Stewardship / Resistance Scan for Mar 14, 2017

Antibiotic misconceptions
Sexual spread of resistant bacteria
New gram-negative antibiotic

Australian parent survey finds misconceptions about antibiotics

A large survey of Australian parents has found significant misconceptions about antibiotic use for acute respiratory infections.

The study, published yesterday in the Annals of Family Medicine, describes the results of a telephone survey in which 401 parents of at least one child aged 1 to 12 years were asked questions about the benefits and harms of antibiotic use for three acute respiratory infections or related conditions: acute otitis media, sore throat, and acute bronchitis. The respondents were also asked to recall the last time their child visited a doctor from treatment of one of these conditions, including any discussion about antibiotics.

The results showed that most of the parents believed that antibiotics can (at least sometimes) help all three conditions, with 92% believing antibiotics can help acute otitis media (middle ear infection), 70% believing they can help sore throat, and 55% believing they can help cough. Many parents, however, also agreed that not using antibiotics for these conditions is an option, especially in the case of cough (99%) and sore throat (97%), but less so for acute otitis media. In addition, 78% said they knew antibiotics could potentially harm, with roughly half mentioning antibiotic resistance.

But parents also grossly overestimated the extent to which antibiotics could reduce illness duration, compared with benefits seen from current empirical evidence, and many believed that antibiotics could help avoid complications from acute respiratory infections—such as hearing loss and perforated eardrum in cases of acute otitis media.

In recalling their most recent visit to a pediatrician for treatment of one of these conditions, 44% of parents reported some discussion about why antibiotics might be used, but 72% reported little or no discussion about why antibiotics might not be used, and 78% did not recall any discussion of potential antibiotic harm. Nearly all parents (93%) said they would like to be involved in future decisions about antibiotic use.

"These findings suggest opportunities for improving acute respiratory infection visits by adopting shared decision making," the authors write.
March/April Ann Fam Med study


HIV study indicates potential for sexual spread of drug-resistant bacteria

Findings from a study yesterday in BMC Infectious Diseases suggest the potential for sexual transmission of multidrug-resistant gram-negative (MDRGN) bacteria in men with HIV.

For the study, researchers at University Hospital Frankfurt retrospectively investigated the MDRGN organism prevalence in rectal swabs of 109 HIV-positive men and 109 HIV-negative men who had been admitted to the hospital from November 2014 through March 2016. They were looking to evaluate whether sexual intercourse could be a potential means of transmission for MDRGN organisms. Their hypothesis was that microbiota, including MDRGN, is exchanged during mucous membrane contact.

The researchers theorized that MDRGN prevalence might be higher in HIV-positive men than in HIV-negative men in part because pre- or co-existing sexually transmitted diseases can be a marker for identifying individuals who have engaged in unprotected sexual intercourse. In addition, they cite recent investigations that have documented the spread of pathogenic Escherichia coli and Shigella species in men who have sex with men.

Among the 208 men evaluated, the researchers found a total of 35 MDRGN isolates, with 26 detected in the HIV-positive men and 9 detected in the HIV-negative men (for an overall prevalence of 23.9% vs. 8.3%). The most frequently detected MDRGN species was E coli with resistance due to extended-spectrum beta-lactamase (ESBL) production and additional resistance to fluoroquinolones, which accounted for 25 of the 35 isolates.

"These findings suggest that HIV positive men might be more susceptible to acquire MDRGN," the authors write. But they also acknowledge that a stronger history of antibiotic pre-treatment and the presence of pre-existing comorbidities in HIV positive men are other factors that need to be evaluated in future investigations of sexual transmission of MDRGN.
Mar 13 BMC Infect Dis study


New antibiotic combo announced for gram-negative bacterial infections

Drugmaker Pfizer, Inc. today announced that a novel combination antibiotic for the treatment of serious gram-negative bacterial infections is now available in the United Kingdom and Germany.

The fixed-dose combination of ceftazidime and avibactam, sold under the brand name Zavicefta, is indicated for the treatment of complicated intra-abdominal infection, complicated urinary tract infection, and hospital-acquired pneumonia. It's also indicated for the treatment of two of the MDRGN organisms—Pseudomonas aeruginosa and Enterobacteriaceae—recently identified by the World Health Organization as "priority pathogens."

"Multidrug-resistant (MDR) infections are an increasing global threat," Matteo Bassetti, MD, PhD, chief of the infectious diseases clinic at University of Udine in Italy, said in a company news release. "The availability of Zavicefta is a major step forward for physicians faced with the challenge of treating patients with known or suspected MDR infections."

Zavifecta was approved for marketing in June 2016 by the European Medicines Agency.
Mar 14 Pfizer news release

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