Stewardship / Resistance Scan for Apr 23, 2018

Global antibiotic prescribing
;
Urinary tract infection treatment
;
Evolution of colistin resistance
;
Regional hospital antibiograms

Global hospital survey highlights antibiotic Rx, high guideline compliance

The first data published by the Global Point Prevalence Survey reveal that penicillins with beta-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones were the most frequently prescribed antibiotics, and guideline compliance was 77.4%. The data, from 2015, were published Apr 19 in The Lancet Global Health.

The researchers used a standardized web-based surveillance method to gather data from 303 hospitals treating adults in 53 countries, including 8 lower-middle-income and 17 upper-middle-income nations. Of the 86,776 patients, 29,891 (34.4%) received at least one antimicrobial. Of the 41,213 prescriptions for antimicrobials, 36,792 (89.3%) were for systemic use. In addition to the data on the three most popular antibiotics, the authors reported that carbapenems were most frequently prescribed in Latin America and west and central Asia.

Of patients who received at least one antimicrobial, 5,926 (19.8%) received a targeted antibacterial for systemic use, and 1,769 (5.9%) received a treatment for multidrug-resistant organisms. The reason for treatment was recorded for 31,694 antimicrobial prescriptions (76.9%), and a stop or review date was specified in 15,778 (38.3%). Local antibiotic guidelines were missing for 7,050 (19.2%) of the 36,792 systemic antibiotic prescriptions, and guideline compliance was 77.4%.

The authors conclude, "The Global Point Prevalence Survey complements WHO's [World Health Organization's] Global Antimicrobial Surveillance System (which provides a standardised approach for collection, analysis, and sharing of data for antimicrobial resistance) by providing a validated method for measuring the quality of antimicrobial prescribing and the effect of interventions to improve prescribing."

They add, "These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals."

The study was funded by France-based biotechnology company bioMerieux.
Apr 19 Lancet Glob Health study

 

Study: Nitrofurantoin beats fosfomycin for uncomplicated UTI

A 5-day course of nitrofurantoin resolved a higher rate of uncomplicated urinary tract infections (UTIs) than one dose of fosfomycin, according to a new study published in the Journal of the American Medical Association (JAMA). Both antibiotics are first-line therapies for UTIs.

In the multicenter international study, 377 women with a confirmed UTI were randomly dosed with either a 5-day course of nitrofurantoin (100 mg three times a day) or one, 3-gram dose of fosfomycin. The primary outcome was clinical resolution at day 28. Seventy percent of patients who received nitrofurantoin were clinically cleared of their UTIs by day 28, compared with 58% of patients who received fosfomycin.

Nitrofurantoin was particularly effective in treating infections caused by Escherichia coli, with 78% of patients being cured by day 28, compared with 50% in the fosfomycin group.

An accompanying editorial in JAMA said the study uses a rigorous study design to reaffirm nitrofurantoin's place as the preferred first-line choice in treating UTIs, which accounts for approximately 10 million ambulatory visits and an estimated $2 billion in total costs each year in the United States.
Apr 22 JAMA
study
Apr 22 JAMA editorial

 

French case study shows evolution of colistin-resistant bacteria

French researchers tracked the evolution of a Klebsiella pneumoniae carbapenemase (KPC) strain of bacteria for more than 4.5 years in a patient who ultimately died from sepsis. The case study, published in Clinical Infectious Diseases, shows the bacteria is capable of several genomic and phenotypic diversifications and mutations in a relatively short period, even from drug resistance to susceptibility.

The patient contracted the bacterium via a contaminated endoscope at a French tertiary care hospital in 2009. The patient was seeking treatment from chronic infection in the liver's bile ducts.

Researchers collected 17 isolates until the patient died in 2014. All 17 isolates were subjected to whole-genome sequencing. During the study period, a total of 98 genetic events occurred, and the average evolutionary rate of the KPC strain was 7.5 single nucleotide polymorphisms per year per genome.

Most interestingly, the researchers reported, "The contaminating strain was colistin resistant but after two years of carriage, all isolates became susceptible to colistin."
Apr 21 Clin Infect Dis study  

 

Study finds regional antibiograms may benefit community hospitals

A study of 20 community hospitals in North Carolina and Virginia determined that a regional antibiogram can provide useful information to these hospitals even for low-prevalence pathogens, according to a study today in Infection Control and Hospital Epidemiology.

Antibiograms are profiles of antimicrobial susceptibility testing results of a specific pathogen to a battery of antimicrobial drugs. To determine the feasibility and value of developing a regional antibiogram for community hospitals, Duke University scientists analyzed data on 69,778 bacterial isolates across 13 gram-negative pathogen-antibiotic combinations. Combinations ranged from 174 to 27,428 results, for a median of 1,100.

The team found that, across all pathogen-antibiotic combinations, 69% of local susceptibility rates fell within 1 standard deviation (SD) of the regional mean, and 97% fell within 2 SDs. But no individual hospital had more than 1 pathogen-antibiotic combination with a local susceptibility rate of more than 2 SDs of the regional mean, and all local susceptibility rates were within 2 SDs of the regional mean for low-prevalence pathogens.

The authors conclude, "Small community hospitals frequently cannot develop an accurate antibiogram due to a paucity of local data. A regional antibiogram is likely to provide clinically useful information to community hospitals for low-prevalence pathogens."
Apr 23 Infect Control Hosp Epidemiol abstract

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