Stewardship / Resistance Scan for Jul 24, 2017

Costly NDM-1 outbreak
Stewardship and vancomycin
Resistant Campylobacter

Study estimates $800,000 cost of an NDM-1 hospital outbreak

A new study in Emerging Infectious Diseases describes the physical and financial burden of a nosocomial outbreak caused by New Delhi metallo (NDM) beta-lactamase–containing Klebsiella pneumoniae.

The 2015 outbreak, which occurred at a tertiary teaching hospital in the Netherlands from Oct 1 to Dec 30, began when NDM-1–producing extended-spectrum beta lactamase (ESBL)-positive K pneumoniae bacteria were cultured and isolated from a patient in the surgical ward. Following that discovery, screening cultures of long-term admitted surgical patients revealed 2 more patients with NDM-producing K pneumoniae, and contact tracing and weekly screening rounds of all hospital patients revealed additional NDM carriers. A total of 29 patients were affected.

An assessment of outbreak-related expenses estimated the total costs of the 3-month outbreak at $804,263, corresponding to a cost of $27,770 per patient. The loss of revenue was mainly attributed to closure of beds during the outbreak. Other cost drivers were diagnostic tests and personnel time spent by laboratory employees and infection prevention experts.

"As shown in this study, the expansion of multidrug-resistant, gram-negative bacteria is of great concern; these bacteria both threaten patient safety and increase healthcare costs," the study authors write. "The intensive outbreak control measures of the hospital were costly and inconvenient for patients and staff."

The authors say that in countries where NDM-positive K pneumoniae is not endemic, early detection of colonized patients and adequate infection control strategies will be important factors in minimizing the spread of the multidrug-resistant bacteria.
Jul 21 Emerg Infect Dis dispatch


ASP associated with reduced mortality in patients treated with vancomycin

Mortality in older patients treated with vancomycin decreased by 7.1% after an antimicrobial stewardship program (ASP) was implemented, researchers at a Veteran Affairs hospital report in the American Journal of Infection Control.

In the retrospective quasi-experimental study, researchers at the Veterans Affairs Western New York Healthcare System in Buffalo, New York, aimed to evaluate the impact of an ASP on 30-day mortality rates in patients treated with intravenous (IV) vancomycin, which is the drug of choice for infections caused by methicillin-resistant Staphylococcus aureus but has been associated with nephrotoxicity. ASP interventions consisted of prospective audit and feedback, including appropriate antibiotic selection and dosing, microbiology, and duration of treatment. A secondary outcome was to determine risk factors for mortality associated with vancomycin.

Overall, 453 patients were treated with a minimum of 48 hours of IV vancomycin therapy during the study period—226 in the pre-ASP period (Oct 1, 2006 through Jul 31, 2008) and 227 during the ASP period (Aug 1, 2011 through Jul 31, 2014). Clinicians using the ASP made on average about four vancomycin recommendations per patient. Deaths occurred in 56 patients (12.4%), with 36 (64.3%) occurring during the pre-ASP period and 20 during the ASP period (P =.02). Patients in the ASP group also had less nephrotoxicity than those in the pre-ASP group (17 vs 31 patients).

Increased mortality was associated with pre-ASP years (odds ratio [OR]. 2.17), older age (OR, 1.08), nephroxicity (OR, 3.24), and hypotension (OR, 3.28). Treatment in the intensive care unit was also associated with higher mortality.

"Our prospective audit and feedback system was associated with improved mortality in an older population with a mean age of 68 years," the study authors write. "The process of comprehensive patient review, including culture data and imaging and close monitoring of any changes in renal function, may be necessary for the elderly patient beyond computerized support software to achieve improved rates of morality."
Jul 21 Am J Infect Control study


US data show increases in Campylobacter cases, outbreaks, resistance

The number of US Campylobacter outbreaks has doubled in recent years, and isolates have proved increasingly antibiotic resistant, according to a study last week in Clinical Infectious Diseases.

The researchers analyzed data on more than 300,000 Campylobacter infections from 2004 through 2012. The average annual incidence rate (IR) was 11.4 cases per 100,000 people, with the rate varying from 3.1 to 47.6 by state. IRs among preschool children were double the overall rate. Overall IRs increased 21%—from 10.5/100,000 in 2004-06 to 12.7/100,000 in 2010-12.

Over the study period, 347 Campylobacter outbreaks were reported. The annual median number of outbreaks doubled, from 28 in 2004-06 to 56 in 2010-12.

Antimicrobial susceptibility testing of isolates from 4,793 domestic and 1,070 travel-associated cases revealed that ciprofloxacin resistance increased among domestic infections from 12.8% in 2004-09 to 16.1% in 2010-12, a 26% increase.

The authors conclude, "These data provide baseline rates for monitoring change now that campylobacteriosis is a nationally notifiable disease," which occurred in 2015.
Jul 20 Clin Infect Dis study

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