Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
Hospital-acquired infections complicate COVID-19 recovery
Originally published by CIDRAP News Dec 30
An Italian study in the Journal of Antimicrobial Chemotherapy yesterday found that 21.9% of hospitalized COVID-19 patients acquired bacterial or fungal superinfections—infection by a secondary pathogen—that complicated the course of their recovery.
Researchers studied clinical data and outcomes for 315 COVID-19 patients admitted to the University Hospital of Pisa from Mar 4 to Apr 30 and found documented superinfections—bacterial or fungal infections occurring 48 hours or more after hospital admission—in 69 patients (21.9%).
Common superinfection pathogens included Enterobacterales bacteria (44.9%), non-fermenting Gram-negative bacilli (15.6%), Gram-positive bacteria (15.6%), and fungi (5.5%).
Patients who required invasive mechanical ventilation were more likely to acquire a superinfection during their hospital stay (odds ratio [OR], 5.6; 95% confidence interval [CI], 2.4 to 13.1; P < 0.001). Patients previously treated with broad-spectrum antibiotics or immune system suppressing medications were also at higher risk of superinfection (OR, 2.85 and 5.09, respectively).
The researchers found that hospital stays for patients with superinfections were significantly longer than for patients without superinfections (30 days vs 11 days; P < 0.001), but mortality rates were similar (18.8% vs 23.2%; P = 0.445).
"The widespread use of antibiotics in the COVID-19 pandemic may exacerbate antimicrobial resistance and may ultimately lead to increased morbidity as an unintended consequence of this already tragic pandemic," the study authors caution.
Dec 29 J Antimicrob Chemother study
PIDS provides guidance for pediatric antibiotic stewardship programs
Originally published by CIDRAP News Dec 28
The Pediatric Infectious Diseases Society (PIDS) today published a policy statement in Pediatrics recommending and providing specific guidance for antibiotic stewardship programs (ASPs) for pediatric populations.
Antibiotics are the most common medications prescribed to children and are also frequently prescribed unnecessarily, and the risks associated with antibiotic overuse—including antibiotic resistance, Clostridioides difficile infections, and other adverse events—are just as significant in children as they are in adults. Yet while many US hospitals have adopted ASPs to promote judicious antibiotic use, the members of the PIDS Committee on Infectious Diseases note that differences in common infections, drug-specific considerations, and evidence surrounding treatment recommendations between children and adults mean that stewardship for pediatric populations requires specific guidance.
Their statement discusses the rationale for inpatient and outpatient pediatrics ASPs, the essential personnel, infrastructure, and activities required for effective stewardship in children, approaches to evaluating their effectiveness, and gaps in knowledge that require further investigation.
Among the recommendations are that pediatric ASPs should include specialists with both pediatric and stewardship expertise, that inpatient ASPs can use clinical guidelines, prior approval, and post-prescription review and feedback as core interventions, but can also use pharmacy-driven interventions. They also recommend that outpatient ASPs focus on judicious use of antibiotics for acute respiratory tract infections and emphasize use of the narrowest spectrum of antibiotics for the shortest duration of therapy.
Dec 28 Pediatrics policy statement
Study links pandemic to drop in common outpatient antibiotics
Originally published by CIDRAP News Dec 22
A study today in Open Forum Infectious Diseases shows that the COVID-19 pandemic had an immediate and sustained impact on the most commonly prescribed outpatient antibiotics in the United States.
To measure the impact of the pandemic on outpatient antibiotic prescribing, researchers from the University of Pittsburgh and the VA Pittsburgh Healthcare System examined monthly prescription fill data from the IQVIA National Prescription Audit databases over a 6-year period (July 2014 through July 2020). Their analysis showed that prescription fills for the 10 most common outpatient antibiotics decreased significantly (from 13% to 56%) in April 2020 compared with the pre-pandemic period (August 2014 through March 2020).
From May through July 2020, monthly prescription fills of seven of those antibiotics steadily rebounded and exceeded pre-pandemic trends. But monthly fills for three outpatient antibiotics—azithromycin, amoxicillin-clavulanate, and levofloxacin—did not rebound, and along with amoxicillin, they did not return to pre-pandemic levels. Amoxicillin, azithromycin, and amoxicillin-clavulanate are the top three outpatient antibiotics based on monthly fills, and among the most common inappropriately prescribed antibiotics in the United States.
The authors of the study say the sharp drop in antibiotic prescription fills at the beginning of the pandemic were likely due to suspension of non-emergent and non-COVID-19 healthcare services, and that increased prescribing of many outpatient antibiotics in the following months reflected resumption of those services.
On the other hand, they suggest the sustained reduction in prescribing of azithromycin, amoxicillin, amoxicillin-clavulanate, and levofloxacin could be explained by patients being less likely to seek outpatient care for respiratory complaints, clinicians being more reluctant to prescribe those antibiotics, or a reduction in respiratory infections linked to COVID-19 restrictions.
They conclude that more research is needed to understand the long-term impact of the pandemic on outpatient prescribing and antibiotic resistance.
"It will be important to identify factors that contributed to sustained reductions in use of oral azithromycin, amoxicillin-clavulanate, levofloxacin and amoxicillin below baseline levels in the first months of the pandemic," they write. "If inappropriate prescriptions were curtailed, insights might provide a foundation for developing successful outpatient stewardship strategies in the future."
Dec 22 Open Forum Infect Dis abstract
