Stewardship / Resistance Scan for Aug 08, 2019

Surgical antibiotic prophylaxis
;
MDR bacteria in urban rats

Italian hospital study finds improved use of pre-surgery antibiotics

A surveillance study of Italian hospitals found improved compliance with surgical antimicrobial prophylaxis (SAP) guidelines over a 6-year period, Italian researchers reported yesterday in the American Journal of Infection Control.

The study by researchers from the University of Turin was conducted in 42 hospitals participating in a national surveillance system for surgical site infections (SSIs). According to data from the European Centre for Disease Prevention and Control, SAP for the prevention of SSIs accounts for 17.4% of antimicrobial use in Italy, but compliance with national SAP guidelines varies widely, and there are concerns that Italian physicians do not routinely follow recommendations. The investigators evaluated data from 2012 through 2017 to assess the prescribing practices and SAP compliance with Italian national guidelines and the association between SAP compliance and SSI risk.

A total of 24,861 surgical procedures were monitored over the study period, and a total of 827 SSIs occurred. Overall compliance with SAP guidelines was achieved in 35.41% of procedures in 2012 and increased to 60.79% of procedures in 2017, and the risk ratios (RRs) for appropriate SAP increased by 22% each year, with significant increasing trends over time found for overall compliance, timing, and duration. Adequate antibiotic choice (RR, 0.57; 95% confidence interval [CI], 0.5 to 0.65), duration of administration (RR, 0.51; 95% CI 0.45 to 0.57), and overall compliance (RR, 0.65; 95% CI, 0.59 to 0.72) were all associated with a significantly reduced SSI risk.

The authors of the study conclude, "Interventions to improve SAP compliance with national guidelines could significantly contribute to reducing antimicrobial resistance, both by reducing the burden of HCAIs [healthcare associated infections] and by promoting more prudent use of antimicrobials."
Aug 7 Am J Infect Control abstract

 

Multidrug-resistant bacteria found in urban rats

A study today in Eurosurveillance by German and Austrian researchers suggests urban rats could be potential spreaders of multidrug-resistant bacteria.

The researchers looked for the presence of antimicrobial-resistant bacteria in 62 urban brown rats captured in Vienna in 2016 and 2017. They were looking specifically to see whether the rats carry extended-spectrum beta-lactamase-producing Enterobacteriaceae, fluoroquinolone-resistant Enterobacteriaceae, and methicillin-resistant Staphylococcus spp (MRSA). Pharyngeal and nasal samples were collected from the animals, and the researchers characterized the isolates using microbiologic and genetic methods.

Eight multidrug-resistant Escherichia coli and two extensively drug-resistant New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Enterobacter xiangfangensis ST114 (members of the Enterobacter cloacae complex) were isolated from 9 of 62 rats. Nine of the Enterobacteriaceae isolates carried the blaCTX-M gene and one carried the plasmid-encoded ampC gene. Forty-four MRS, belonging to seven different staphylococcal species, were isolated from 37 of 62 rats. The overall presence of antimicrobial-resistant bacteria in the rats was 62.9%.

"Although the interaction between urban wildlife reservoirs of AMR [antimicrobial resistance] and human health risk remains unclear, the overall prevalence of AMR we observed in the sampled rats is of concern," the authors of the study write, noting that several of the rats colonized with multidrug-resistant isolates were captured in a neglected garden used by the homeless. "This particular situation enhances the risk of spillover of antimicrobial-resistant bacteria."

The authors say the results stress the importance of urban wildlife species as bio-indicators for AMR surveillance programs in urban ecosystems.
Aug 8 Eurosurveill study

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