Stewardship / Resistance Scan for Apr 25, 2017

Colistin rapid test
Urologist overprescribing
Staph aureus antibiotic

Test can detect colistin rapidly, cheaply

Data presented at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), which wrapped up today, suggest that equipment already owned by most hospitals can quickly and accurately detect resistance to last-resort antibiotics like colistin.

Researchers from Imperial College London tested two Enterobacteriacae strains, Escherichia coli and Klebsiella pneumoniae, for resistance to the class of antibiotics called polymixins, which includes colistin. In recent years MCR-1 and other genes that confer resistance to colistin have been increasingly reported.

The team analyzed 134 different colonies of bacteria using a mass spectrometer. Using test results, they were able to distinguish not only between bacteria that are colistin-resistant and those that are not, but also which bacteria have plasmid-encoded resistance. This type of resistance is especially worrisome because it can be passed from one type of bacteria to another type.

The investigators say the test can be carried out in about 15 minutes and would cost less than $1 per sample, according to an ECCMID press release yesterday. Author Gerald Larrouy-Maumus, PhD, said, "The exciting thing about this technique is that it relies on technology that is already available in most hospitals. This means that it could be rolled out quickly and cheaply, and potentially have a rapid impact on tackling drug resistance."
Apr 24 ECCMID abstract
Apr 24 ECCMID news release


German survey finds higher antibiotic prescribing by urologists

A survey of 18 German hospitals found that urologists prescribe antibiotics more frequently than other specialists, but almost a third of them would incorrectly prescribe broad-spectrum antibiotics to a woman who has an uncomplicated urinary tract infection.

Of 1,061 questionnaires targeted to general surgeons, internists, gynecologists, and urologists, 456 physicians responded, for a 43% response rate, according to the study in International Urology and Nephrology.

The share of urologists who prescribed antibiotics to more than five patients in the previous 7 workdays was 50.7%, compared with 24.3% for the other specialists. Urologists were more confident than the other physicians regarding dosage, frequency, and duration of antibiotic treatment, in interpreting antibiograms, and regarding local resistance patterns. Both urologists and non-urologists, though, had poor knowledge about antibiotic stewardship.

Despite this confidence, local rates of ciprofloxacin-resistant E coli strains were correctly categorized by only 36.3% and 31.2% of urologists and non-urologists, respectively. And 31.5% and 30.7% of urologists and non-urologists, respectively, would prescribe broad-spectrum antibiotics to a female patient who has an uncomplicated urinary tract infection. On the upside, urologists more often acknowledged the use of broad-spectrum antibiotic agents as a problem.

The authors conclude, "There is substantial need for advanced training regarding [multidrug-resistant organisms] and antibiotic stewardship, regardless of medical specialty."
Apr 21 Int Urol Nephrol study


Antibiotic shows promise for treating Staph aureus

Drug maker Theravance Biopharma, Inc., of Dublin, reported positive preliminary data  yesterday from an observational study designed to evaluate how telavancin, a US Food and Drug Administration–approved antibiotic for the treatment of skin infections and pneumonia caused by Staphylococcus aureus, is being used to treat patients in real-world settings.

The findings, presented at ECCMID, were based on a review of data from 593 patients diagnosed as having complicated skin and skin structure infections (cSSSIs), bone and joint infections, and lower respiratory tract infections (LRTIs). The company also announced additional findings from studies that evaluated the in vitro and in vivo potency of televancin—which is sold under the brand name Vibativ—against S aureus.

According a company press release yesterday, researchers reported positive clinical response in 75.3% of 279 patients with confirmed cSSSIs mainly caused by methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), with telavancin generally being well-tolerated by patients. In 174 patients with confirmed bone and joint infections predominantly caused by MRSA and MSSA, the positive response rate was 68.4%, with 33 patients experiencing at least one adverse event and 7 patients having one serious adverse event. There were 3 deaths within 28 days of the first dose of the drug, and 20 patients discontinued treatment because of adverse events.

In 36 patients with LRTIs caused by hospital-acquired bacterial pneumonia, ventilator-associated bacterial pneumonia, and MRSA, researchers reported a positive clinical response for in 58.3% of patients treated with telavancin, with eight patients having at least one adverse event and four having at least one serious adverse event. Six patients died within 28 days of the first dose, and two patients discontinued treatment.

In findings presented today at ECCMID, researchers reported that telavancin demonstrated the greatest in vitro activity of all antibiotics evaluated against a global collection of difficult-to-treat S aureus clinical isolates, including MRSA and MSSA. They also reported that telavancin showed more potency than vancomycin against S aureus strains in neutropenic murine thigh and lung infection models.
Apr 24 Theravance Biopharma press release
Apr 25 Theravance Biopharma press release

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