Stewardship / Resistance Scan for Dec 11, 2017

Asymptomatic bacteriuria treatment guide
;
Antimicrobial resistance workshop

Interventions to reduce overtreatment of asymptomatic bacteriuria noted

A paper today in JAMA Internal Medicine proposes an evidence-based implementation guide to help reduce inappropriate treatment of asymptomatic bacteriuria (ASB).

Despite efforts to reduce the practice, treatment of ASB—defined as isolation of bacteria in an uncontaminated urine specimen in the absence of urinary tract infection symptoms—remains prevalent across settings and frequently leads to inappropriate antibiotic prescribing. A multicenter retrospective review of three US hospitals found that 38% of in patients with ASB were treated with antibiotics the day of a positive urine culture report, and 43% were treated by the fourth day.

To come up with an implementation guide that could help clinicians reduce ASB overtreatment, a team of researchers from Johns Hopkins, Sinai Health System, and the University of Toronto first reviewed the evidence behind supporting reduced treatment of ASB. Based on that evidence, they determined that efforts to reduce inappropriate treatment of ASB in low-risk populations (excluding pregnant women and patients undergoing invasive urologic procedures) can reduce preventable harm from unnecessary antibiotic exposure.

The team then looked at safety and quality outcomes data for different interventions aimed at reducing ASB treatment. From those data, they determined that the most successful interventions used a multimodal approach that combined the following elements: education, audit and feedback, withholding routine urine culture reports, and clinical decision support tools and protocols.

"While the interventions described in this guide have proven efficacy in certain settings, we acknowledge the importance of context and encourage teams to select and adapt specific interventions that best suit the needs and resources specific to the institution," the authors write. "In reality, a bundle of interventions may be needed to address different contributors to the problem specific to the local setting."
Dec 11 JAMA Internal Med paper

 

New National Academies publication details AMR workshop proceedings

The National Academies of Sciences, Engineering, and Medicine (NAS) have released a new document summarizing the presentations and discussions at a 2-day workshop on antimicrobial resistance (AMR) held earlier this year.

The workshop, held Jun 20 and 21 in Washington, DC, brought together experts in infectious disease, microbiology, and human and animal health to explore the issue of AMR through the One Health lens, which views the health of humans, animals, and the environment as interconnected. The workshop was convened to examine short-term actions and research needs that are feasible and cost-effective and will have the greatest effect on reducing AMR.

Among the topics explored were the implications and effects on human health of the movement of resistance genes across different ecosystems; the expected effect of new US regulatory policies regarding the use of antibiotics in food animals; the role and effectiveness of antibiotic stewardship programs in reducing and preventing AMR, and the importance of data availability and data sharing for evaluating stewardship strategies; strategies for maintaining the effectiveness of existing drugs, for developing new drugs and diagnostics, and for implementing disease prevention steps; and the need for national and international collaboration.

The document contains the opinion of the presenters, but it does not reflect the conclusions of the Health and Medicine Division of the NAS.
Dec 8 National Academies proceedings of AMR workshop

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