Stewardship / Resistance Scan for Aug 16, 2017

MDR- and XDR-TB in China
Patient empowerment tool for hand hygiene

Study finds poor treatment outcomes for MDR- and XDR-TB patients in China

A study today in BMC Infectious Diseases reports that patients with multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB) in China's Hunan province had low rates of treatment success.

The aim of the retrospective study, which used data from patients in Hunan province who were treated for TB from 2011 through 2014, was to assess treatment outcomes for patients with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least one second-line injectable drug) and identify factors associated with poor treatment outcomes. Information about patients with drug-resistant TB in China, one of the top 30 MDR-TB and TB burden countries in the world, is limited.

Of the 481 bacteriologically-confirmed patients, 10 (2%) had XDR-TB and 471 (98%) had MDR-TB. Evaluation of treatment outcomes showed that 262 patients (54%) were cured, 14 (3%) completed treatment, 13 (3%) died, 63 (13%) had treatment failure, and 130 (27%) were lost to follow-up. For the entire cohort, the treatment success rate was 57% (n=275), with a success rate of 58% for MDR-TB (n=272) and 30% for XDR-TB (n=3 patients). Resistance to oxifloxacin was an independent predictor of poor treatment outcomes (associated hazard ratio [AHR] = 3.1) and unfavorable treatment outcomes (AHR = 1.7), and those patients who started treatment during 2011-2012 had nearly three times the risk of treatment failure (AHR = 2.8) as those who started treatment in 2014.

The authors note that while the overall treatment success rate of 57% for MDR- and XDR-TB patients in Hunan province is consistent with reported global (52%) and national (56%) MDR-TB treatment success rates, it is still far short of the World Health Organization target of 75% treatment success.

"This low rate of treatment success among MDR-TB patients poses a serious threat for national TB control efforts as patients may develop additional resistance and may also transmit drug resistant forms of TB to others," they write.
Aug 16 BMC Infect Dis study

Surveys examine patients' role in promoting hand hygiene

A study yesterday in the American Journal of Infection Control suggests most parents and adult patients feel it's their role to remind healthcare providers to perform hand hygiene, while providers are less open to the idea.

In the study, researchers at a tertiary care teaching hospital in Morgantown, W. Va., performed a cross-sectional survey of parents of hospitalized children, adult patients, and primary care physicians to examine their attitudes toward a new patient empowerment tool (PET) that can be used by patients to remind doctors and nurses to wash their hands. The PET, introduced in 2015, consists of a picture with a reminder phrase (eg "Did you wash your hands?") attached to a tongue depressor. From 2015 to 2016, hand hygiene rates at the hospital increased from 48% to 75%.

A total of 222 parents and adult patients responded to the survey (114 parents and 108 adult patients). Parents were more likely than adult patients to feel that it's their role to speak up if a physician (95.6% vs. 77.6%) or a nurse (99.1% vs. 86.0%) did not perform hand hygiene. A smaller number of parents (77% for physicians and 81.4% for nurses) and adult patients (64.8% for physicians and 71.2% for nurses) felt comfortable using the PET to remind healthcare workers to perform hand hygiene.

Of the 89 physicians who responded to the survey (29 residents 60 attending physicians), only 54.9% (65.5% of resident physicians and 49.0% of attending physicians) agreed that patients should be involved in reminding providers to perform hand hygiene. Of the physicians who did not support patient involvement, 37% felt it was not the patient's responsibility to remind them to perform hand hygiene, 16.2% said it was embarrassing to the doctor, and 13.5% said it would negatively affect the doctor patient relationship. Physicians said they would be more likely to sanitize their hands if a patient made a verbal request rather than using the PET.

"Health care providers should not see patient participation as a threat, but instead as another tool to improve patient care," the authors write. "We should work to make patients and families more comfortable in participating in their care, but even more importantly, we need to change the culture of medicine."

Hand hygiene is considered the single most effective measure to reduce health-associated infections, which occur in 5% to 10% of patients admitted to acute care hospitals in the United States.
Aug 15 Am J Infect Control study

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