Stewardship / Resistance Scan for Apr 02, 2020

News brief

Review finds dearth of data on antibiotic stewardship in Africa

A literature review by Nigerian and UK researchers found only a handful of studies on antimicrobial stewardship programs (ASPs) in African countries, highlighting the paucity of data on ASP implementation on the continent, according to a paper published yesterday in the Journal of Global Antimicrobial Resistance.

The review of five electronic databases found 13 studies published that met the criteria for inclusion. Seven were conducted in South Africa, three in Kenya, and one each in Sudan, Tanzania, and Egypt. The studies mainly assessed the effectiveness of the interventions using process measures, including change in total antibiotic consumption, cost savings, appropriateness of prescribing and reduction in antibiotic encounters, and compliance with antibiotic guidelines. In some of the studies, change in mortality, 30-day readmission, and surgical-site infection rate were also assessed.

Of the studies reviewed, 6 reported overall reduction in antibiotic use, 3 reported improvements in antibiotic appropriateness and reduction in antibiotic encounters, 2 reported improved compliance with antibiotic guidelines, 2 reported cost savings, and 2 reported decreases in surgical-site infection rates. Non-significant change in mortality and 30-day readmission rate were reported in 2 studies.

Despite the paucity of data, the authors say the findings indicate the ASP interventions were associated with improvements in antibiotic use and demonstrate that ASPs can be implemented in other African countries.

"Whilst the continent faces a myriad of challenges which impact on effective healthcare delivery and implementation of health programmes, such as ASPs, all included studies reported improvement in outcome measures (e.g., decrease in antibiotic consumption, compliance with antibiotic policy, reduction in surgical site infections) following the antimicrobial stewardship interventions," they write. "Other African countries can emulate these examples."
Apr 1 J Glob Antimicrob Resist study

Study examines antibiotic options for injection drug users

Injection drug users with invasive infections who leave the hospital before completing intravenous (IV) antibiotics fare better when offered oral antibiotic therapy on discharge, researchers from Washington University in St. Louis School of Medicine reported today in Clinical Infectious Diseases.

The retrospective, single-center study looked at a cohort of injection drug users admitted to an academic medical center with an invasive bacterial or fungal infection. While infectious disease physicians recommend 4 to 6 weeks of IV antibiotic therapy for such patients, for a variety of reasons, injection drug users frequently leave the hospital against medical advice (AMA) before completing therapy, and significant controversy exists among infectious disease specialists over antibiotic treatment strategies in these situations.

The study compared three different treatment strategies in 293 injection drug users who had severe invasive infections: a full course of inpatient IV antibiotics, a partial course of IV antibiotics without oral antibiotics on AMA discharge, and a partial course of IV antibiotics with oral antibiotics on AMA discharge. The primary outcome was 90-day all-cause readmission rates.

The results showed that 90-day all cause readmission rates were highest among injection drug users who did not receive oral antibiotic therapy on AMA discharge (n = 46, 68.7%), compared with inpatient IV (43, 31.5%) and partial oral antibiotics (27, 32.5%). In a multivariate analysis, 90-day readmission risk was higher among injection drug users who did not receive oral antibiotic therapy on AMA discharge (adjusted hazard ratio [aHR], 2.32; 95% confidence interval [CI], 1.41 to 3.82) and not different among those prescribed oral antibiotic therapy on AMA discharge (aHR, 0.99; 95% CI, 0.62 to 1.62) compared with those who completed IV therapy. Surgical source control (aHR, 0.57; 95% CI, 0.37 to 0.87) and addiction medicine consultation (aHR, 0.57; 95% CI, 0.38 to 0.86) were both associated with reduced readmissions.

The authors say the study supports the concept of multifaceted, holistic management of injection drug users with invasive infections who cannot complete prolonged IV therapy.

"Additional studies specifically evaluating the role and impact of health navigators, case managers, therapists and addiction medicine providers are needed to identify key bundle components while containing costs," they write.
Apr 2 Clin Infect Dis abstract

News Scan for Apr 02, 2020

News brief

Guam records first locally acquired dengue cases since 1944

A study today in Morbidity and Mortality Weekly Report (MMWR) details the first evidence of locally acquired dengue infections on Guam in more than 75 years. In September of 2019, a Guam resident with no travel history suffered dengue-like symptoms and tested positive for dengue serotype 3, prompting a public health emergency, as this was the first locally acquired dengue case documented in Guam since 1944.

A public health campaign focused on identifying other cases was soon launched, and from Sep 9 to Nov 25, scientists identified 249 suspected cases, of which 17 (7%) were confirmed, including 13 locally acquired and 4 travel-associated cases. Two patients were hospitalized, but no deaths were reported.

From 1988 to 2019, Guam tracked 45 travel-related dengue cases. After a Japanese encephalitis outbreak in 1947, the US military eradicated the Aedes aegypti mosquito from the island, which is a common dengue vector.

"Current mosquito surveillance on Guam has identified Aedes albopictus, another DENV [dengue virus] vector, but not A. aegypti. This outbreak provides evidence that autochthonous transmission of DENV is possible on Guam and likely transmitted by A. albopictus," the authors of the study concluded. "It is important that future arboviral preparedness addresses gaps in detection and response exposed by the reemergence of dengue on Guam."
Apr 3 MMWR study

Hungary, Germany, and Poland report H5N8 avian flu outbreaks in poultry

Three European countries reported more highly pathogenic H5N8 avian flu outbreaks in poultry, part of a small but steady stream of activity under way during the past cooler-weather months, according to notifications from the World Organization for Animal Health (OIE).

Hungary, in two separate reports, noted 39 outbreaks. Two outbreaks occurred at commercial duck farms in Csongrad county in the south, where the birds had subclinical illness. All 195,652 birds were slated for culling. The country also reported 37 outbreaks at poultry farms, all in Bacs-Kiskun county, also in the south. The events began between Mar 22 and Mar 30, killing 4,261 of 282,742 susceptible birds. The survivors will be destroyed to curb the spread of the virus. Though the source of the virus isn't known, investigators suggest that wind, high humidity, and human contact contributed to its spread.

Germany reported one more H5N8 outbreak, this time at a turkey-fattening farm in Saxony-Anhalt state. The event began on Mar 27 and killed 137 of 20,087 birds, with the rest culled as part of the outbreak response.

In Poland, animal health officials reported an outbreak at a commercial poultry farm in Lubuskie province in the west of the country, which began on Mar 23, killing 300 of 94,206 birds. The remaining ones were culled.
Apr 1 OIE report on subclinical H5N8 in Hungary
Apr 1 OIE report on H5N8 in Hungary
Apr 1 OIE report on H5N8 in Germany
Mar 31 OIE report on H5N8 in Poland