Stewardship / Resistance Scan for Sep 05, 2019

Antibiotics on citrus trees
Telehealth-based stewardship

Trump administration sued over expanded use of antibiotics on citrus trees

The Center for Biological Diversity today sued the Environmental Protection Agency (EPA) and the Food and Drug Administration (FDA) for refusing to provide documents related to the EPA's decision to allow expanded use of medically important antibiotics on citrus trees.

The organization filed a Freedom of Information Act (FOIA) request for the documents in March. The lawsuit says the delay in providing those records is a violation of FOIA, and is asking the court to order the agencies to provide the documents.

In December 2018, the EPA approved expanded use of the antibiotic oxytetracycline in Florida and other citrus-growing states to combat citrus greening disease, a bacterial infection that has devastated the citrus industry. It's currently reviewing a request for expanded use of streptomycin.

Under expanded use, citrus growers could use 388,000 pounds of oxytetracycline and 650,000 pounds of streptomycin—amounts far greater than those used to treat human bacterial infections. The Center for Biological Diversity and other concerned groups, including the Centers for Disease Control and Prevention (CDC), have warned that spraying massive amounts of antibiotics on citrus trees could spur antibiotic resistance in soil bacteria, and resistant pathogens in the soil could ultimately impact human health.

Earlier in the year, the center obtained a 2017 CDC report to the EPA that concluded that using antibiotics as pesticides has the potential to select for antibiotic-resistant bacteria in the environment, including bacteria that pose a risk to human health. The organization is currently seeking all communications among the EPA, FDA, and CDC regarding the use of oxytetracycline and streptomycin as pesticides.

"The Trump administration is recklessly endangering public health by allowing these human medicines to be sprayed on crops," Center for Biological Diversity senior scientist Nathan Donley, PhD, said in a press release from the organization. "The EPA is trying to conceal conversations revealing the risks these careless actions pose to public health and wildlife."
Sep 5 Center for Biological Diversity press release
Aug 29 CIDRAP News story "Lawmakers urge EPA to rethink use of antibiotics on citrus trees"


Telehealth-based stewardship program shows promise in 2 small hospitals

Implementation of a telehealth-based antimicrobial stewardship program (ASP) at two Pennsylvania community hospitals was associated with a nearly 25% reduction in broad-spectrum antibiotic use, researchers reported today in Clinical Infectious Diseases.

The telehealth-based ASP implemented in two community hospitals in the Heritage Valley Health System involves hospital pharmacists without previous stewardship training who were trained to provide audit and feedback to providers. During weekly hour-long telehealth meetings, the pharmacists and infectious disease (ID) physicians from another health system (Allegheny Health Network) review patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft-tissue infections. The ID physicians then make ASP intervention recommendations that are relayed to provider teams by the pharmacists.

To study the impact of the program, researchers from both health systems tracked antibiotic use and local ID consults  at the two hospitals over a12-month baseline period and the 6-month intervention period, and estimated the antibiotic cost savings. Their analysis found that during the intervention period (March 2018 through August 2018), 1,419 recommendations were made, of which 1,262 (88.9%) were accepted. Broad-spectrum antibiotic use decreased by 24.4% from the baseline period (342.1 vs 258.7 days of therapy per 1,000 patient-days). ID consults increased by 40.2% (15.4 vs 21.5 consults per 1,000 patient-days), and the estimated annualized cost savings on antibiotic expenditures was $142,629.

"In conclusion, we describe a practical model by which an intense ASP may be implemented in a community hospital setting via telehealth," the authors of the study write. "It represents a unique and viable strategy by which community hospitals not affiliated with a large system may gain access to robust stewardship support, and a mechanism by which larger institutions with such infrastructure may assist unaffiliated hospitals with expansion of ASP efforts."
Sep 5 Clin Infect Dis abstract

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