Stewardship / Resistance Scan for Jun 24, 2019

Core stewardship and antibiotic use
Antibiotic overuse in dengue

Compliance with CDC stewardship elements linked to higher antibiotic use

In a surprise finding, an analysis of US hospitals today in Infection Control and Hospital Epidemiology has found that meeting all seven of the Centers for Disease Control and Prevention's (CDC's) core elements of hospital antibiotic stewardship programs is associated with higher use of certain antibiotics than meetings six or fewer elements.

The cross-sectional analysis, led by researchers from Virginia Commonwealth University, used responses from a survey that was sent to antibiotic stewardship program (ASP) members at more than 400 hospitals in April 2016. The surveys contained 24 questions regarding aspects of the ASPs and whether they met the CDC's seven core elements, which include leadership, accountability, drug expertise, tracking, actions, reporting, and education. The responses to the survey were then linked to antibacterial use data, measured in days of therapy (DOT) per 1,000 patient-days (PD).

Overall, 211 of 446 hospitals responded to the survey, and antibiotic use was measured in a subset of 57 hospitals that completed the survey and subscribe to a database that tracks inpatient medication use. Of the 57 hospitals, 27 (47%) met all 7 core elements and 30 (53%) met 3 to 6 elements. The analysis found that compliance with all 7 core elements was associated with higher use of broad-spectrum antibiotics for community-acquired infections (145 DOT/1,000 PD vs 124 DOT/1,000 PD, P = .03) and anti–methicillin-resistant Staphylococcus aureus agents (155 DOT/1,000 PD vs 133 DOT/1,000 PD, P = .02).

The findings were unexpected, as the researchers thought that hospitals that met all the core elements would likely use fewer antibiotics. But they note that it's possible that the hospitals that adopted all elements may have required a more robust ASP because of a higher baseline rate of antibiotic use. In addition, they say that the results may have differed if antibacterial use data had been available for all the hospitals that completed the survey.
Jun 24 Infect Control Hosp Epidemiol study


Study: Pediatric dengue patients overprescribed antibiotics in Indonesia

A new study in PLOS Neglected Tropical Diseases suggests children at private hospitals in Indonesia are overprescribed antibiotics when seeking treatment for dengue fever.

Dengue is endemic in Indonesia, and infections with the flavivirus are one of the leading causes of pediatric hospitalization. In this retrospective study, researchers looked at the prevalence of antibiotics prescribed to dengue patients under the age of 15 in teaching and private hospitals in the city of Bandung in 2015.

The authors found that the use of antibiotics in private hospitals was mostly inappropriate. A total of 17.5% out of 3,078 cases in both hospitals received antibiotics. Among cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in only 1 case (0.6%) and 6 cases (3.4%), respectively, the authors said.

Among 2,902 dengue cases in the private hospital, presumed bacterial URTI was found in 324  cases (11.2%), typhoid fever in 188 cases (6.5%), and urinary tract infection in 18 cases (0.6%). In 67% of URTI cases, broad-spectrum third generation antibiotics were prescribed.

"The use of this agent for URTI is considered as misuse of antibiotics, which can result in detrimental effects for the patients, and the healthcare system, including the emergence of antibiotic resistant pathogens," the authors said.
Jun 21 PLOS Negl Trop Dis study

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