Stewardship / Resistance Scan for Oct 08, 2019

Post-hospital antibiotic use
;
Resistant gonorrhea response plan

Nationwide US data show high levels of post-discharge antibiotic exposure

An analysis of nationwide Veterans Health Administration data across 3 years finds that a large proportion of antimicrobial exposure among hospitalized patients occurs immediately following discharge, according to a study yesterday in Clinical Microbiology and Infection.

The researchers looked at data from 1,681,701 million acute-care admissions in 122 hospitals from 2014 through 2016 and found that 335,369 patients (19.9%) were prescribed an oral antimicrobial drug at discharge. Fluoroquinolones were the most commonly prescribed drug, accounting for 38.3% of the post-discharge antimicrobials, followed by cephalosporins (14.8%) and beta lactam/lactamase inhibitors (14.4%).

In addition, 39% of the total duration of antimicrobial exposure occurred after hospital discharge. And the investigators found that inpatient use of antimicrobials was only weakly correlated with post-discharge antibiotic use.

The researchers say the study is the first nationwide description of oral antimicrobials prescribed on hospital discharge, making it the largest study on the topic. A study in May involving hospitals in the southeastern United States found prolonged antibiotic courses were common at discharge.

The authors of the current study conclude, "Our findings suggest that standard stewardship metrics, which focus entirely on inpatient antimicrobial use, are providing an incomplete assessment of total antimicrobial exposure associated with an acute-care hospital stay."
Oct 7 Clin Microbiol Infect abstract
May 29 CIDRAP News scan on earlier study

 

European health officials update resistant gonorrhea response plan

The European Centre for Disease Prevention and Control (ECDC) yesterday published an updated response plan to manage the threat of multidrug- and extensively drug-resistant (MDR and XDR) gonorrhea in Europe.

Noting the rising resistance of Neisseria gonorrhoeae to several antibiotics over the last decade, and the report of an XDR gonorrhea strain in the United Kingdom in 2018, the ECDC said an update to its 2012 response plan was needed to manage the threat of untreatable gonorrhea in Europe. "The present ECDC 2019 response plan strives to further support Member States to develop and implement national strategies and interventions to control the threat of MDR and XDR gonorrhoea in a multidisciplinary approach," the agency said.

The plan calls for European Union/European Economic Activity member states to strengthen surveillance of gonococcal antimicrobial susceptibility so that MDR and XDR strains can be detected and monitored, ensure that appropriate capacity for culture and susceptibility testing is available, implement suitable treatment failure monitoring procedures so that national and international authorities can develop targeted interventions to prevent the spread of MDR and XDR strains, effectively disseminate results from surveillance to increase awareness among healthcare workers and the public, and introduce strategies to reduce the burden of gonorrhea.

The ECDC says other elements of a comprehensive management strategy should include appropriate treatment, diagnostics, and testing algorithms (such as three-site testing in men who have sex with men), test of cure, notification and treatment of partners, and enhanced focus on risk groups and sexually transmitted infection prevention measures.
Oct 7 ECDC MDR and XDR gonorrhea response plan

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