Stewardship / Resistance Scan for Jun 20, 2019

ER, urgent care stewardship
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Resistant E coli in Dutch livestock

Study finds physician education tied to fewer urgent antibiotics

A study involving nine emergency departments and acute care centers in California and Colorado found that educating physicians and patients about safe antibiotic use was tied to a 34% drop in inappropriate antibiotic prescribing, but the absolute reduction was fairly small because levels were already low to begin with.

Writing in Academic Emergency Medicine yesterday, researchers in the two states describe two approaches designed to help physicians make better choices about prescribing antibiotics for acute respiratory infections. One approach offered educational materials from the "Be Antibiotics Aware" campaign from the US Centers for Disease Control and Prevention for patients and providers, plus an on-site physician stewardship "champion." The other more intensive approach provided education and behavioral "nudges," which gave each physician feedback on prescribing rates and other information.

The investigators then tracked 44,820 visits for respiratory infections caused by viruses—which don't require antibiotics—among 292 providers at five emergency departments and four urgent care centers. They found that, after adjusting for health‐system and provider‐level effects, inappropriate antibiotic prescribing fell from 2.2% (95% confidence interval [CI], 1.0%-3.4%) before the interventions to 1.5% (95% CI, 0.7%-2.3%) with an odds ratio of 0.67 (95% CI, 0.54 to 0.82). Both interventions yielded similar results.

"Our study shows that this relatively simple approach can get us to near-zero inappropriate antibiotic use for acute respiratory infections," said senior author Larissa May, MD, MSPH, MSHS, of the University of California-Davis, in a UC-Davis new release.
Jun 19 Acad Emerg Med abstract
Jun 19 UC-Davis news release

 

Dutch researchers report increased resistance in E coli in livestock, poultry

A longitudinal analysis of Escherichia coli isolated from fecal samples from chickens, pigs, and calves in the Netherlands found generally increasing levels of antimicrobial resistance, according to a report today in Eurosurveillance.

Dutch researchers collected fecal samples at slaughter from broilers, pigs, and veal calves from 1998 to 2016—about 300 samples from each animal type per year. They observed a statistically significant increasing resistance trend for all antimicrobials tested except tetracycline among broilers from 1998 to 2009, then a decreasing trend in all antibiotics from 2009 to 2016.

In pigs, resistant counts were generally lower than in broilers except for tetracyclines, where they were a bit higher. Resistance also increased in veal calves, but, because of a sampling change in 2012, results could not be compared directly with the other animal species. The authors also reported sporadic detection of colistin-resistant isolates since 2010, which increased in poultry.
Jun 20 Eurosurveill report

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