Stewardship / Resistance Scan for Jul 18, 2019

Stewardship survey results
Non-prescription antibiotic sales in Ethiopia

SHEA survey finds increasing support for hospital stewardship programs

A survey of hospitals in the Society for Healthcare Epidemiology of America (SHEA) Research Network shows an increase in antimicrobial stewardship programs (ASPs) and more financial support for ASP personnel since 2013, as well as concerns about ASP funding and staffing levels.

The results of the survey, which appeared yesterday in Infection Control and Hospital Epidemiology, also show a shift in surveillance focus to multidrug-resistant gram-negative (MDR-GN) organisms.

Of the 132 facilities invited to participate in the 2018 survey, 64 responded, including 47 from the United States and 17 from 11 other countries. ASPs were present in 95% of facilities in 2018, compared to 85% in 2013, and the proportion of facilities providing financial support for physician stewardship medical directors rose to 78%, up from 52% in 2013. Financial support for stewardship pharmacists grew as well, from 54% of hospitals in 2013 to 85% in 2018. However, while 50% of ASPs expected an increase in responsibilities in 2019, more than 50% cited lack of funding and staff as challenges.

Active surveillance for multidrug-resistant organisms (MDROs) was frequently reported in both surveys, with methicillin-resistant Staphylococcus aureus (MRSA) the most common organism for which surveillance was performed. But the proportion of facilities performing MRSA surveillance fell from 90% in 2013 to 69% in 2018, while surveillance for MDR-GNs rose from 46% of hospitals to 50%. Although respondents weren't asked about surveillance for specific MDR-GNs in 2013, 50% of hospitals reported surveillance for carbapenem-resistant Enterobacteriaceae in 2018.

The survey also found that monitoring of environmental cleaning effectiveness was performed in 98% of hospitals in 2018, compared with 80% in 2013.

"Overall, our survey demonstrates the increasingly complex role of the healthcare epidemiologist and ASP, including growing regulatory demands, burgeoning antibiotic resistance threats, and integration of emerging technologies into existing workflows; however, most facilities do not anticipate receiving additional resources to meet these demands," the authors write. "Funding to support healthcare epidemiology research from all governmental levels, as well as hospital-level support of IPC [infection prevention and control] programs and ASPs should be prioritized."
Jul 17 Infect Control Hosp Epidemiol abstract 

Ethiopian study finds non-prescriptions antibiotics for kids are common

A study involving simulated patient encounters suggests pharmacies and drug stores in Ethiopia commonly dispense antibiotics for childhood illnesses without a prescription, researchers reported this week in Antimicrobial Resistance and Infection Control.

To explore the prevalence of non-prescription antibiotic sales for childhood illnesses, the researchers selected a random sampling of 262 privately-owned pharmacies and drug stores in Addis Ababa, then analyzed responses to five scenarios of simulated patient encounters. Each encounter involved a medical student posing as a parent or caretaker of a sick child and requesting antibiotics without a prescription; in each scenario, the child's illness was increasingly severe, and stronger antibiotics were requested. The researchers also explored factors associated with non-prescription antibiotic sales.

Of the 262 encounters observed, 63.4% ended up with the dispenser agreeing to provide the requested antibiotics. Sixty-two percent of dispensers asked whether the child had seen a doctor, while only 11% asked about past history of drug allergies. Requests were more likely to be approved when dispensers asked about the child's symptoms (adjusted odds ratio aOR, 2.41; 95% confidence interval [CI], 1.24 to 4.71); when a request for more than one antibiotic was made (aOR, 2.99; 95% CI, 1.26 to 7.10); when the request was for oral antibiotics for a child with acute diarrhea (aOR, 3.30; 95% CI, 1.25 to 8.71); and when antibiotics for children hospitalized with pneumonia were requested (aOR, 4.52; 95% CI, 1.72 to 11.86).

The authors of the study say that further education and training for pharmacy staff and stricter enforcement of national regulations against non-prescription sales of antibiotics are needed.
Jul 16 Antimicrob Resist Infect Control study

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