Stewardship / Resistance Scan for Mar 01, 2019

Antibiotic stewardship and C diff
CPE activity increase in Europe

CDC study links reduced antibiotic use with decrease in C difficile rates

Researchers with the US Centers for Disease Control and Prevention (CDC) reported today in Clinical Infectious Diseases that reductions in antibiotic use, particularly fluoroquinolones and third- and fourth-generation cephalosporins, was associated with a decrease in Clostridioides difficile rates in US acute care hospitals.

To examine cross-sectional and temporal associations between levels of antibiotic use and incidence of hospital-onset C difficile infection (HO-CDI), the researchers conducted an ecological analysis using data from 549 US hospitals from 2006 to 2012. Cross-sectional associations between annual rates of antibiotic use and HO-CDI were examined using multivariable generalized estimating equation models, and temporal trends in HO-CDI and antibiotic use rates were assessed through analysis of monthly rates of HO-CDI, total antibiotic use, and use of antibiotic classes for which significant cross-sectional associations with HO-CDI were observed.

During 2006-2012, the unadjusted annual rates of HO-CDI and total antibiotic use were 7.3 per 10,000 patient-days (PD) and 811 days of therapy (DOT)/1,000 PD, respectively. In the cross-sectional analysis, for every 50 DOT/1,000 PD increase in total antibiotic use, there was a 4.4% increase in HO-CDI. In particular, higher use of third- and fourth-generation cephalosporins and carbapenems was associated with increases in HO-CDI.

In the time-series analysis, hospitals that reduced total antibiotic use by 10% or lower experienced a 3% decrease in annual HO-CDI rates, and the 6 acute care hospitals with a decrease in total antibiotic use of 30% or more had a 33% decrease in HO-CDI. In addition, acute care hospitals with a decrease in fluoroquinolone or third- and fourth-generation cephalosporin use of 20% or more had a corresponding decrease in HO-CDI of 8% and 13%, respectively.

"These findings support the evidence that effective antibiotic stewardship programs can have major impact on HO-CDI in the U.S.," the authors of the study write.
Mar 1 Clin Infect Dis abstract


Carbapenem-producing Enterobacteriaceae activity increasing in Europe

Only 14 of 37 European countries have national action plans to address carbapenem-producing Enterobacteriaceae (CPE), while 11 nations report a worsening CPE situation, researchers from the Public Health Agency of Sweden and the European Centre for Disease Prevention and Control reported yesterday in Eurosurveillance.

The investigators conducted a survey on the epidemiological situation, surveillance, and containment activities for CPE in European countries in 2018. All 37 participating nations reported cases, but since 2015, CPE activity has increased in 11 countries. The authors also found that 33 countries have reference laboratory capability, 27 have dedicated surveillance efforts, but only 14 have a specific national containment plan.

The researchers ranked CPE epidemiologic activity from stage 0 (no cases reported) to stage 5 (endemic situation), with Greece, Italy, Malta, and Turkey reaching stage 5. In 2010, Greece was the only country with endemic CPE. Eleven countries were at stage 4—inter-regional spread, compared with only two in 2010.

"These results do not provide information on the factors driving the apparent increasing dissemination of CPE in Europe, which would require further investigations," the authors concluded.
Feb 28 Eurosurveill report

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