicrobial stewardship. And in a recorded webinar for ThermoFisher Scientific, CIDRAP-ASP Advisory Committee member Dilip Nathwani, OBE, MBChB, discusses "Antimicrobial Stewardship: A Patient Safety Emergency."


[Read] CIDRAP News recently published stories on a US policy change that aims to boost antibiotic development, the implications of telemedicine for pediatric antibiotic stewardship, drug resistance in US Salmonella cases related to pig ear dog treats, and much more.


[Research] Please take a moment to revisit our newly revamped antimicrobial stewardship diagnostics resources, our database containing hundreds of publicly available clinical tools for antimicrobial stewardship programs, and our educational multimedia page. The diagnostics page is updated at least weekly, and we add new clinical and educational tools monthly.


[Stay Current] If you'd like to stay current on all our news and events, please follow CIDRAP-ASP on Twitter and Facebook, subscribe to our YouTube channel, and subscribe to our antimicrobial stewardship podcasts on iTunes.




[Register] Registration is open for an Aug 13 and Oct 15 webinar on "Creating Impact in the Treatment and Prevention of Recurrent C. Difficile Infection," hosted by the Society of Infectious Diseases Pharmacists and featuring presentations from Nicholas S. Britt, PharmD, MS, and Maggie Reavis, BSN, RN.


[Explore] Check out the educational and engagement resources on the new website for Superheroes Against Superbugs, an initiative that empowers children to build awareness about antimicrobial resistance (AMR) and stewardship in India.


[Examine] In Health Technology Assessment, Matthew Scarborough, MB BCh BAO, PhD, et al outline results from the OVIVA (Oral Versus IntraVenous Antibiotics) trial to determine whether oral antibiotics are non-inferior to intravenous antibiotics for treating bone and joint infection, finding that oral therapy is non-inferior when used during the first 6 weeks of infection.


[Assess] In the Pharmaceutical Journal, Julia Robinson, MSc, reports on plans by NHS England to carry out an audit of antibiotics supplied by pharmacists under the NHS Urgent Medicine Supply Advanced Series (NUMSAS), at the request of England's chief pharmaceutical officer Keith Ridge, PhD. The announcement comes on the heels of a release of data obtained by the Pharmaceutical Journal in June that revealed that the number of antibiotic courses supplied by NUMSAS nearly doubled over one year.


[Discover] Northern Ireland's Public Health Agency released a report showing that new diagnoses of gonorrhea had risen by 30% during 2018. Susceptibility data for 387 gonococcal isolates showed that 9% were resistant to azithromycin, while all were susceptible to ceftriaxone. And in news from the University of British Columbia Action on Sepsis Research Cluster, Michelle Lui, MOT, profiles the work of Joseph Ting, MBBS, MPH, in identifying research and diagnostic priorities for antimicrobial stewardship in neonatal sepsis.


[Study] In Open Forum Infectious Diseases, Michael Katzman, MD, et al evaluate the integration of antimicrobial stewardship interventions into the electronic medical record at a US hospital, finding that the project was associated with increased chart reviews, an increase in recommendations to de-escalate therapy, decreases in fluoroquinolone use, reductions in Clostridioides difficile infection, and increased ciprofloxacin susceptibility among Escherichia coli and Pseudomonas aeruginosa isolates.


[Listen] The Society for Healthcare Epidemiology of America is hosting a podcast series on diagnostic stewardship, which features episodes on C difficile testing, urine culturing, procalcitonin, and the interpretation of results from a rapid gastrointestinal assay.


[Learn] The Pew Charitable Trusts features interviews with Laura Sage and Mike Stonnington, MD, two family farmers who are integrating antimicrobial stewardship principles into their agricultural practices. And in the New York Times, Matt Richtel, MS, describes the problem of drug-resistant Salmonella infections in the US, highlighting roadblocks to accessing information on antibiotic use and infection control practices on pig farms.


[Analyze] In the International Journal of Pediatric Otorhinolaryngology, Shelby C. Barrera et al found that, among 277 children seen for 365 episodes of acute otitis media in a Texas clinic system from 2016 to 2018, 95.6% of patients received an antibiotic, of which only 3.8% were watch-and-wait prescriptions. Children who saw their primary care provider were less likely to receive antibiotics, and nurse practitioners had the highest rate of antibiotic prescribing compared with other clinician groups.


[Engage] In Down to Earth, Bhavya Khullar, PhD, reports on Madhya Pradesh becoming the second Indian state, after Kerala, to develop a One Health action plan on AMR.


[Evaluate] In Emerging Infectious Diseases, Erika van Schalkwyk, MBChB, MPH, et al describe how 14% of 6,669 cases of candidemia managed at 269 hospitals in South Africa from 2016 to 2017 were caused by Candida auris, with prior systemic antifungal therapy associated with an adjusted 40% increased odds of C auris fungemia compared with other causes of candidemia. And in BMC Research Notes, Margaret Lubwama, MBChB, MMed, et al assess 24 positive blood cultures from febrile cancer patients in Uganda, finding that multidrug-resistant gram-negative bacteria, mainly Enterobacteriaceae, were the primary causes of bacteremia.


[View] Infection Prevention and Control (IPAC) Canada posted recordings of presentations given at the recent 2019 International Federation of Infection Control/IPAC Canada National Education Conference, including presentations on the role of the bacteriology laboratory and infection control in antimicrobial stewardship. And the Nebraska Antibiotic Stewardship Assessment & Promotion Program posted the recording of a presentation on the management of skin and other soft-tissue infections by Travis Van Schooneveld, MD, given at the 2019 Nebraska Antimicrobial Stewardship Summit.


[Rethink] A new journal, Phage: Therapy, Applications, and Research, will feature peer-reviewed bacteriophage research across the One Health spectrum. And in The Conversation, David Pride, MD, PhD, and Chandrabali Ghose, PhD, MS, discuss the limitations of antibiotic development and describe the potential of phage therapy and policy improvements in contributing to greater uniformity in stewardship across US healthcare systems.


[Review] In Diagnostic Microbiology and Infectious Disease, Ketzela J. Marsh, MD, MS, et al compiled an antibiogram for one year's worth of urine isolates from a US Veterans Affairs Medical Center to inform empirical therapy, finding that E coli represented only 27% of overall isolates and that susceptibility varied significantly by Gram stain characteristic, between E coli and other gram-negative organisms, and by clinical site. And in the European Journal of Clinical Microbiology & Infectious Diseases, Ashfaq Hussain, MBBS, et al evaluate 292 typhoidal Salmonella isolates collected from a hospital in Pakistan during 2018, finding that 76% of Salmonella Typhi and 34% of Salmonella Paratyphi isolates were multidrug-resistant, with 115 Salmonella Typhi isolates (48%) being extensively drug-resistant.

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