Stewardship / Resistance Scan for Aug 30, 2018

News brief

Review identifies top risk factors for antibiotic resistance

A systematic review and analysis of available evidence by researchers in the United Kingdom has identified previous antibiotic exposure, underlying disease, and invasive procedures as the top risk factors for antibiotic resistance in humans.

For the review, which was published yesterday in The Lancet Infectious Diseases, researchers with Imperial College London selected and analyzed 565 studies that reported on risk factors from humans, animals, and the environment that result in antibiotic resistance in humans. Using a One Health approach, their aim was to link the quality with the quantity of data reported on antibiotic-resistant bacteria that arise from human, animal, and environmental reservoirs and identify the most evidence-based risk factors. Study quality was assessed in accordance with Cochrane recommendations.

Of the 565 studies included, 527 were reports of primary research and 38 were meta-analyses; the vast majority of the primary research studies (89%) reported on risk factors within the human reservoir, and 11% reported on risk factors arising from the relationships between animal and human reservoirs or human and environmental reservoirs. The 527 primary research studies were used to construct a map of antibiotic resistance drivers.

Of the 88 risk factors identified in these studies, previous antibiotic exposure, underlying disease, and invasive procedures were the risk factors with the most supporting evidence identified. The odds ratios of antibiotic resistance were reported to be between 2 and 4 for these risk factors when compared with their respective controls or baseline risk groups.

Overall, there was little evidence pertaining to cross-reservoir drivers; the effect of the animal reservoir on humans was the most frequently studied aspect of cross-reservoir factors, while evidence supporting the environment as a transmission source for antibiotic-resistant bacteria was scarce.
Aug 29 Lancet Infect Dis review summary

Canadian experts build business case for hospital stewardship programs

Canadian experts have created a business case for antimicrobial stewardship programs (ASPs) in acute care hospitals, which they say will be essential as regulatory and legislative requirements increase.

Writing in Antimicrobial Resistance & Infection Control yesterday, the scientists conducted a review of legislative requirements and outline human resource requirements for ASPs. The also met as a working group to develop the business case.

They found two sets of ASP requirements at the national level: part of the Required Organization Practice by Accreditation Canada and in the National Safety and Quality Health Service Standards required for hospital accreditation in Australia. In addition, ASP legislation was passed in 2014 in California. (The US Joint Commission developed standards in January 2017, but this was after the working group had met.)

The experts identified only one study that addressed human resource requirements. A survey of 65 hospitals in France concluded that 3.6 full-time equivalent (FTE) leads, 2.5 FTE pharmacists, and 0.6 FTE of dedicated microbiologists per 1,000 beds were needed to sustain an ASP, but the study did not provide an evidence-based rationale.

Based on the literature review and consensus development, the working group recommended the following minimum human resources complement: 1 physician, 3 pharmacists, 0.5 program administrative and coordination support, and 0.4 data analyst support as FTEs per 1,000 acute care beds. The experts also developed a spreadsheet-based tool for developing a business case for hospital AFPs into which inputs can be applied to build scenarios for presentation to hospital administration.
Aug 29 Antimicrob Resist Infect Control paper

News Scan for Aug 30, 2018

News brief

Study of Zika-affected babies shows early epilepsy onset, treatment resistance

Clinical follow-up of 141 babies born with congenital Zika virus problems who were evaluated at a referral center in Brazil revealed that 67% experienced epilepsy, a prevalence that was higher than the 9% to 50% reported in earlier studies. Researchers from Brazil described their findings today in a letter to the New England Journal of Medicine.

The mean age of epilepsy in the group of infants was 4.9 months, and parents reported that seizures occurred during the first 6 months of life in 74% of the babies. The main seizure types were epileptic spasms (72%), followed by focal motor seizures (21%) and tonic seizures (4%). A single seizure type was noted in 77% of the infants.

All of the children received antiepileptic medication, with 56% receiving more than one drug. At the last clinic visit, 62 infants (65%)—24 on monotherapy and 38 on polytherapy—had experienced remission.

Electroencephalography (EEG) pattern analysis showed that classic or modified hypsarrhythmia or a burst-suppression pattern was associated with drug-resistant epilepsy. Only one child in the group that had those patterns experienced remission.

The scientists concluded that, for children at the referral center, epilepsy occurred early and was often drug-resistant. They added that some EEG features, such as the burst-suppression pattern, seemed to predict severe epilepsy.
Aug 30 N Engl J Med letter

Experts give recommendations for next phase of US global health strategy

A spending bill passed by Congress in March that extended funding for global health security programs for another 3 years directed the Trump Administration to create a strategy to guide future US efforts in the area, which is due this fall.

In July, a group of stakeholders brought together by the Johns Hopkins Center for Health Security met to contribute their input. The center yesterday released a summary report that covers the major recommendations from the daylong event, which involved discussion among more than 70 experts.

Among the main recommendations, the US strategy should define global health security in a flexible way that keeps the focus on health security, call for meaningful integration of nongovernmental groups into global health security efforts, recognize that continued US investments are needed, establish clear targets for measuring progress, and address gaps in existing efforts.

In a press release, the Center for Health Security said it would share the report with US government agencies and departments that oversee global health security programs.

In its summary report, the center said as the next phase of the US global health security strategy approaches, "communicating the benefits of these programs, engaging with diverse non-governmental partners, ensuring sustained funding, strengthening health systems, allowing targeted strategic flexibility, and maintaining robust measurements will all be critical steps toward continued progress."
Aug 29 Johns Hopkins Center for Health Security press release
Aug 29 stakeholder recommendations for US Global Health Security Strategy