Stewardship / Resistance Scan for Jul 06, 2017

ED antibiotic Rx drop
Diagnosing bacterial infections
MRSA in Taiwan

National guidelines in France tied to drop in ED antibiotic use

After France implemented national guidelines in 2011, antibiotic prescriptions for acute respiratory infections (ARIs) in children in emergency departments (EDs) dropped 31% over 3 years, representing more than 13,000 avoided antibiotic prescriptions, according to data presented yesterday in Clinical Infectious Diseases.

The multicenter, quasi-experimental, interrupted time series analysis of data from seven French pediatric EDs included all 242,534 patients with ARI from November 2009 to October 2014.

After national guidelines were implemented, antibiotic prescriptions for those cases fell 0.4% per 15-day period on average, for a cumulative drop of 30.9% by the end of the study period. This represented 13,136 antibiotic prescriptions avoided, the study authors said. They also noted that the relative percentage of broad-spectrum antibiotics prescribed dropped 62.7%; they were replaced with amoxicillin.
Jun 5 Clin Infect Dis abstract


UK researchers fine-tune diagnostic tool for serious bacterial infections

In a separate study involving children in the ED, UK researchers found that updating a published diagnostic model helped clinicians discriminate between pneumonia, serious bacterial infections (SBIs), and non-SBIs, representing a possible tool to bolster antibiotic stewardship.

The study, published yesterday in Pediatrics, involved 1,101 children younger than 16 years who had a fever and visited an ED, 264 of whom had an SBI. The investigators validated a published model for diagnosing pneumonia or other SBI in children, then updated it by including measures of procalcitonin and resistin.

In validating the published model, which incorporated various clinical symptoms, the authors reported that it discriminated well between pneumonia and no SBI (concordance statistic [CS], 0.85) and between other SBIs and no SBI (CS, 0.76). Refining the model with procalcitonin and resistin, however, led to even better results. In discrimination of pneumonia, CS increased from 0.88 to 0.90 (P = .03), and for other SBI models it increased from 0.82 to 0.84 (P = .03).

The researchers further reported that at a low-risk threshold for pneumonia, the extended pneumonia model had a sensitivity of 92% and a negative likelihood ratio of 0.12. For other SBIs, sensitivity was 92%, and negative likelihood ratio was 0.21. At a high-risk threshold, specificity was 89% for pneumonia and 86% for other SBIs.

The authors conclude, "Improvements in the classification of nonevents have the potential to reduce unnecessary hospital admissions and improve antibiotic prescribing. The benefits of this improved risk prediction should be further evaluated in robust impact studies."
Jul 5 Pediatrics study


Study finds high rate of MRSA in pediatric Staph infections in Taiwan

Almost two thirds of Staphylococcus aureus isolates from kids in northern Taiwan from 2004 to 2012 were methicillin-resistant S aureus (MRSA), and the MRSA proportion rose significantly, according to a study yesterday in BMC Infectious Diseases.

Scientists analyzed 409 S aureus isolates collected from a university hospital from 2004 to 2012 from patients younger than 19 years old. Of the total, 260 (63.6%) were MRSA. The percentage of MRSA-positive isolates rose from 48.5% in 2004-05 to 63.6% in 2012, a statistically significant increase. The highest rate, 69.3%, was recorded in both 2007 and 2011.

In addition, 181 (70%) of the 260 MRSA isolates were community-associated. Among those 181 patients, 157 (86.8%) had skin or soft-tissue infections, 13 (7.2%) had urinary tract infections, and 6 (3.3%) had pneumonia.
Jul 5 BMC Infect Dis study

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