Stewardship / Resistance Scan for May 03, 2017

Stewardship in VA hospitals
Resistant hospital infections
Hospital CRE rate

VA study identifies factors associated with antimicrobial utilization

A new study of antimicrobial stewardship efforts at Veterans Administration (VA) hospitals published in the Journal of Hospital Medicine has identified factors associated with positive and negative effects on antimicrobial utilization.

The study comes out of a 2012 survey of antimicrobial stewardship practices at 130 acute care VA facilities administered by the VA National Antimicrobial Stewardship Task Force (ASTF). From the survey results, investigators derived 57 facility characteristics considered relevant to antimicrobial utilization, then whittled that number down to 34 variables. The variables were entered into a multivariable model that was used to determine associations between the variables and four antibiotic utilization measures: aggregate acute care antimicrobial use, antimicrobial use in patients with noninfectious primary discharge diagnoses, missed opportunities to convert from parenteral to oral antimicrobial therapy, and missed opportunities to avoid double anaerobic coverage with metronidazole.

Variables associated with at least three favorable changes (ie, reduced overall or noninfectious antimicrobial use, fewer missed opportunities to convert from parenteral to oral therapy or avoid double anaerobic coverage) included the presence of postgraduate physician/pharmacy training programs, the number of antimicrobial-specific order sets, frequency of systematic de-escalation review, the presence of pharmacists and/or infectious disease (ID) attending physicians on acute care ward teams, and formal ID training of the lead antibiotic stewardship program pharmacist. Variables associated with two unfavorable changes (increases in noninfectious antimicrobial use and missed opportunities to switch from parenteral to oral therapy) included number of hospital beds, the degree to which the facility engaged with the online resources of the VA stewardship task force, and the presence of antimicrobial stop orders.

"In summary, the VA has made efforts to advance the practice of antimicrobial stewardship system-wide, including a 2014 directive that all VA facilities have an ASP," the authors of the study write. "Our study identifies areas of stewardship that may correlate with, positively or negatively, antimicrobial utilization measures that will require further investigation."
May J Hosp Med study

Drug-resistant hospital infections tied to higher death rates

Hospital-associated infections caused by multidrug-resistant organisms (MDROs) can increase mortality, readmission rates, and emergency department (ED) visits compared with those caused by susceptible strains, Spanish investigators reported yesterday in Clinical Infectious Diseases.

The team studied 324 patients with MDRO infections and 686 with drug-susceptible infections. The risk of all-cause and 30-day mortality after infection was 70% and 77% higher, respectively, in MDRO patients. Probability of readmission was more than double that of patients with susceptible infections. ED visits were significantly higher with methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli infections, in which case the risk was about triple and double the risk in patients with susceptible infections.

The authors noted the MDROs did not appear to influence length of hospital stay or the need for hospital admission, intensive care, surgery, or diagnostic tests.
May 2 Clin Infect Dis study


Study finds 6% resistance rate in hospital Enterobacteriaceae isolates

Scientists at a Malaysian teaching hospital found a 6% rate of carbapenem resistance among Enterobacteriaceae isolates obtained from patients and high rates of the resistance gene NDM-1, according to a study yesterday in Antimicrobial Resistance & Infection Control.

The team analyzed 8,306 Enterobacteriaceae isolates collected from August 2013 to December 2015 from patients at a 700-bed tertiary teaching hospital. Of those, 477 (5.7%) were carbapenem-resistant Enterobacteriaceae (CRE). About 86% of the CRE were Klebsiella pneumoniae, and 49.3% were isolated from rectal swabs, with urine (15.9%) and blood samples (9.6%) accounting for most of the rest.

Of the 136 organisms that were genotyped, 112 (82.4%) were positive for the New Delhi metallo-beta-lactamase 1 (NDM-1) gene, which was first reported in 2009.
May 2 Antimicrob Resist Infect Control report

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