Stewardship / Resistance Scan for Jan 10, 2018

C difficile decline
Antibiotics in nursing homes
Environmental health risks

CDC says C diff cases in long-term care facilities have dropped sharply

A study yesterday by experts from the US Centers for Disease Control and Prevention (CDC) found that the incidence of Clostridium difficile in long-term care facilities decreased 17.5% annually from 2011 to 2015 at 10 US sites, along with a concomitant decline in inpatient fluoroquinolone use.

C difficile infection, a largely healthcare-related disease, can cause severe symptoms and death, the CDC says, with states reporting increased cases in US hospitals in recent years.

Writing in the American Journal of Infection Control, the CDC researchers said they analyzed data from 10 labs serving the agency's Emerging Infections Program (EIP) in 10 states during the 5-year period. The number of C difficile infections in long-term care facilities dropped from 3,151 in 2011 to 1,909 in 2015, for an overall decrease of 49%. The decline ranged from 6% to 65% by EIP site. The adjusted annual decrease across the country was 17.5%.

The researchers reported that the rate of the NAP1/027 epidemic strain likewise dropped, from constituting 29% of all C difficile strains in 2011 to accounting for only 18% in 2015. Fluoroquinolone use dropped a full 25 days of therapy per 1,000 patient-days.

The authors concluded, "A concomitant decline in inpatient fluoroquinolone use and the C difficile epidemic strain NAP1/027 among persons aged ≥65 years may have contributed to the decrease in long-term-care facility-onset C difficile infection incidence rate."
Jan 9 Am J Infect Control study


Study notes high antibiotic use in nursing homes linked to confusion

A study today in the Journal of the American Geriatrics Society reports high antibiotic use in nursing homes, especially for urinary tract infections (UTIs), with patient confusion tied to antibiotic treatment for suspected UTI.

Researchers reviewed the charts of 450 residents of five nursing homes in northern Queensland, Australia, from Aug 28, 2015, through Jun 21, 2016, to determine the prevalence of documented UTI, nonspecific and specific UTI symptoms, antibiotic use, and other factors.

They found that UTI accounted for 33% of all infections treated with antibiotics and 40% of all infections treated with antibiotics in the past 30 days. They also found that 20% of residents had received antibiotics in the past 30 days, 45% of which were for UTI. At the time of review, 40 residents (9%) were currently on antibiotics, of which 16 (40%) were for a UTI.

The investigators also found that new or worsening confusion was found to be strongly associated with urinary frequency (odds ratio [OR], 33), current UTI antibiotic prescription (OR, 15), and having a full blood count measured (OR, 8.6).

Lead author Sean Mayne, MD, of James Cook University, in Cairns, Australia, said in a Wiley news release, "Suspected UTI is the most common reason for antibiotic prescription in nursing home residents, often a presumptive diagnosis based on non-specific symptoms, which makes it a key target for reducing inappropriate antibiotic prescriptions."
Jan 10 J Am Geriatr Soc study
Jan 10 Wiley
news release


UN Environment-WHO collaboration to tackle environmental health issues

United Nations (UN) Environment and the World Health Organization (WHO) have established a new collaboration to accelerate steps to curb environmental health risks—including antimicrobial resistance—that cause an estimated 12.6 million deaths a year, the two agencies said in a press release today.

Today in Nairobi, Erik Solheim, head of UN Environment, and WHO Director-General Tedros Adhanom Ghebreyesus, MD, signed an agreement to ramp up joint efforts to combat air pollution, climate change, and antimicrobial resistance, as well as to improve coordination on waste and chemicals management, water quality, and food and nutrition issues.

Although the two agencies cooperate on a range of concerns, today's measure represents their most significant formal agreement across the spectrum of environment and health issues in more than 15 years, according to the release. "There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate—which are the foundations for life on this planet," said Solheim.

The two agencies will develop a joint work program and hold annual meetings to evaluate progress and make recommendations. The collaboration creates a more systematic framework for joint research, development of tools and guidance, capacity building, global and regional partnerships, and other approaches.
Jan 10 UN Environment news release

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