Stewardship / Resistance Scan for Jul 31, 2017

Stewardship in US hospitals
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Resistant E coli
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Death and MDR-TB

Study: US comprehensive hospital ASP programs grew by 18% in 1 year

A new study from researchers at the US Centers for Disease Control and Prevention (CDC) assessed the success of the CDC's core elements of hospital antimicrobial stewardship programs (ASPs). Using data reported in the 2015 National Healthcare Safety Network's Annual Hospital Survey, the researchers found that uptake of the core elements increased from 40.9% in 2014 to 48.1% in 2015, a 17.6% bump. The results were published Jul 29 in Clinical Infectious Diseases.

The core elements are antimicrobial stewardship program leadership, accountability, drug expertise, action, tracking, reporting, and education. All hospitals included in the survey self-reported on activity for each element.

A total of 4,569 hospitals participated in the survey, with an average bed size of 164. Of the respondents, 48.1% reported uptake from all seven of the core elements, with nearly half of all larger hospitals reporting increases in antimicrobial stewardship programs. Teaching hospitals were 1.5 times more likely to implement all of the core elements, as were large facilities.

"Hospitals in the U.S. are making progress towards a national goal of universal presence of ASPs, but faster progress is needed. Efforts to support smaller hospitals will be especially important," the authors said.
Jul 29 Clin Infect Dis study

 

Study reports high drug resistance in Shiga toxin-producing E coli

High frequencies of antibiotic resistance were observed in strains of Shiga toxin–producing Escherichia coli (STEC) recovered from patients in Michigan during 2010 to 2014, researchers report in Emerging Infectious Diseases.

Of the 358 STEC isolates recovered from the Michigan Department of Health and Human Services Reference Laboratory, 31 (8.8%) were resistant to antibiotics. Eight of the isolates were O157, the strain that causes most foodborne illnesses in the United States, and 23 were non-O157. Resistance to ampicillin (7.4%) was most common, followed by trimethoprim/sulfamethoxazole (4.0%), and ciprofloxacin (0.3%). One strain was resistant to all drugs.

Notably, researchers found that resistance was twice as common for non-O157 (11.1%) than for O157 (5.5%) strains, and was independently associated with hospitalization (odds ratio, 2.4), indicating that resistance could cause more severe disease outcomes.

The authors also noted higher O157 resistance frequencies in Michigan compared with the rest of the nation, a finding they said indicates that selection pressures vary by location and source. And while no differences in resistance frequencies were observed for counties with high versus low antibiotic prescription rates, the authors suggest that selection pressure from antibiotic use on farms—not investigated in this study—may be affecting emerging STEC resistance in Michigan.

STEC contributes to 265,000 cases of foodborne illness annually in the United States.
Jul 28 Emerg Infect Dis research letter

 

US data show sharp decline in deaths among MDR-TB patients

Death rates from multidrug-resistant tuberculosis (MDR-TB) have fallen by almost two-thirds in recent years, according to a study from CDC experts published in Clinical Infectious Diseases.

The investigators analyzed data from 1993 through 2013 from the CDC's National Tuberculosis Surveillance System and assessed factors associated with all-cause mortality. The database contained information on 3,434 MDR-TB cases, 96% of which involved adults.

The researchers found that the all-cause mortality rate decreased from 31% during 1993 through 2002 to 11% in 2003 through 2013. In addition, coverage of directly observed therapy, a key to successful, complete treatment, increased from 74% to 95% in the two study periods. The researchers also found that the effect of HIV on mortality greatly decreased from the earlier period to the latter.

Despite the apparent success of directly observed therapy, the authors point out that foreign-born MDR-TB patients living with HIV still have twice the risk of death compared with US-born patients with MDR-TB and HIV.
Jul 29 Clin Infect Dis study

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