ASP Scan (Weekly) for Oct 06, 2017

Antimicrobial use in Danish animals
UTI susceptibility test
Kidney injury and antibiotics

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Antimicrobial use in Danish animals drops for 3rd straight year

Total antimicrobial consumption in Danish food and companion animals has fallen for the third consecutive year, according to the annual DANMAP report that is based on 2016 data. It's from researchers at Statens Serum Institut and from the National Veterinary Institute and the National Food Institute, both departments at the Technical University of Denmark (DTU).

In 2016, total antimicrobial consumption in kilograms was down about 5% in Danish animals, compared with a drop of 4% in 2015 and 2% in 2014. And overall antimicrobial use has declined 10% since 2013, which is the equivalent of 12 tons of drugs, according to a DTU National Food Institute news release yesterday.

The 2016 reduction was substantially driven by a 4% reduction in antimicrobial use in swine production compared with 2015, as pig production in Denmark constitutes about 85% of the country's meat production and about 75% of veterinary-prescribed drugs.

After 2 years of much higher than normal drug use in poultry because of serious outbreaks in poultry, antimicrobial use in that industry dropped 36% from 2015 levels. And use in aquaculture was at its lowest in a decade in 2016, the report noted.

Antimicrobial use in pets increased slightly from 2015 to 2016 but has generally decreased in the past 5 years, especially regarding the consumption of third- and fourth-generation cephalosporins.

"A reduction in the use of antimicrobials is necessary if we are to tackle the problem of antimicrobial resistant bacteria," division head Flemming Bager with the National Food Institute said in the release. "The Danish Veterinary and Food Administration has in recent years implemented several initiatives to limit consumption, and it is positive to see that the downward trend in consumption continues."
Oct 5 DTU National Food Institute news release


Scientists develop rapid susceptibility test for urinary tract infections

Originally published by CIDRAP News Oct 4

California researchers have developed a rapid test to detect antibiotic susceptibility in urinary tract infections (UTIs) in less than 30 minutes, which could allow patients to be diagnosed and prescribed effective antibiotics during just one healthcare visit, according to a study today in Science Translational Medicine.

The team of scientists used an ultrafast single-molecule DNA amplification and quantification method called digital real-time loop-mediated isothermal amplification (dLAMP), which directly counts bacterial genomes in urine samples instead of relying on lab cultures, which can take days. The researchers diluted and incubated the samples for 15 minutes before dLAMP testing, which takes about 7 minutes. The dLAMP analysis calculated the ratios of DNA concentration between untreated samples and those treated with antibiotics to determine susceptibility and resistance levels among UTI pathogens.

The researchers validated the test using 51 clinical samples that had already been confirmed as either susceptible or resistant to ciprofloxacin or nitrofurantoin.

UTIs, which almost always are treated with antibiotics, account for about 8 million primary care visits a year, and antibiotic resistant infections are a growing threat, the authors note.

They conclude, "Here, we solved three problems to determine phenotypic antibiotic susceptibility in clinical samples within 30 min. First, we used digital quantification of a DNA marker to reduce the antibiotic exposure time to 15 min. Second, we showed that dAST [digital antimicrobial susceptibility testing] is robust to the presence of commensal bacteria and clinical urine matrices. Third, we developed and optimized a rapid, high-resolution measurement method for quantifying NA [nucleic acid] targets that shortens the measurement step to less than 10 min."
Oct 4 Sci Transl Med abstract


Acute kidney injury tied to combo antibiotics in hospitalized kids

Originally published by CIDRAP News Oct 3

Researchers from Philadelphia and Cincinnati yesterday reported a potential tripling of the risk of acute kidney injury in children administered intravenous (IV) vancomycin combined with piperacillin/tazobactam, according to their study in JAMA Pediatrics.

The retrospective cohort study included 1,915 children hospitalized for 3 or more days and prescribed IV vancomycin plus one other antipseudomonal beta-lactam combination therapy at six large US children's hospitals from Jan 1, 2007, through Dec 31, 2012. Patients with underlying kidney disease or abnormal serum creatinine levels on hospital days 0 to 2 were excluded from the analysis.

Of the 1,915 patients, 157 (8.2%) had antibiotic-associated acute kidney injury. After adjusting for various potential confounders, the investigators determined that the adjusted odds ratio for sustaining such injuries after receiving IV vancomycin plus piperacillin/tazobactam was 3.4 compared with IV vancomycin plus other beta-lactam combo therapies.

The authors conclude, "Pediatricians must be cognizant of the potential added risk of this combination therapy when making empirical antibiotic choices."
Oct 2 JAMA Pediatr study

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