Stewardship / Resistance Scan for Mar 07, 2018

MDR bacteria in Italy
Guidance on C diff prevention

Italian study finds large reservoir of MDR bacteria in nursing homes

Researchers in Italy report widespread diffusion of multidrug-resistant (MDR) bacteria in residents from long-term care facilities (LTCFs) in three different northern Italian regions, according to a study yesterday in Antimicrobial Resistance and Infection Control.

The study, conducted in October and November of 2016, involved multicenter point prevalence screening in four LTCFs in the provinces of Milan, Piacenza, and Bolzano. The aim was to compare colonization frequencies with MDR bacteria in the facilities. The screening included Enterobacteriaceae expressing extended-spectrum beta-lactamases (ESBLs), high-level AmpC cephlasporinases, and carbapenemases, Pseudomonas aeruginosa or Acinetobacter baumannii with carbapenemases, methicillin-resistant Staphylococcus aureus (MRSA), or vancomycin-resistant enterococci (VRE).

Among the LTCF residents, 75.0% (78/104), 69.4% (84/121) and 66.1% (76/115) were colonized with at least one of the target organisms in LTCFs located in Milan, Piacenza, and Bolzano, respectively, and many residents had more than one organism. ESBL producers (60.5%, 66.1%, and 53.0%) were highly predominant, mainly belonging to Escherichia coli expressing CTX-M group-1 enzymes. Carbapenemase-producing enterobacteriaceae were found in 7.6%, 0.0%, and 1.6% of residents; carbapemenase-producing P aeruginosa and A baumannii were also detected. Colonization by MRSA (24.0%, 5.7%, and 14.8%) and VRE (20.2%, 0.8%, and 0.8%) was highly variable.

Variability between the facilities was partly attributed to different risk factors for MDR colonization, resident populations and staff/resident ratios, applied hygiene measures, and differences in the local antibiotic resistance epidemiology.

"This widespread diffusion of MDR bacteria in LTCFs of three Italian Provinces confirms that these healthcare facilities are an important reservoir for MDR organisms," the authors conclude. "Future efforts should focus on screening activities, infection control strategies tailored on the complex aspects of LTCFs and implementation of antibiotic stewardship programs."
Mar 6 Antimicrob Resist Infect Control abstract


European C diff guidance stresses stewardship, diagnostics, other steps

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) has published new guidelines on preventing Clostridium difficile infection (CDI) in acute-care settings that include strong recommendations for a two-stage diagnostic test, surveillance with timely feedback, the use of personal protective equipment (PPE) in outbreak settings, and other steps.

Writing in Clinical Microbiology and Infection, the ESCMID panel of experts detailed their current literature review on interventions to control CDI in adults. In contrast to the previous ESCMID guideline on the topic, they used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to rate the quality of evidence.

The guidance includes 36 statements on preventing CDI, including 18 strong recommendations. Strong recommendations include a two-stage test to diagnose CDI, performance of surveillance with timely feedback, no screening of healthcare workers, the use of PPE in outbreak settings, implementation of contact precautions, introduction of daily environmental sporicidal disinfection and terminal disinfection of rooms in outbreak settings, antibiotic stewardship interventions, and education of healthcare workers, patients, and visitors on prevention measures. The experts said the highest quality of evidence grading was for antibiotic stewardship interventions.

"Overall the document aims to provide guidance to those responsible for institutional infection control programs, serving as a reference for best medical practice," lead author Sarah Tschudin-Sutter, MD, MSc, told CIDRAP News.
Mar 2 Clin Microbiol Infect guidance document

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