Stewardship / Resistance Scan for Nov 11, 2019

C diff in VA hospitals
;
UK antibiotic development
;
ESBL carriage in dogs

Study shows decline in C difficile incidence at VA hospitals

A retrospective analysis of Veterans Administration (VA) patients who had stool testing for Clostridiodes difficile shows an overall decrease in C difficile infection (CDI) over the course of a decade, with temporal increases linked to implementation of molecular testing methods, researchers reported today in Infection Control and Hospital Epidemiology.

From 2006 through 2016, 472,346 VA patients were tested for C difficile and 68,995 new cases of CDI were reported. The incidence of total inpatient CDI per 10,000 patient-days decreased from 16.81 in 2006 to 13.66 in 2016, and incidence of hospital-onset healthcare facility-associated (HO-HCFA) CDI fell from 10.87 to 6.41. For both CDI and HO-HCFA CDI, temporal increases in incidence observed in 2011 were associated with increased use of molecular-based testing methods such as polymerase chain reaction (PCR) tests (P < .0001). Decreases for both CDI and HO-HCFA CDI were associated with reduced use of fluoroquinolones (P < .0001), clindamycin (P = .0006), and third-generation cephalosporins (P < .0002). Implementation of VA mandatory reporting of HO-HCFA CDI in 2012 did not influence overall CDI rates (P = .24) or HO-HCFA CDI rates (P = .72).

The analysis also found that the overall crude 30-day mortality rate for CDI fell from 2.17 deaths per 10,000 patient-days in 2006 to 1.41 in 2016. The decrease in mortality correlated with PCR testing (P = .0003) but not with decreased antibiotic use or with mandatory VA reporting.

The authors of the study conclude, "Controlling CDI is likely multifactorial. Although the VA initiative to report cases of hospital-acquired CDI was not significant in our model, the advent of stewardship programs throughout the VA and reductions in the use of third-generation cephalosporins, fluoroquinolones, and clindamycin were significantly associated with reduced rates of CDI."
Nov 11 Infect Control Hosp Epidemiol abstract

 

UK antibiotic development group to work on metallo-beta-lactamase inhibitor

UK-based antibiotic and diagnostic development group the AMR Centre announced today that is has selected a preclinical candidate from its program to address antibiotic resistance caused by metallo-beta-lactamase (MBL) enzymes.

According to an AMR Centre press release, the MBL inhibitor program is focused on a novel small molecule that inhibits a range of MBL enzymes—including NDM-1, IMP, and VIM—and has been shown in lab studies to restore the function of existing beta-lactam antibiotics, which are inactivated by MBLs. The goal is to combine the molecule with carbapenems to treat serious, multidrug-resistant infections caused by gram-negative, MBL-harboring bacteria.

"Our mission is to overcome resistance mechanisms and develop new treatments for serious infections," AMR Centre Executive Director Peter Jackson, PhD, said. "Our MBL inhibitor will be one of the first and, we hope, most effective broad-spectrum therapies against the emerging class of superbugs coming out of India and China."

Clinical trials are scheduled to begin in late 2020.
Nov 11 AMR Centre press release

 

Dutch study measures ESBL carriage in dogs, cats, and their owners

A nationwide study by Dutch researchers has found that more than 10% of dogs in the Netherlands carry extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). The findings appear today in the Journal of Antimicrobial Chemotherapy.

For the cross-sectional study, which aimed to identify the prevalence, risk factors, molecular characteristics, persistence, and acquisition of ESBL-E in dogs and cats, the researchers randomly invited Dutch residents to fill out a web-based questionnaire and provide a fecal sample from their dog or cat. Participants were also invited to provide a fecal sample so researchers could investigate co-carriage in human-pet pairs belonging to the same household.

Overall, 550 pairs of fecal samples from humans and dogs and 282 pairs of fecal samples from humans and cats were submitted. The prevalence of ESBL-E carriage in these cohorts was 3.8% for human participants, 10.7% for dogs, and 1.4% for cats. Among the dogs and the cats, the most abundant ESBL gene were blaCTX-M-1 and blaCTX-M-15. The persistence of ESBL-E carriage in dogs was 57.1% at 1 month and 42.9% at 6 months. The primary risk factors for ESBL-E carriage in dogs was eating raw meat (odds ratio, 8.8; 95% confidence interval [CI], 4.7 to 16.4). Risk factors could not be determined for cats.

No ESBL-E co-carriage was found between cats and their owners, but in five households, both the human and dog fecal samples were positive for the same ESBL gene, which was more than expected based on chance. Whole-genome sequencing in three of the human-dog pairs found that the isolates were nearly identical.

The authors of the study say the observed ESBL-E co-carriage between humans and their dogs suggests either clonal transmission between humans and pets within the same household, or exposure to the same source.
Nov 11 J Antimicrob Chemother study

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