Stewardship / Resistance Scan for Jan 26, 2017

VA antibiotic stewardship
;
Antimicrobial use in food animals
;
MDR Staph capitis in NICUs

VHA says its stewardship efforts have cut antibiotic use 12%

More than 90% of Veterans Health Administration (VHA) hospitals have developed written antimicrobial stewardship policies, and the agency's Antimicrobial Stewardship Initiative has cut antibiotic use 12% overall so far, VHA officials noted yesterday in an analysis in Infection Control and Hospital Epidemiology.

The analysis of the 140-plus VHA medical facilities in the United States found that 92% had written stewardship policies by 2015. The investigators also noted that, while the proportional distribution of antibiotics did not change, inpatient antibiotic use decreased significantly (P < .0001) after the VHA stewardship initiative activities were implemented. They reported a 12% decrease in antibiotic use overall.

The analysis also noted significantly declining use overall of antimicrobials prescribed for resistant gram-negative organisms, including carbapenems, and declining hospital readmission and mortality rates. They also reported decreased rates of Clostridium difficile infection.

The VHA's stewardship efforts include continuing education, disease-specific guidelines, and development of example policies.
Jan 25 Infect Control Hosp Epidemiol study

 

European experts call for innovation on antimicrobial use in food animals

European health and food safety experts say in a new report that while efforts to reduce the use of antimicrobials in food-producing animals have had an impact, innovative solutions are needed to further protect animal and public health.

In a joint report issued this week, experts from the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) reviewed the measures that have already been taken by European Union (EU) nations and concluded that the wide range of control strategies implemented have produced favorable results, especially in northern European countries. These strategies use a multifaceted approach, take into account the local livestock production system, and have certain elements in common, such as national targets for reducing antimicrobial use.

But the authors note that while it's reasonable to assume that these efforts have had an impact on antimicrobial resistance in food-producing animals and food, assessing that impact has been difficult.

Beyond continuing efforts to encourage responsible antimicrobial use in food-producing animals, the authors conclude that more antimicrobial reduction strategies are necessary, including improved disease prevention measures to stop the spread of microorganisms within and between farms. In addition, they argue that antimicrobial alternatives, such as vaccines, probiotics, and bacteriophages, should be considered. And they suggest that alternative farming systems that require fewer antimicrobials without sacrificing animal health should be explored.

"It is clear that strategies that are already available can be implemented immediately and will have a positive impact on levels of antimicrobial resistance," EFSA Executive Director Bernhard Url, DVM, says in a press release. "At the same time, there is a need for innovative solutions—we need to find alternative ways to prevent and treat bacterial infections in animals."
Jan 24 EMA and EFSA joint scientific opinion
Jan 24 EMA and EFSA press release

 

Study shows high MDR Staph capitis levels in French NICUs

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, that has been isolated from neonatal intensive care units (NICUs) in 17 countries is plaguing some NICUs in France, according to a research letter in Emerging Infectious Diseases today.

The French team conducted a lab-based retrospective epidemiologic probe of 47 of the country's 57 NICUs to estimate NRCS-A prevalence. The researchers found that only 4 NICUs were completely free of the bacterium. Of the 43 affected NICUs, NRCS-A strains accounted for up to 46% of cases of positive blood cultures from newborns, with a median of 13%.

The authors conclude that these data and other global data "unquestionably demonstrate the unusual worldwide endemicity of the multidrug-resistant NRCS-A clone in NICUs. In addition, the epidemiologic data from France highlight the propensity of NRCS-A to invade and settle in most NICUs on a national scale.

"Once endemic in a NICU, NRCS-A strains expose infected neonates to a risk of therapeutic failure because treatment of neonatal sepsis involving methicillin-resistant coagulase-negative staphylococci is usually based on vancomycin and aminoglycosides, to which NRCS-A isolates are not susceptible."
Jan 26 Emerg Infect Dis research letter

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