Stewardship / Resistance Scan for Jan 04, 2019

Stewardship cost-effectiveness
Klebsiella bacteremia in Taiwan

Dutch study shows cost-effectiveness of stewardship intervention for RTIs

A study today in the Journal of Antimicrobial Chemotherapy shows that online training for general practitioners (GPs) and an online booklet for parents was associated with a decrease in antibiotic prescribing in children with respiratory tract infections (RTIs) and was cost-effective.

The study, conducted by Dutch researchers, was a cost-effectiveness analysis performed alongside the RAAK (RAtional Antibiotic use in Kids) randomized controlled trial, a study that assessed whether an intervention consisting of online training for GPs about RTIs in children and prudent antibiotic use combined with information booklets for parents could reduce antibiotic prescribing for kids with RTIs. The patient population consisted of children from 32 general practices in the Netherlands whose parents kept a 2-week cost diary. The researchers analyzed the difference in antibiotic prescribing and costs between the intervention group and the usual-care group.

Overall, 153 children from 15 practices in the intervention group and 107 children from 15 practices in the usual-care group were available for analysis. Antibiotic prescribing was 12 percentage points lower and the total costs per child were €10.27 ($11.71) higher in the intervention group, with much of the difference resulting from the productivity loss of parents. This resulted in an incremental cost-effectiveness ratio of €0.85 ($0.97) per percentage decrease in antibiotic prescribing. The probability that the intervention was effective, but more expensive, was 53%, while the probability that the intervention was more effective and less expensive compared with usual care was 41%.

"The online training for GPs and the information booklet for parents resulted in a decrease in antibiotic prescribing for children with RTI, at very low cost, and would therefore be suitable for implementation in quality assurance programmes in primary care," the authors of the study write, though they note that whether the intervention should be implemented depends on society's willingness to pay for a percentage decrease in antibiotic prescribing.
Jan 4 J Antimicrob Chemother study


Study describes different characteristics of Klebsiella bacteremia

A retrospective study of patients in Taiwan has found distinct differences in the clinical and microbiologic features of healthcare-associated (HCA), community-acquired (CA), and nosocomial Klebsiella pneumoniae bloodstream infections, researchers reported yesterday in Antimicrobial Resistance and Infection Control.

In the single-center study, researchers at Taipei Veterans General Hospital and National Yang-Ming University identified patients hospitalized with K pneumoniae bacteremia in 2015, collected clinical information on the demographic characteristics of the patients, and conducted antimicrobial susceptibility testing and capsular genotyping on all K pneumoniae isolates. They wanted to compare the clinical characteristics, antimicrobial resistance, and distribution of capsular types among HCA, CA, and nosocomial K pneumoniae bacteremia, which is a major cause of morbidity and mortality worldwide.

A total of 337 patients with K pneumoniae bacteremia were identified: 70 (20.8%), 102 (30.3%), and 165 (48.9%) had CA, HCA, and nosocomial infection, respectively. The 28-day mortality of HCA bacteremia was lower than that of nosocomial bacteremia (17.6% vs 30.9%, P = 0.016), but that of HCA and CA bacteremia was similar (17.6% vs 14.3%, P = 0.557). CA isolates had the highest prevalence of virulent capsular types (51.4%), followed by HCA (36.3%) and nosocomial isolates (19.4%). The proportion of multidrug-resistant isolates was highest in nosocomial infections (41.8%), followed by HCA (23.5%) and CA infections (5.7%).

The authors of the study conclude, "The characterization of the clinical characteristics of CA, HCA, and nosocomial bacteremia will help professionals to better manage patients. Further studies on the microbiological characteristics of HCA strains must be conducted to accurately identify the transmission of virulent or antimicrobial-resistant strains between community and hospital."
Jan 3 Antimicrob Resist Infect Control study

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