Stewardship / Resistance Scan for Oct 12, 2018

Antibiotic duration for group B strep
C diff risk and antibiotics
Veterinary pharma controversy

Study examines shorter IV antibiotics for group B strep bacteremia

A study yesterday in Pediatrics has found that, contrary to national guidelines, a portion of infants with uncomplicated, late-onset group B Streptococcus (GBS) bacteremia are being treated with shortened intravenous (IV) antibiotic courses, with low rates of recurrence and treatment failure.

Although guidelines recommend prolonged IV antibiotic therapy (10 days) to treat uncomplicated, late-onset cases of GBS bacteremia, questions about the optimal duration of IV antibiotic therapy for this condition remain. Complications from peripherally inserted central catheters are common, and a 2007 study found that conversion to oral therapy after 48 hours was a successful strategy in 29 infants with GBS bacteremia. In addition, shortened IV antibiotic courses could decrease healthcare costs and allow patients to leave the hospital sooner.

The multicenter retrospective cohort study looked at infants aged 7 days to 4 months who were admitted to 49 children's hospitals with GBS bacteremia from 2000 to 2015. The purpose was to see how often infants with late-onset, uncomplicated GBS bacteremia are being treated with IV antibiotic durations that are shorter than the guideline recommendation (less than 8 days), and to compare rates of disease recurrence and treatment failure among infants treated with prolonged versus shortened IV antibiotic treatment.

Among 775 infants diagnosed as having late-onset, uncomplicated GBS bacteremia, 612 (79%) received a prolonged course of IV antibiotics and 162 (21%) received a shortened course. Patients who received a shortened course were older, more often admitted in later years, and more likely to have a concomitant urinary tract infection. The proportion of children who received a shortened IV course varied considerably by hospital (range, 0% to 67%; standard deviation, 20%), with 14 hospitals administering shortened courses to no patients and 5 hospitals treating more than 50% of their patients with shortened courses.

Overall, 17 patients (2.2%) suffered a recurrence—three (1.8%) in the shortened-IV-duration group and 14 (2.3%) in the prolonged-duration group (adjusted absolute risk difference, −0.2%; 95% confidence interval [CI], −0.3% to 2.5%).

The authors of the study conclude that, in lieu of a randomized controlled trial (which would be difficult to conduct because of the modest prevalence of GBS disease), their findings suggest early transition to oral antibiotic therapy may be appropriate for carefully selected infants with GBS bacteremia.
Oct 11 Pediatrics study


Longer antibiotic therapy tied to C diff risk in bloodstream infections

Patients hospitalized with Enterobacteriaceae bloodstream infections (BSI) who received anti-pseudomonal beta-lactam (APBL) antibiotics for more than 48 hours had triple the risk of developing Clostridioides difficile infection (CDI), researchers report today in Clinical Infectious Diseases.

The study, conducted by researchers with the University of South Carolina School of Medicine and College of Pharmacy, looked at adult patients hospitalized for more than 48 hours for Enterobacteriaceae BSI at two South Carolina hospitals from January 2011 through June 2015. They were looking to determine the effect of early de-escalation of antibiotic therapy on CDI rates. Previous research on APBLs, which are among the most frequently used antibiotics in US hospitals despite the relatively low prevalence of Pseudomonas aeruginosa BSIs, has found an increased risk of CDI compared with other antibiotics. The researchers wanted to know if early de-escalation might reduce that risk.

Among 808 patients with Enterobacteriaceae BSI, 414 received more than 48 hours of ABPL and 394 received less than 48 hours. Overall incidence of CDI was 4.4%. Incidence of CDI among patients receiving more than 48 hours of APBL was 7.0%, compared with 1.8% among patients treated for less than 48 hours. After adjustment for propensity to receive more than 48 hours of APBL and other variables in the multivariable model, receipt of more than 48 hours of APBL was found to be independently associate with higher risk of CDI (hazard ratio [HR], 3.38; 95% CI, 1.40 to 9.47; P = 0.006), along with end-stage renal disease (HR, 4.04; 95% CI, 1.75 to 8.78; P = 0.002).

"The current study highlights the importance of initial selection of antimicrobial regimen in hospitalized patients with suspected BSI," the authors of the study write. "It enhances antimicrobial stewardship message as it provides objective evidence demonstrating clinical benefit of minimizing unnecessary broad spectrum therapy."         
Oct 12 Clin Infect Dis abstract


Veterinary pharmaceutical company accused of 'double standard'

The Bureau of Investigative Journalism reports today that Zoetis, the world's largest animal health company, is selling antibiotics for growth promotion to Indian farmers.

Although there are no Indian laws against the use of antibiotics for growth promotion in livestock and poultry, the practice is banned in the United States and Europe, and the World Health Organization has called for a worldwide ban. Public health and infectious disease experts argue that using medically important antibiotics to help food-producing animals gain weight more quickly contributes to antibiotic resistance and endangers the future use of those drugs.

Zoetis started removing growth promotion from the labels of medically important antibiotics sold to US farmers in 2016, and has publicly supported the US Food and Drug Administration's efforts to promote antibiotic stewardship in food-producing animals. The bureau reports that on the company's Indian website, however, antibiotics are being sold with the claim that they will make animals grow bigger and faster.

The company told the bureau that it works with national regulatory authorities in various countries, including India, to "understand, respect, and comply with local regulatory interpretation and oversight.”
Oct 12 Bureau of Investigative Journalism report

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