Stewardship / Resistance Scan for Feb 15, 2017

ASP recommendations
MCR-1 in chicken meat

Experts recommend strategies for successful stewardship

An article yesterday in Clinical Infectious Diseases aims to help healthcare institutions comply with newly mandated antimicrobial stewardship standards by highlighting the habits of successful antimicrobial stewardship programs.

The article, which borrows its title from the popular self-help book "The 7 Habits of Highly Effective People," reviews the eight elements of performance that make up the New Antimicrobial Stewardship Standard, a set of guidelines developed by The Joint Commission for hospitals, critical access hospitals, nursing homes, ambulatory care organizations, and office-based surgery practices. The standard requires these institutions to have an antimicrobial stewardship program (ASP) based on current scientific literature as of Jan 1, 2017.

As the article notes, there is little guidance for hospital administrators on how to comply with the standard. Using real-world experience from established ASPs, the authors reviewed the eight elements of performance and recommended strategies that will help institutions implement each of those elements, reduce inappropriate antibiotic usage, and improve patient outcomes. Among the strategies they recommend are endorsement of an institution's ASP policy by hospital administration, mandated educational ASP competencies for all healthcare providers involved in antibiotic ordering and dispensing, use of various communication venues to educate patients about appropriate antibiotic use, and regular collection and analysis of data on antibiotic use and outcomes.

"Simply asking clinicians to do a better job at prescribing antimicrobials has not and does not work," the authors write. "Unraveling years of overprescribing antimicrobials will require behavior change."
Jan 14 Clin Infect Dis abstract


MCR-1-carrying E coli found in Brazilian chicken meat

A new study in Antimicrobial Agents and Chemotherapy reports that colistin-resistant Escherichia coli isolates carrying the MCR-1 gene have been identified in commercial chicken meat in Brazil.

As part of a local investigation into the presence of colistin-resistant bacteria, researchers collected 41 chicken samples from markets in Sao Paulo and tested them for susceptibility to polymixin B and colistin and for the presence of the MCR-1 gene, which confers resistance to the last-resort antibiotic. They found eight clonally unrelated colistin-resistant E coli isolates carrying MCR-1.

The authors report that most of the E coli isolates exhibited a multidrug-resistant phenotype and carried additional genes conferring resistance to aminoglycosides, quinolones, sulphonamide, and tetracyclines. In addition, they found the presence of IncX4-type plasmids, which have been implicated in global dissemination of the gene, in five of the isolates.

Since it was first identified in China in 2015, the MCR-1 gene has been identified in food-producing animals, foods, aquatic environments, and humans in more than 30 countries. But studies reporting its presence in Enterobacteriaceae from foods have been infrequent, the authors note. They suggest it could be linked to widespread use of colistin in Brazilian pigs and poultry. Use of colistin in animal feed was banned by Brazil in 2016.

"In summary, these results highlight that commercial chicken meat can be an important reservoir of mcr-1-carrying E coli, which is a cause for public health concern, since this could contribute to the acceleration of the spread of the mcr-1 gene," the authors write.

Brazil is the third largest producer of chicken meat, according to the study.
Feb 13 Antimicrob Agents Chemother study

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