Stewardship / Resistance Scan for Sep 11, 2017

Antibiotics for asthmatic children
Drug resistance in the ICU

More children with asthma getting unnecessary antibiotics, study finds

New research presented today at the annual meeting of the European Respiratory Society (ERS) indicates that children with asthma are more likely to be prescribed antibiotics than those without a diagnosis of asthma, even though antibiotics are not recommended for asthma treatment.

The study, presented by Esme Baan, MD, of Erasmus University in the Netherlands, compared antibiotic prescription data for 1.5 million children from the United Kingdom, including 150,000 with asthma, and 375,000 from the Netherlands, including approximately 30,000 with asthma. The patients, ages 5 to 18 years, were identified from population-based primary care databases in both countries.

Baan and her co-authors found that 197 antibiotic prescriptions were dispensed per 1,000 children with asthma per year in the Netherlands, compared with 126 prescriptions per 1,000 children without asthma. The United Kingdom saw 374 antibiotic prescriptions per 1,000 children with asthma annually, compared with 250 prescriptions per 1,000 children without asthma. In both countries, amoxicillin was the most commonly prescribed antibiotic.

Baan said in a news release that their analysis found most of the antibiotic prescriptions in the asthmatic children were linked to asthma exacerbations or bronchitis—conditions often caused by a virus.

"It can be difficult for a GP [general practitioner] to differentiate between a deterioration in asthma symptoms and a bacterial respiratory infection," Baan said. "We think this might be leading to more antibiotic prescriptions in children with asthma."

The Netherlands and the United Kingdom both follow the same international guidelines on asthma treatment, which state that antibiotics should not be given for deterioration in asthma symptoms. Baan says she suspects the situation may be similar in other countries.
Sep 11 ERS International Congress 2017 news release
Sep 11 MedPage Today story


Environmental hygiene cited as key to combating resistant bacteria in ICU

Clinicians in Spain were able to combat a simultaneous intensive care unit (ICU) outbreak of OXA-48–producing Enterobacteriaceae (OXA-48-PE) and multidrug-resistant Acinetobacter baumannii (MRAB) by focusing on environmental hygiene and other measures, according to a new study in the American Journal of Infection Control.

The authors describe on outbreak from July to October 2015 that involved 13 patients colonized or infected by OXA-48-PE and 18 by MRAB in an ICU. Interventions included patient isolation, daily hygiene with 4% chlorhexidine soap, and contact precautions. An in-depth cleaning of the ICU was performed with a chlorine solution, followed by decontamination with vaporized hydrogen peroxide (VHP). Researchers obtained environmental samples before and after the decontamination.

The cumulative incidence of OXA-48-PE and MRAB was 3.48% and 4.81%, respectively, before interventions. In the period after the intervention, the rates were 0.8% and 0%, respectively. Before the VHP biodecontamination, 4.5% of environmental samples were positive for OXA-48-PE and none for MRAB. After biodecontamination, 1.4% of samples were positive for OXA-48-PE and none for MRAB.

The authors conclude, "This study emphasizes the importance of environmental hygiene in the control of outbreaks caused by microorganisms of high environmental impact. The rapid effect after the VHP treatment suggests an influence of this measure in eradication."
Sep 8 Am J Infect Control study

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