Stewardship / Resistance Scan for Jan 17, 2018

Prescribing short antibiotic course
Drug-resistant bacteria in surfers

Survey: Most infection specialists don't recommend short antibiotic course

Most infection specialists currently do not advise the shortest possible duration of antibiotic therapy to prescribers, but nearly half are willing to shorten the duration most of the time, a French-led team of researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.

The findings are from a cross-sectional international survey conducted by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Antimicrobial Stewardship and the French Infectious Diseases Society. Infection specialists who gave at least weekly advice on antibiotic prescriptions were invited to participate in the online survey, which included 15 vignettes corresponding to common clinical cases with favorable outcomes. In the first part of the survey (A), the respondents were asked the usual recommendation they would make regarding antibiotic duration for each vignette, and in the second part (B) they were asked the shortest recommendation they would be willing to make for the same cases.

Overall, 866 participants from 58 countries responded to the survey, mostly members of an antibiotic stewardship team (73%), infectious disease specialists (58.7%), or clinical microbiologists (22.8%). Of the 86.5% of respondents (749/866) who were eligible for part A, 36.2% (217/749) recommended a short duration of antibiotic therapy (compared with the literature) in more than 50% of the vignettes, and 4.1% (31/749) recommended a short duration in more than 75% of the cases. Among all answers, short durations of antibiotic therapy were recommended in 42.7% of cases. In multivariable analysis, having fixed durations of antibiotic treatment in regional/national guidelines was independently associated with recommending a short duration (adjusted odds ratio, 1.5).

Of the 76.4% (622/866) of participants eligible for part B, 47.1% (316/622) were willing to shorten treatment duration for at least 50% of the vignettes.

"It is encouraging that almost half of the participants were ready to shorten durations of treatment, as it suggests that these infection specialists, who are frequently antibiotic stewards, are ready to promote strategies aimed at reducing duration of antibiotic therapy," the authors write. "Nevertheless, our results also show that the rest of the participants, who represent the majority, should be the target of specific educational and awareness initiatives, if they are to act as leaders and role models to promote such a strategy."    
Jan 16 J Antimicrob Chemother study


UK study finds surfers more likely to be colonized with resistant bacteria

A first-of-its-kind study combining surveillance of antibiotic-resistant bacteria in bathing waters and human exposure estimates has found that surfers are more likely to be colonized by drug-resistant bacteria than non-surfers, UK scientists report in the journal Environment International.

The study, conducted by researchers from the University of Exeter Medical School, aimed to estimate the prevalence of Escherichia coli harboring the extended-spectrum beta-lactamase (ESBL) gene blaCTX-M in waters along the UK coastline. CTX-M genes represent nearly 80% of ESBLs in clinical isolates and can encode resistance to multiple antibiotics. Previous research has indicated that ingesting seawater containing antibiotic-resistant E coli is associated with gut colonization by these bacteria, and that swimming is a risk factor for urinary tract infections caused by ESBL-producing bacteria.

In the first section of the study, the researchers conducted an environmental assessment, collecting 97 coastal water samples to analyze for the proportion of E coli harboring blaCTX-M. The results indicated that, on average, 0.07% of E coli in the coastal waters of England and Wales carry blaCTX-M. They then estimated the risk of exposure to these bacteria among coastal water users, based on the likely number of exposure events, E coli density data in English and Welsh coastal waters, and estimates of the volume of water that water users ingest. They calculated that more than 2.5 million water sport sessions occurred in England and Wales in 2015 that resulted in people ingesting blaCTX-M-harboring E coli, and that surfers were at particularly high risk.

In the third section of the study, rectal swabs were collected from 143 surfers (defined as frequent surfers, body boarders, and body surfers) and a control group of 130 people with very little exposure to seawater. Analysis of the swabs showed that 13 of 143 surfers (9.1%) were fecal carriers of E coli that were phenotypically resistant to cefotaxime, compared with 4 of 130 non-surfers (3.1%), for a risk ratio (RR) of 2.95. Nine of 143 surfers (6.3%) were found to be carriers of blaCTX-M-harboring E coli, compared with 2 of 130 controls (1.5%)—an RR of 4.09.

"While surfers colonised by potentially pathogenic [antibiotic-resistant bacteria] may by asymptomatic, gut bacteria are a major source of infection, and these bacteria may cause problems if colonised individuals develop a health condition in the future that makes them more susceptible to infections," the authors write. They add that further research is needed to investigate the role of coastal waters and other natural environments in the transmission of antibiotic-resistant bacteria.
Jan 14 Environ Int study

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