Stewardship / Resistance Scan for Jul 23, 2018

Antibiotic redosing
Resistance trends in Swiss nursing homes
Antibiotic legislation nixed

Study: Intervention improves intraoperative antibiotic redosing

A multipronged project to improve intraoperative antibiotic redosing led to dramatic and sustained improvements in antibiotic redosing rates at an Iowa hospital, according to a new study in the American Journal of Infection Control.

The quality improvement project at University of Iowa Hospitals and Clinics began in 2015 with the introduction of a guideline-based intraoperative Antibiotic Administration Guide that listed recommendations for antibiotic choice by surgical category on one side and redosing recommendations on the other. The guide was distributed to anesthesia providers, and multiple education sessions were held for anesthesia providers, surgeons, nurses, and pharmacists who work regularly in the operating room. In addition, an automated redosing reminder was included in anesthesia electronic health records (EHRs). The department of anesthesia reported antibiotic redosing rates monthly to hospital leadership to encourage peer accountability and feedback.

In the retrospective observational study, a total of 13,695 surgical procedures performed from 2013 through 2017 were assessed using an interrupted time-series model. The compliance rate with intraoperative antibiotic redosing criteria for all surgeries lasting more than 4 hours was the primary outcome. Although the interrupted time-series model showed there was an already improving trend prior to the multifaceted intervention (incidence rate ratio [IRR], 1.004 per week), a 15% increase in appropriate antibiotic redosing rates (IRR, 1.158) was observed at the end of the intervention, with no compromise in the baseline improvement trend.

"Our experience demonstrates that combining EHR-based interventions with education and incentive models may help further improve compliance rates," the authors of the study conclude. They note that further studies to determine whether the intervention had an effect on clinically meaningful outcomes, such as surgical-site infections, are ongoing.
Jul 20 Am J Infect Control study


Antibiotic-resistant E coli increasing in Swiss nursing homes

An analysis of 10 years of resistance data from nursing homes in Switzerland found increasing levels of extended-spectrum cephalosporin-resistant (ESC-R) Escherichia coli, but with declining levels of methicillin-resistant Staphylococcus aureus (MRSA).

The study covers data from isolates sent to the Swiss Centre for Antibiotic Resistance from January 2007 to October 2017. Researchers from Switzerland published their findings in a Jul 20 online edition of Antimicrobial Resistance and Infection Control.

To explore carbapenem-resistance patterns in nursing homes among gram-negative bacteria, which included ESC-R E coli and Klebsiella pneumonia, MRSA, and glycopeptide-resistant enterococci (GRE), the group looked at 16,804 samples from 9,040 patients, mostly from urinary sources. Most patients were from the French/Italian speaking part of Switzerland in the west and south.

ESC-R E coli increased from 5% in 2007 to 22% in 2017, while MRSA levels declined from 34% to 26% over the same period. Nitrofurantoin and fosfomysin retained high susceptibility rates against E coli, even for ESC-R isolates.

The researchers said a significant increase of ESC-R among E coli and K pneumonia mirrors an increase seen in the antibiotic resistance database for hospitals and outpatient clinics. The team also noted that the proportion of MRSA among S aureus isolates is also declining in hospitals.

The authors said the generalizability of their data is hampered by overrepresentation of the French/Italian speaking part of the country, but the prevalence of ESC-R E coli and K pneumonia among Swiss nursing homes has clearly been rising over the past decade. Also, they noted that more efforts should be taken to increase the number of nursing home samples from German-speaking parts of Switzerland to the resistance database.
Jul 20 Antimicrob Resist Infect Control abstract


PAHPA reauthorization moves forward, without new antibiotic incentive

A reauthorization of a pandemic preparedness bill approved last week by the US House Energy and Commerce Committee will not include an incentive aimed at spurring development of new antibiotics.

According to reporting by Stat, proponents of the incentive, the language of which was originally included in a bill titled the Re-Valuing Anti-microbial Products (REVAMP) Act of 2018, had hoped to have it inserted as an amendment to the reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA), but that effort stalled. PAHPA, originally passed in 2006, now heads for a vote in the full US House of Representatives.

The proposed incentive would award drug companies that develop a priority antimicrobial product an extra 12 months of market exclusivity that could be used for another drug product. Companies could also extend market exclusivity for several drugs for less than a year. In return, drug makers would have to track resistance data, develop guidelines and procedures for appropriate use, and assess stewardship of the new antibiotic.

Backers of the idea view it as an important "pull" incentive that could spur antibiotic development. But as Stat reports, a coalition of physicians, hospitals, insurers, and pharmacy benefit managers, concerned that the incentive would delay patient access to cheaper generic drugs, urged Congress not to include the proposal in the PAHPA reauthorization.
Jul 18 Stat story
Jun 29 CIDRAP News story "Bipartisan bill proposes new 'pull' incentives for priority antibiotics"



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