Stewardship / Resistance Scan for Jan 18, 2018

ICU antimicrobial stewardship
Drug-resistant gonorrhea

Spanish clinicians report successful ICU stewardship program

An antimicrobial stewardship program (ASP) in an intensive care unit (ICU) in a Spanish hospital was associated with a 22% drop in antimicrobial doses, according to a new study in Antimicrobial Agents and Chemotherapy.

Investigators evaluated defined daily doses (DDDs) of antimicrobials per 1,000 patient-days and days of therapy (DOT) per 100 occupied bed-days in a Barcelona ICU before and after ASP implementation (2007-2010 vs. 2011-2015). They also measured associated costs. Data were compiled on 1,971 patients in the pre-ASP period and on 3,031 patients after ASP implementation.

The researchers reported that the percentage of patients treated with one or more antimicrobials dropped from 88.6% to 77.2%, DDDs decreased from 246.8 to 192.3, or 22.1%, and DOT were reduced from 66.7 to 54.6 (an 18.1% drop). The mean cost per trimester decreased from €115,543 ($141,302) to €73,477 ($89,858), a €42,065 ($51,443) savings, and the percentage of the total cost of hospital antimicrobials attributed to ICU antimicrobials decreased from 28.5% to 22.8%.

The cost savings over the 5 years that the program was implemented amounted to almost €1 million ($1.2 million).
Jan 16 Antimicrob Agents Chemother study


German study finds varying antibiotic resistance levels in gonorrhea

A German study published yesterday in BMC Infectious Diseases found low levels of cephalosporin resistance in gonorrhea cases, but resistance was moderate to high against other antibiotics.

Researchers with the country's Gonococcal Resistance Network surveillance system analyzed susceptibility data on samples collected from patients from April 2014 to December 2015. All told, 90% of the 537 Neisseria gonorrhoeae isolates were from men, with a median age of 32 for men and 25 for women.

None of the isolates were resistant to ceftriaxone, and 1.9% (in 2014) and 1.4% (in 2015) of the isolates were resistant to cefixime. But 11.9% and 9.8% of samples showed resistance against azithromycin in 2014 and 2015, respectively, compared with 72.0% and 58.3% for ciprofloxacin and 29.1% and 18.8% for penicillin.

The authors concluded, "Continued surveillance of antimicrobial drug susceptibilities for N. gonorrhoeae remains highly important to ensure efficient disease management."
Jan 17 BMC Infect Dis study

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