Stewardship / Resistance Scan for Dec 14, 2016

Carbapenem-resistant A baumannii
Fewer hospital-acquired infections
Proton-pump inhibitors and ESBL-E

ECDC report warns of rising threat from carbapenem-resistant A baumannii

European health officials are warning about an increase in carbapenem-resistant Acinetobacter baumannii infections in hospitals across the continent.

In a rapid risk assessment issued Dec 9, the European Centre for Disease Prevention and Control (ECDC) said recent data from the European survey on carbapenemase-producing Enterobacteriaceae (EuSCAPE) and the European Antimicrobial Resistance Surveillance Network (EARS-Net) confirm that although there is already a high resistance baseline in some EU countries, there's been an overall increase in carbapenem-resistant A baumannii throughout the continent.

Acinetobacter spp. are gram-negative bacteria that are ubiquitous in the environment, with most species having low pathogenicity. But A baumannii, which can survive for long periods on dry surfaces and easily acquires resistance to different classes of antibiotics, has emerged as an important cause of outbreaks in healthcare settings.

A baumannii outbreaks typically occur in intensive care units among patients who've had invasive procedures or indwelling devices, but infections in patients admitted to conventional medical and surgical wards have been increasing. The bacteria are difficult to eradicate once they've become endemic. Over the last decade, the increasing resistance to carbapenems—traditionally the antibiotics of choice for A baumannii infections—has led to increasing use of the last-resort antibiotic colistin.

According to the data from EuSCAPE, a higher number of EU and European Economic Area (EEA) countries reported interregional spread or endemicity of carbapenem-resistant A baumannii in 2015 compared to 2013. In addition, data from EARS-Net showed that in 2015, 12 of 27 countries reported carbapenem resistance in more than 50% of their Acinetobacter spp. isolates. These findings, the ECDC report said, support the conclusion that the epidemiological situation of carbapenem-resistant A baumannii is worsening in Europe.

The ECDC said the findings highlight the need for increased efforts to reduce the clinical risk of carbapenem-resistant A baumannii infections, prevent hospital outbreaks and cross-border transmission, and improve preparedness for outbreak situations.
Dec 9 ECDC rapid risk assessment


HHS report highlights drop in hospital-acquired conditions

A new report from the Department of Health and Human Services (HHS) shows that hospital-acquired conditions (HACs) are continuing to decline, a finding that has positive implications for the battle against antibiotic resistance.

According to the National Scorecard on Rates of Hospital-Acquired Conditions, a report compiled and analyzed by the Agency for Healthcare Research and Quality (AHRQ), preliminary estimates for 2015 show a 21% decline in HACs since 2010. That translates into a cumulative total of 3.1 million fewer HAC's over 5 years than would have occurred had rates remained at the 2010 level, 125,000 fewer deaths, and approximately $28 billion in healthcare savings.

The preliminary rate for 2015 is 115 HACs per 1,000 discharges, down from 145 in 2010.

"Today's report shows us hundreds of thousands of Americans have been spared from deadly hospital acquired conditions, resulting in thousands of lives saved and billions of dollars saved," HHS Secretary Sylvia Burwell said in a news release.

While the largest cumulative reductions were in adverse drug events (a 42% reduction from 2010) and pressure ulcers (23%), there were also declines in four types of healthcare-associated infections (HAIs) whose treatment can be complicated by antibiotic-resistant bacteria: catheter-associated urinary tract infections (15.2%), surgical site infections (2.4%), central-line associated infections (1.3%), and ventilator-associated pneumonias (0.5%).

Cutting down on these types of infections is considered a critical element in efforts to combat antibiotic resistance and promote antibiotic stewardship in the US healthcare system.
Dec 2016 AHRQ report on hospital-acquired conditions
Dec 12 AHRQ news release


Proton-pump inhibitors linked to rectal carriage of ESBL-E

A study yesterday in Clinical Infectious Diseases reports that use of proton-pump inhibitors (PPIs) is independently associated with rectal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E).

The findings of the study are relevant because ESBL-E rectal carriage in the general community has become endemic globally and because PPIs, which neutralize or reduce the production of gastric acid, are among the most frequently prescribed class of drugs in the world and have been shown to increase the risk of gastrointestinal infections. But previous studies linking PPIs and ESBL-E have produced conflicting results.

In the cross-sectional study performed at an 850-bed teaching hospital in the Netherlands, investigators obtained valid rectal cultures from 570 of 702 hospitalized or day care patients. Of these 570 patients, 259 used PPIs on admission. In the PPI users, prior hospitalization and antibiotic use were more frequent, and median age was higher.

Overall, rectal carriage of ESBL-E was detected in 31 of the 570 patients, with Escherichia coli as the predominant species in 87% of the cases. Twenty-two of those patients were PPI users on admission. In a multivariable analysis, PPI users were found to have nearly four times the risk of ESBL-E rectal carriage as non-PPI users (adjusted OR, 3.89). While antibiotic use on the day of culture was not associated with ESBL-E rectal carriage, no data were available on antibiotic use prior to hospital admission.

The authors of the study say prospective studies are warranted to further explore the role of PPIs in ESBL-E infections
Dec 13 Clin Infect Dis study

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