Stewardship / Resistance Scan for Apr 04, 2019

Stewardship in nursing homes
US MDR-TB treatment

CDC study finds room for improving stewardship in US nursing homes

Forty-two percent of the nursing homes enrolled in the National Healthcare Safety Network (NHSN) met all seven of the Centers for Disease Control and Prevention's (CDC's) Core Elements of Antibiotic Stewardship in 2016, CDC researchers reported today in Clinical Infectious Diseases.

Analysis of data from the NHSN's annual survey for nursing homes showed that 1,262 out of 2,982 reported implementing all seven core elements, with the vast majority of facilities fulfilling the tracking (95%), action (94%), accountability (91%), and leadership elements (87%). Access to drug expertise was reported by 77% of nursing homes, while 73% fulfilled education recommendations and 62% met the criteria for reporting.

Bivariate analysis showed that for-profit ownership, nursing home chain affiliation, and staff hours devoted to infection prevention and control activities were statistically significantly associated with implementing all seven core elements.

The results are similar to the findings of the 2014 NHSN survey, which found that 41% of nursing homes had implemented all seven core elements. The Centers for Medicare and Medicaid Services started requiring nursing homes to have antibiotic stewardship programs in 2016.

The authors of the study conclude, "These results are promising, with only 3 elements fulfilled by <80% of NHs [nursing homes]. However, there is still room for improvement across all core elements in NHs, particularly in the areas of drug expertise, reporting, and education."
Apr 4 Clin Infect Dis abstract


Few US patients eligible for shorter MDR-TB treatment

In another CDC study today in Clinical Infectious Diseases, researchers from the Division of Tuberculosis Elimination reported that only 10% of multidrug-resistant tuberculosis (MDR-TB) cases in the United States would be eligible for a shorter treatment regimen. And although treatment costs would be reduced significantly for eligible patients, the reduction in societal costs would be minimal.

The researchers assessed eligibility for the 9-to-12-month regimen among US MDR-TB cases that had full drug susceptibility testing and were reported to the US National TB Surveillance System (NTSS) from 2011 through 2016. The shorter series was recommended by the World Health Organization in 2016 for patients with extrapulmonary TB, pregnancy, previous second-line TB medication exposure, and resistance to pyrazinamide, ethambutol, kanamycin, moxifloxacin, ethionamide, or clofazimine. The investigators also estimated the costs of the shorter regimen compared with the conventional 20-month treatment, and the economic impact on overall MDR-TB cost burden and on individual patients.

During 2011 through 2016, 586 MDR-TB cases were reported to the NTSS, and 59 (10%) were eligible for shorter treatment. Of the 527 ineligible cases, 347 (66%) had reported resistance to a medication in the shorter regimen. Among the 386 ineligible cases who had full drug susceptibility testing, most were resistant to ethambutol (64%) and/or pyrazinamide (56%), often in combination with other drug resistance. Sensitivity analysis showed that if those with prior TB were not excluded, the proportion of eligible patients would rise to 12%.

Applying the shorter regimen to those eligible would reduce the direct costs by 25% to 41% ($12,000 to $46,000) compared with the conventional regimen, and direct costs plus productivity losses would be reduced by 37% to 46%. But because the number of eligible patients is so small, the overall societal cost burden would be reduced by only 4%.
Apr 4 Clin Infect Dis abstract

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