Stewardship / Resistance Scan for Oct 12, 2017

ASPs in long-term care
;
Contact precautions for MRSA, VRE
;
Antimicrobial restrictions
;
New CARB-X funding

Study shows ASP is effective, sustainable, in a long-term care hospital

An antimicrobial stewardship program (ASP) at a long-term acute care hospital in Detroit improved antimicrobial prescribing practices, reduced costs, and has proven to be sustainable, researchers report today in the American Journal of Infection Control.

The multi-part study, led by researchers from Detroit Medical Center-Wayne State University, included a survey of healthcare workers at the Kindred Hospital Detroit to assess knowledge and attitudes toward antimicrobial resistance (AMR), a retrospective review of common antibiotic prescribing practices before the ASP was implemented, and a two-phase post-implementation evaluation of the ASP's impact on antibiotic use and expenditures. Kindred's ASP, launched in November 2011, was a seven-step pyramid approach based on the Centers for Disease Control and Prevention's (CDC's) 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults.

The survey found that 65% of the 26 respondents viewed AMR as a national problem, but only 38% viewed it as a problem at their facility. And while 80% were familiar with multidrug-resistant infections like methicillin-resistant Staphylococcus aureus (MRSA), only 35% expressed confidence in caring for patients with such infections.

In the pre-ASP implementation phase, the researchers found that 43% of antibiotic courses administered to a cohort of 28 patients were inappropriate, 77% of opportunities for antibiotic de-escalation were missed, and 48% of antibiotic courses requiring early discontinuation because of misdiagnosis were not stopped. The total antibiotic cost for treating this cohort was $57,168, and the extra drug costs related to missed de-escalation opportunities and unnecessary days of therapy amounted to $23,540.

In the first post-implementation phase, there was a 42% and 58% decrease in the use daptomycin and tigecycline (the two most frequently used antibiotics in the pre-implementation phase), resulting in cost savings of $55,000. In the second post-implementation phase, the researchers demonstrated that from January through March in the years 2016 and 2017, total antibiotic costs were $26,837 and 22,397, respectively—more than $30,000 lower than the pre-ASP cost.

The authors say the findings indicate that the current ASP pilot model is effective and sustainable and can potentially be replicated at other long-term acute care hospitals.
Oct 12 Am J Infect Control study

 

Analysis: Ending contact precautions for MRSA, VRE doesn't increase infections

A systematic review and meta-analysis of 14 studies indicates that discontinuation of contact precautions (CPs) for MRSA and vancomycin-resistant enterococci(VRE) does not increase infection rates.

While CPs for infections caused by multidrug-resistant infections are recommended by the CDC and are considered an essential element of infection control and prevention in US hospitals, there has been little evidence to support the use of gloves and gowns in the prevention of MRSA and VRE infections in endemic settings, and questions have been raised about the impact of CP on patient care and safety. As a result, several hospitals have discontinued CPs for MRSA and VRE patients, and others are considering it.

To assess the impact of this policy, researchers from the University of Iowa reviewed 14 previously published quasi-experimental studies conducted at hospitals that had discontinued CPs for MRSA and VRE. When they pooled the results of these studies, the investigators found that discontinuation of CPs for MRSA was associated with a non-significant reduction in MRSA infection rates (pooled risk ratio [pRR], 0.84) and a statistically significant reduction in VRE infection rates (pRR, 0.82). 

"We think discontinuation of CPs (as currently practiced) for MRSA and VRE can be safely accomplished, particularly in hospitals with a strong horizontal infection prevention strategy, including high levels of compliance with hand hygiene," the authors write today in the American Journal of Infection Control.

They caution, however, that the results are limited by the design of the studies included in their review, and are not applicable to outbreak situations.
Oct 12 Am J Infect Control study

 

Research reveals opportunities for improving antimicrobial restriction

In a third study today in the American Journal of Infection Control, researchers with the Virginia Commonwealth University Health System report that antimicrobial restriction at an academic medical center led to significant decreases in consumption of restricted agents in more than half of the medical units studied, but in none of the surgical units.

In an analysis conducted at the 865-bed academic medical center from January 2013 through May 2015, the researchers looked at the use the restricted drugs linezolid, daptomycin, and ceftaroline and the non-restricted agent vancomycin. Use was quantified by individual hospital unit and unit type (medical vs. surgical) in days of therapy per 1,000 patient-days. A total of 11 units were analyzed.

In terms of the restricted antibiotics, significant reductions in consumption were detected in 4 of 7 medical units (57%), while increases were detected in 2 of 7 medical units (29%) and 1 of 4 surgical units (25%). No significant reductions in restricted antibiotics were detected in the surgical units. In addition, no significant reductions in vancomycin use were detected in any of the units, but significant increases were detected in 1 of 7 medical units (14%) and 1 of 4 surgical units (25%).

The authors say their analysis reveals opportunities for improving the hospital's antimicrobial restriction strategy, particularly in those units that demonstrated increases in consumption of restricted agents, and they suggest that the methodology may be useful to other programs assessing their restriction policies.
Oct 12 Am J Infect Control study

 

CARB-X awards $3.8 million to Entasis to develop novel antibiotic class

CARB-X today awarded $3.8 million in funding to Entasis Therapeutics, Inc. to develop its penicillin-binding protein (PBP) inhibitor program, according to a company press release.

The PBP inhibitor program is a novel antibiotic class that targets PBPs—groups of proteins that are essential to bacterial cell wall synthesis. While beta-lactam antibiotics kill bacteria by binding to these proteins, many types of gram-negative bacteria have evolved to produce beta-lactamase enzymes that inactivate these antibiotics. The non-beta-lactam PBP inhibitors developed by Entasis, however, are unaffected by all four classes of beta-lactamases.  The company says current leads in the program have demonstrated potent in vivo and in vitro activity against multidrug-resistant Pseudomonas aeruginosa, carbapenem-resistant Enterobacteriaceae, and multidrug-resistant Acinetobacter baumannii.

The award is the company's second from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership launched in 2016 to address gaps in new antibiotic development and funding, specifically in the pre-clinical phase. In March, Entasis received $2.1 million for development of ETX0282, an extended-spectrum beta-lactamase inhibitor.

"We are excited to extend our work with CARB-X following our initial partnership earlier this year and look forward to working together to bring these new anti-infective products through discovery into clinical trials," Entasis CEO Manos Perros, PhD, said in the release.

In addition to the $3.8 million in initial funding, Entasis could receive another $6.3 million from CARB-X if it hits certain milestones.

With today's announcement, CARB-X is now supporting 19 different projects in the pre-clinical phase of development. It aims to invest more than $450 million over 5 years, with a goal of accelerating the discovery and development of at least 20 new antibacterial products.
Oct 12 Entasis press release

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