Stewardship / Resistance Scan for Nov 27, 2017

Protecting the gut from antibiotics
Cost of C diff in kids
MDR-TB in Europe

Activated charcoal may help protect gut microbiome from antibiotics

The results of a small phase 1 clinical trial show that an activated charcoal product helped protect the gut microbiome in volunteers treated with moxifloxacin, French researchers report in the Journal of Infectious Diseases.

The product, called DAV132, was developed as a potential strategy to protect the gut microbiome from the deleterious effects of non-absorbed antibiotics, which can wipe out beneficial bacteria in the gut and result in Clostridium difficile infection and the selection of antibiotic-resistant bacteria. It contains 5.11 grams of activated charcoal as the active absorbing ingredient. A previous phase 1 trial had shown that DAV132 could deliver a powerful non-specific absorbent to the late ileum of healthy volunteers and did not affect the plasma pharmacokinetics of the antibiotic amoxicillin.

For the randomized controlled trial, investigators recruited 28 healthy volunteers and randomized them to receive moxifloxacin alone or with DAV132 for 5 days. Two control groups of 8 volunteers, each receiving either DAV132 alone or a non-active substitute, were added. The primary objective was to evaluate the influence of DAV132 on free fecal moxifloxacin concentrations.

The investigators found that the combination of moxifloxacin and DAV132 reduced free moxifloxacin fecal concentrations by 99% compared with moxifloxacin alone, without affecting the plasma pharmacokinetics of the antibiotic or causing serious adverse effects. In addition, co-administration of DAV132 largely protected the richness and composition of the intestinal microbiota of the moxifloxacin-treated volunteers. DAV132 also showed it could absorb a wide range of antibiotics in ex vivo tests.

The authors conclude, "DAV132 may constitute a breakthrough product to prevent short- and long-term detrimental effects of antibiotic treatments." They say further studies are under way to evaluate DAV132's clinical potential.
Nov 23 J Infect Dis abstract

US pediatric C diff cases in hospitals cost thousands, study finds

Using a large US pediatrics database, researchers determined that the cost of a Clostridium difficile infection (CDI) in a hospitalized child ranged from almost $2,000 to over $8,000, depending on the length of stay, according to a study today in Infection Control and Hospital Epidemiology.

The investigators used a logistic regression model to predict CDI during hospitalization based on data from 8,527 pediatric hospitalizations with a diagnosis of CDI and 1,597,513 discharges of patients who did not have a CDI diagnosis. They found that that the cost attributed to CDI ranged from $1,917 to $8,317, depending on whether the team used a model adjusted for length of stay or not. The average hospital stay for CDI was about 4 days.

The authors concluded, "Clostridium difficileinfection in hospitalized children is associated with an economic burden similar to adult estimates. This finding supports a continued focus on preventing CDI in children as a priority."
Nov 27 Infect Control Hosp Epidemiol abstract


Report finds MDR-TB burden low in European children

European scientists reported late last week in Eurosurveillance that the burden of multidrug-resistant tuberculosis (MDR-TB) appears to be low in European children but could be underestimated because of challenges with lab confirmation.

From surveillance data from 2007 through 2015, the researchers reported 18,826 pediatric TB cases, of which 4,129 (21.9%) were lab-confirmed. Of the 3,378 cases for which drug-susceptibility data were available, 249 (7.4%) were single-drug-resistant TB, 64 (1.9%) were poly-resistant TB, 90 (2.7%) were MDR-TB, and 8 (0.2%) were extensively drug-resistant.

Children with a foreign background had almost double the risk of MDR-TB, while those with previous TB treatment had a more than sixfold-higher risk. Successful treatment outcome was reported for 58 (78.4%) of 74 pediatric MDR-TB cases that had outcome information available. Children aged 5 to 9 years old were the only group significantly associated with unsuccessful treatment outcome.

The authors concluded, "The burden of MDR TB in children in the EU/EEA appears low, but may be underestimated owing to challenges in laboratory confirmation. Diagnostic improvements are needed for early detection and adequate treatment of MDR TB."
Nov 23 Eurosurveill study

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