Stewardship / Resistance Scan for Feb 07, 2018

Antimicrobial prescribing survey
Antibiotic-resistant gonorrhea
Insurers and antibiotic stewardship

Survey finds knowledge and practice gaps among antibiotic prescribers

An online survey of frontline prescribers found mostly positive attitudes toward antimicrobial stewardship programs (ASPs) but also identified several specific deficiencies related to knowledge, prescribing practices, and awareness of available resources, according to a study yesterday in Infection Control and Hospital Epidemiology.

The anonymous online survey of antimicrobial prescribers was administered in 2015 at five acute care hospitals within a hospital network in New York. The 49-item survey included questions to assess the knowledge, attitudes, and practices of prescribers related to different aspects of antimicrobial prescribing. The objective of the survey was to identify opportunities for education and other interventions to optimize prescribing practices.

A total of 402 respondents completed the survey. The vast majority of respondents (89%) agreed that antimicrobial resistance is a problem, and almost all agreed that ASPs can reduce resistance (96%) and improve patient care and safety (94%). Yet 32% felt that their hospital's ASP delayed care.

In addition, several knowledge and practice gaps were identified. Nearly one third (32%) of respondents "usually" or "always" liked to use the most broad-spectrum antibiotics possible, and 29% chose an unnecessarily broad-spectrum antibiotic for treating Escherichia coli urinary tract infection with susceptibilities that were provided in the survey. Some respondents lacked confidence in selecting empiric therapy using hospital antibiograms (30%), interpreting susceptibility results (24%), de-escalating therapy (18%), and determining duration of therapy (31%). Only 55% reported always reviewing antimicrobial appropriateness at 48 to 72 hours.

Nearly half (45%) of respondents believed they had not received adequate training regarding antimicrobial prescribing, and 23% said they were unaware of local web-based empiric treatment guidelines.

"The results of this survey demonstrate that prescriber education is an important role of the ASP team and that there is no 'one size fits all' approach to education," the authors write. "Understanding the facilitators of and barriers to appropriate antimicrobial prescribing within a healthcare facility and among prescribers is critical to the successful implementation of ASPs."
Feb 6 Infect Control Hosp Epidemiol study


Chinese surveillance data show substantial gonorrhea resistance levels

An analysis of gonorrhea isolates from seven provinces across China found substantial resistance to azithromycin and decreased susceptibility to ceftriaxone, the two drugs recommended as first-line treatment for the disease in many countries but not as yet in China.

Chinese scientists conducted antibiotic susceptibility and resistance testing on 3,849 clinical Neisseria gonorrhoeae isolates from patients from 2013 to 2016. Defining resistance to azithromycin as a mean inhibitory concentration (MIC) of 1.0 milligrams per liter (mg/L) or higher and decreased susceptibility to ceftriaxone as an MIC of 0.125 mg/L or higher, they found an 18.6% resistance rate to azithromycin and a 10.8% prevalence of decreased susceptibility to ceftriaxone.

Overall prevalence of both qualities was 2.3% but increased from 1.9% to 3.3% over the study period, as reported yesterday in PLoS Medicine.

The authors conclude, "To our knowledge, this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. . . . Although dual therapy with azithromycin and ceftriaxone has been recommended by [the World Health Organization] and many countries to treat gonorrhea, reevaluation of this therapy is needed prior to its introduction in China."

Monotherapy with ceftriaxone for uncomplicated gonorrhea is still the recommended regimen in China, the study authors say.
Feb 6 PLoS Med study


Aetna highlights its efforts to fight antimicrobial resistance

Healthcare benefits provider Aetna International has released a new white paper on the antimicrobial resistance crisis that highlights some of the strategies the company is using to address the problem.

One of the initiatives the company has undertaken with US healthcare providers focuses on acute bronchitis in adults. Using claims data, Aetna identified more than 1,000 providers who were overprescribing for the condition, which is generally viral in nature and doesn't benefit from antibiotics. Aetna researchers then sent letters to these providers that detailed their position relative to their peers and included information on antibiotic resistance from the Centers for Disease Control and Prevention.

In India, the company is taking a three-stage approach that emphasizes antimicrobial stewardship in clinical training, auditing of medical consultations and prescribing practices, and counseling patients about appropriate antibiotic use. Aetna says it's also supporting efforts by accrediting bodies to make antimicrobial stewardship a standard in hospitals and outpatient settings alike.

According to the paper, these and other efforts helped reduce antibiotic use across Aetna's membership population from 27% in 2014 to 18% in 2016.

"We at Aetna International are doing our part through proactive education, early intervention, data analysis, and an emphasis on value-based care," the company says in the paper. "We invite our members, customers, providers, and everyone else who is affected by this crisis—in other words, everyone on the planet—to join us."
Feb 1 Aetna International white paper

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