Stewardship / Resistance Scan for Apr 13, 2018

MDR infections in cirrhosis
Antibiotics in treated manure
Carbapenem resistance in German hospital

Multidrug-resistant bacteria found in many cirrhosis patients

An international team of researchers reported yesterday that more than a third of patients hospitalized with liver cirrhosis and bacterial infections were infected with multidrug-resistant (MDR) pathogens, according to a news release from the European Association for the Study of the Liver (EASL).

The research, presented yesterday at the International Liver Congress in Paris, evaluated 1,302 hospitalized patients with cirrhosis and bacterial or fungal infections from 46 sites in Asia, Europe, and North and South America. The most common infections identified were spontaneous bacterial peritonitis (27%), urinary tract infections (22%), and pneumonia (19%). A total of 740 patients (57%) had at least one positive culture.

The global prevalence of MDR bacteria was 34%, with the likelihood of having an MDR infection higher in Asia (odds ratio [OR], 2.79) and South America (OR, 2.23) and significantly higher in India (OR, 7.94). The use of antibiotics in the 3 months prior to hospitalization, the category of infection, and the site of infection were also associated with increased risk for MDR bacteria.

MedPage Today reports that extended-spectrum beta-lactamase producing Enterobacteriaceae were the most common MDR pathogens, found in 34% of the patients. Other MDR bacteria included Acinetobacter and vancomycin-resistant enterococci. In addition, 8% of the patients had extensively drug-resistant bacteria. Overall, nearly 20% of the patients in the study died.

"Not surprisingly, we found a significantly lower rate of response to empirical antibiotic treatment in patients with infections caused by MDR bacteria compared with those due to non-MDR bacteria," the authors of the study told the audience, according to the news release. "We also saw a significantly higher incidence of shock and new organ failures, and a higher rate of in-hospital mortality among those with MDR bacterial infections."
Apr 12 EASL news release
Apr 12 MedPage Today story


Studies highlight problem of antibiotics in treated animal manure

Two top methods of converting animal manure into fertilizer do not fully remove antibiotics during the process, creating a potential risk of environmental contamination, a news release from the University of Buffalo yesterday notes.

The two technologies—advanced anaerobic digestion and reverse osmosis filtration—leave behind both antibiotics and molecules that the drugs break down into. In addition, one study reported that solid excrement, which is often filtered out from raw, wet manure before the waste is treated, may contain higher concentrations of antibiotics than unprocessed manure. This finding is particularly disturbing because this material is often released into the environment when it's used as animal bedding or sold as fertilizer, according to the news release.

"We were hoping that these advanced treatment technologies could remove antibiotics. As it turns out, they were not as effective as we thought they could be," Aga says.

Researchers conducted the experiments at two dairy farms in upstate New York. The study on advanced anaerobic digestion, published in Chemosphere, examined tetracyclines and found that they and their breakdown products migrated from the fluid part of the sludge into the solid part during treatment. The study on reverse osmosis, published in Environmental Pollution, looked at how well this water purification technique removed synthetic antimicrobials called ionophores, which are used to promote growth in dairy cows and to treat coccidiosis but are not used in human medicine.

"This problem is not limited to agriculture," said Diana Aga, PhD, of the University of Buffalo, who led both studies. "Waste treatment systems today, including those designed to handle municipal wastewater, hospital wastes, and even waste from antibiotic manufacturing industries, do not have treatment of antibiotics in mind. This is an extremely important global issue."
Apr 12 University of Buffalo news release
April Chemosphere study
May Environ Pollut study


Study looks at incidence, treatment of MDR bacteria in German hospital

A study yesterday in PLoS One provides a look at the prevalence, characteristics, and treatment of multidrug-resistant gram-negative bacteria (MDR-GNB) in a German hospital.

The retrospective, observational cohort study, conducted at an academic tertiary medical center from September 2015 through August 2016, identified 119 patients who were colonized or infected with carbapenem-resistant MDR-GNB, corresponding to a prevalence of 0.22% of all hospital admissions. Carbapenem-resistant isolates of Pseudomonas aeruginosa were detected in 66 patients (55.5%), Enterobacteriaceae in 44 patients (37.0%), and Acinetobacter baumannii in 18 patients (15.1%).

Infection was diagnosed in 50 patients (42.0%), with nosocomial pneumonia diagnosed in 23 patients (19.3%) and bloodstream infections in 11 patients (9.2%). Major predisposing factors for acquisition of carbapenem-resistant MDR-GNB included treatment with broad-spectrum antibiotics in the previous 6 months, which was recorded in 105 patients (88.2%), and nosocomial transmission, which was documented in 29 patients (24.4%). The rate of detection was highest for the intensive care unit (55 patients, 46.2%) and the stem cell transplantation unit (19 patients, 16.0%), but infected or colonized patients were found in 10 other wards.

Analysis of treatment showed that 45 patients with clinically diagnosed infections (90%) were treated with colistin, and that 94.3% of isolates were susceptible to the drug. New beta-lactam/beta-lactamase inhibitor combinations ceftolozane/tazobactam and ceftazidime/avibactam were administered to three and five patients, respectively, but development of high-level resistance was observed during therapy.

The authors conclude that the high number of patients infected or colonized with these pathogens, in several hospital departments, highlights their clinical relevance in German tertiary care centers. They conclude, "There is an urgent need for infectious diseases specialists coordinating their multidisciplinary management in close collaboration with hospital hygiene experts."
Apr 12 PLoS One study

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