Stewardship / Resistance Scan for Nov 25, 2019

Educational outpatient stewardship
Antibiotic overuse in Saudi Arabia, Pakistan
Funds for resistant gonorrhea

Educational stewardship program tied to better antibiotic prescribing

A comprehensive educational antimicrobial stewardship program (ASP) implemented in 214 Spanish primary care clinics was tied to improved use of antibiotics and a sustained reduction of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, according to a new study in The Lancet Infectious Diseases.

In total, 1,387 physicians participated in the ASP from 2014 to 2017 in outpatient primary care clinics serving more than 1.9 million patients across a wide area of Spain. The ASP combined educational presentations on correct prescribing; practice-based diagnostic and treatment guidelines; case-based, in-person discussions with clinicians about their prescribing practices; and audit and feedback reports. Researchers analyzed data from January 2012 (before implementation) through December 2017.

The investigators noted a 36.5% rate of inappropriate antibiotic prescribing in 2014, compared with a 26.9% rate in 2017. Ciprofloxacin use dropped 15.9% and cephalosporin use 22.6% after ASP implementation, and both reductions were sustained. The use of antibiotics recommended in guidelines, meanwhile, increased: Amoxicillin use climbed 22.2%, while fosfomycin use rose 6.1%.

The incidence of ESBL-producing E coli in urine samples declined 65.6%, down 0.028 cases per 1,000 inhabitants. Before the ASP was begun, the rate of that resistant pathogen had been increasing.

The study was funded by the Instituto de Salud Carlos III and the Spanish government.

In a related commentary in the same journal, two Johns Hopkins experts who were not involved in the study wrote, "Understanding whether the intervention can persist in the long-term and which of its components must be hardwired into the clinic workflow to achieve sustainability are important next steps. Elements of the investigators' work, such as education via a massive open online course and tools developed for audit, feedback, and peer review, can and should be disseminated and implemented in other ambulatory practices, such that optimal antibiotic prescribing in the outpatient setting becomes the norm, not the exception."
Nov 22 Lancet Infect Dis study
Nov 22 Lancet Infect Dis commentary


Studies note high rates of improper antibiotic use in Saudi Arabia, Pakistan

A two-hospital study in Saudi Arabia highlights inappropriate antibiotic use in patients both with and without sepsis, while a second study in the same journal—Antimicrobial Resistance & Infection Control—notes antibiotic overprescribing in hospitals in Lahore, Pakistan.

The case-control study in Riyadh, Saudi Arabia, involved 157 patients with sepsis and 158 without. All patients with sepsis received antibiotics, while 87.3% of controls received the drugs. The researchers compared antibiotic use before and after management by critical care response teams (CCRTs).

Overall appropriateness was 59.6% in sepsis patients and 50.7% in controls. In addition, only 48.5% of antimicrobials prescribed by CCRTs were de-escalated by a primary team within 4 days across both study groups. Individual appropriateness was highest with piperacillin/tazobactam (87.1%) and colistin (78.3%) and lowest with meropenem (16.7%) and imipenem (25.0%).

The authors concluded, "Empiric use and inadequate de-escalation of broad-spectrum antimicrobials were major causes for inappropriate antimicrobial use in CCRT patients."
Nov 21 Antimicrob Resist Infect Control Saudi Arabia study

In the second study, Pakistani scientists analyzed data on 1,185 patients who, over a 2-month period in 2017, were prescribed antibiotics in one of four acute-care hospitals in the capital city, two public and two private. Among those patients, 70.3% received at least one antibiotic that was deemed inappropriate based on guidelines. Of the 27.2% of patients who had respiratory tract infections, 62.8% received inappropriate antibiotic therapy.

Macrolides were tied to the highest rate of inappropriate prescribing—74.6%—followed by penicillins (71.0%), carbapenems (70.9%), cephalosporins (67.2%), and fluoroquinolones (64.2%). The inappropriate rate for aminoglycosides, in contrast, was 35.8%.
Nov 21 Antimicrob Resist Infect Control Pakistan study


CARB-X announces funding for drug targeting resistant gonorrhea

CARB-X today announced funding of up to $4.1 million for VenatoRx Pharmaceuticals, Inc to develop a new class of oral antibiotics to treat multi-drug-resistant (MDR) Neisseria gonorrhoeae

"Neisseria gonorrhoeae are highly adept at avoiding the action of antibiotics that are meant to kill them. Some strains resist even last-resort antibiotics and these superbugs continue to build resistance at an alarming rate," said Kevin Outterson, JD, executive director of CARB-X, in a press release. VenatoRx could receive an additional $8.9 million if it meets certain project milestones.

Each year, 78 million people worldwide are infected with the gonorrhea, and half of all infections are resistant to at least one antibiotic, CARB-X said. VenatoRx's product is a novel non-beta-lactam penicillin-binding protein inhibitor that has acts against select gram-negative bacteria, including N gonorrhoeae.

The award is CARB-X's second for VenatoRX, and the 51st the organization has made since its inception in 2016. The awards together exceed $154 million.

CARB-X stands for the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, and the organization has pledged to invest up to $500 million between 2016-2021 to support the development of new antibiotics, rapid diagnostics, vaccines and other life-saving products.
Nov 25 CARB-X press release

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