Stewardship / Resistance Scan for Feb 28, 2017

Drug-resistant TB plea
MDR infections in organ transplants
Stewardship app

WHO calls for R&D into drug-resistant tuberculosis treatment

The World Health Organization (WHO) issued a statement today reaffirming the need for more research and development on new antibiotics for multidrug-resistant tuberculosis (MDR-TB).

"Addressing drug-resistant TB research is a top priority for WHO and for the world," WHO Director-General Margaret Chan, MD, MPH, said in a press release. "More than US $800 million per year is currently necessary to fund badly needed research into new antibiotics to treat TB."

The statement comes a day after the agency released a list of antibiotic-resistant "priority pathogens" for which new antibiotics are urgently needed. WHO officials said in a press conference yesterday that although drug-resistant TB is the most important priority for development of new antibiotics, it was not included on that list because it is already recognized as a top public health threat and is targeted by dedicated programs.

The WHO estimates there were 580,000 cases of MDR-TB globally in 2015 and 250,000 related deaths. Only two new antibiotics to treat MDR-TB have completed phase 2B trials in the past 50 years, the agency said, and both are still in phase 3 trials.
Feb 28 WHO press release


Study details drug-resistant bloodstream risks in organ transplants

A study yesterday in BMC Infectious Diseases details the factors most associated with mortality in abdominal organ transplant recipients with multidrug-resistant bloodstream infections.

In the retrospective study, investigators analyzed all episodes of multidrug-resistant gram-negative bacteremia (MDR-GNB) in abdominal solid organ transplant (ASOT) recipients at two Chinese hospitals from 2003 to 2016. Although the emergence of MDR-GNB in organ transplant recipients has been documented, information on risk factors for mortality has been scarce. To identify those risk factors, the investigators compared two groups of patients: those who survived and those who died within 30 days after the first episode of MDR-GNB.

During the 13-year study period, 2,169 patients underwent ASOT, and 99 MDR gram-negative samples (4.6%) were isolated from 91 patients with bloodstream infections. Of the 99 MDR-GNB isolates, 29 (29.3%) were Escherichia coli, 24 (24.2%) were Acinetobacter baumanni, 11 (11.1%) were Escherichia cloacae, and 10 (10.1%) were Klebsiella pneumoniae. The incidence of MDR-GNB was higher in liver recipients (12.3%) than in kidney recipients (2.6%). MDR-GNB-related 30-day mortality after the first episode of MDR-GNB was 39.6% (36 deaths).

Comparison of the two groups of patients showed that nosocomial origin, presence of other concomitant bloodstreams infections, increased creatinine level, and septic shock were the main risk factors for MDR-GNB–related mortality in ASOT recipients. Septic shock led to a 160-fold increase in mortality and was the strongest predictor of outcomes in multivariate models.

"Recognition of these factors is useful in identifying individuals who are at risk of mortality," the authors write.
Feb 27 BMC Infect Dis study


Researchers say antibiotic stewardship app boosted compliance

A study today in the Journal of Antimicrobial Chemotherapy reports that converting antimicrobial stewardship policies to a smartphone app modestly boosted compliance with prescribing policy at three hospitals in London, England.

The study looked at the 3 years before and after the 2011 rollout of the Imperial antibiotic prescribing policy application (IAPP), which was launched at the three main hospitals of Imperial College Healthcare Trust Hospitals in west London. The hospitals already had a multimodal antimicrobial stewardship program (ASP) in place; the purpose of IAPP was to make antimicrobial prescribing policy available at the point of care.

To measure the impact on antimicrobial prescribing pre- and post-IAPP adoption, the investigators chose three proxy indicators: adherence of choice of antimicrobial to local policy or microbiology/infectious disease team recommendation, documentation of stop or review dates on medication charts, and documentation of indication on medication charts. Data from general medical and surgical patients were analyzed separately.

The results of the interrupted time series analysis showed that compliance with policy increased in both medicine and surgery after IAPP was implemented, although the change in level of compliance was statistically significant only in surgery. IAPP also improved the documentation of the stop/review date in both medical and surgical specialties, but the improvement was not significant. Documentation of indication for prescribing, however, decreased significantly in both medicine and surgery after IAPP was implemented. 

In conclusion, the authors note that the addition of IAPP to a multifaceted ASP did not demonstrate significant change in antimicrobial prescribing trends. The added value, they write, is in the "reach and access to the antimicrobial prescribing policy among a wider range of staff across our organization."     
Feb 28 J Antimicrob Chemother study

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