Stewardship / Resistance Scan for Feb 16, 2018

Carbapenem-resistant infections
Hospital stewardship savings

Trial finds no benefit of combo drugs for severe carbapenem-resistant infections

In patients hospitalized with serious infections from carbapenem-resistant gram-negative bacteria, a combination of colistin and meropenem wasn't associated with fewer clinical failures compared with colistin alone, researchers reported today in The Lancet Infectious Diseases.

The randomized controlled open-label trial was conducted from October 2013 through December 2016 and included 406 patients from six hospitals in Israel, Greece, and Italy who mainly had ventilator-associated pneumonia, hospital-acquired pneumonia, or bloodstream infections caused by carbapenem-resistant Acinetobacter baumannii.

Among the group, 156 were randomized to colistin alone and 152 received colistin plus meropenem. After evaluating the patients 14 days after treatment, the researchers found no significant difference in clinical failure between the two groups. They observed that combination therapy increased diarrhea incidence but decreased the incidence of mild renal failure.

The team concluded that the combination treatment wasn't superior in severe A baumannii infections and that the trial wasn't powered to assess the impact on other bacteria.

In a related commentary in the same issue, two experts from the Case VA Center for Antimicrobial Resistance and Epidemiology and Case Western Reserve University School of Medicine in Ohio wrote that the findings are consistent with other similar studies of colistin combination therapies.

They said the findings don't close the door on combination therapy for carbapenem-resistant A baumannii or other gram-negative bacteria, because certain genotypes or phenotypes may respond differently to combination therapy. The authors also said they are awaiting results of another trial that may be better powered to assess carbapenem-resistant Enterobacteriaceae or Pseudomonas aeruginosa.
Feb 16 Lancet Infect Dis abstract
Feb 16 Lancet Infect Dis commentary


Review: Stewardship could save millions of days of antibiotic therapy

Experts from the Centers for Disease Control and Prevention (CDC), in a letter yesterday in Infection Control and Hospital Epidemiology, estimated that antibiotic use could be cut 16%—resulting in saving 16 million days of therapy—if effective antimicrobial stewardship programs (ASPs) are implemented in adult acute-care hospitals the United States.

The team analyzed date from 13 studies that reported the effects of ASPs on total antibiotic use in adult US acute-care hospitals. They then applied the median and interquartile range (IQR) to the 2012 national estimate of adult antibiotic use in such hospitals obtained from a national database.

They determined a median decline of 15.8% in 2012 (IQR, 0 to 27.3%). This would save 18 million days of antibiotic therapy (IQR, 0 to 28 million).

"This number does not include other important improvements that could be made, such as narrowing the spectrum of therapy and shortening postdischarge efforts," they concluded. "Hospital stewardship programs should be supported in their efforts to protect patients from preventable harms caused by unnecessary antibiotic exposure."
Jan 15 Infect Control Hosp Epidemiol letter

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