Stewardship / Resistance Scan for Jul 18, 2019

News brief

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

News Scan for Jul 18, 2019

News brief

Study: Early neuraminidase inhibitors shorten hospital stays

Treatment with neuraminidase inhibitors when patients are first admitted for flu reduced the length of hospitalization by 19%, according to a meta-analysis published yesterday in the Journal of Infectious Diseases.

The analysis included 18,309 pediatric and adult patients from 70 clinical centers across all 6 World Health Organization (WHO) regions who were hospitalized with suspected or confirmed 2009 H1N1 infections between Jan 2, 2009, and Mar 4, 2011, a time period that covers the pandemic years. More than 80% of the infections were lab confirmed. Researchers compared early neuraminidase inhibitor treatment, later treatment, and no treatment.

Shorter hospitalization was seen across all clinical groups and translated into a median decrease of 1.19 days in those who were treated upon admission.

The team notes that treatment in early hospitalization avoids the uncertainty of gauging the symptom onset date, and they said their findings support recommendations to treat adults hospitalized with suspected flu as soon as possible. "If used consistently, this strategy would contribute to the management of surge pressures and healthcare costs during seasonal influenza epidemics and pandemics," they wrote.
Jul 17 J Infect Dis abstract

Probe details Trump administration cutbacks in WMD prevention programs

The Trump administration has scaled back or dismantled some programs created after the Sep 11, 2001, terror attacks to detect and prevent weapons of mass destruction (WMD), according to an investigation by the Los Angeles Times.

In a report today the Times, quoting both current and former Department of Homeland Security employees and contractors, said, for example, that training exercises have been scrapped and that there has been a loss of several scientists and experts.

The shifts have occurred under the direction James McDonnell, head of the DHS Countering Weapons of Mass Destruction Office, who has been appointed to different posts within the DHS, which has gone through several leadership changes since 2017. Neither McDonnell nor the DHS commented for the Times story. A department spokeswoman said some programs were realigned or restructured to remove bureaucratic redundancy.

Examples of programs that have been gutted or reduced include an elite "red team" that conducted several drills and assessments each year, the Operations Support Directorate that leads 20 WMD training exercises each year, and the National Technical Nuclear Forensics Center. A DHS group that works with foreign counterparts to track and stop the flow of dangerous nuclear materials has been disbanded and the use of portable detection units at large public events has been reduced.

According to the report, the DHS has also halted an update of a formal assessment of chemical, biological, and nuclear-related risks. And according to the Times, more than 100 science or policy experts have been reassigned or put in jobs unrelated to their expertise.
Jul 18 LA Times story

Alaska records first measles case in years

An unvaccinated teen from Alaska’s Kenai Peninsula is the first person from that state to be diagnosed with measles in years, the Alaska Department of Health and Social Services (HSS) confirmed earlier this week.

The case makes Alaska the 29th state to have at least one confirmed measles infection in 2019. The teen recently traveled from Alaska to Arizona via Seattle, officials said.

"The last confirmed case of measles in an Alaskan patient was diagnosed in 2015 in Fairbanks. That was after almost 15 years with no measles cases," HSS said in a statement.

Yesterday officials in El Paso, Texas also confirmed the fourth measles case in that city in the last 2 weeks. Three of the four cases are in toddlers, and the fourth case is one of the children’s mother.

According to the El Paso Times, these are the first measles cases the city has seen in 25 years.
Jul 16 HHS statement
Jul 17 El Paso Times story