Stewardship / Resistance Scan for Jun 06, 2019

News brief

Scoring system identifies infants at risk of invasive bacterial infections

A nationwide team of pediatric infectious disease and emergency medicine specialists has developed a new scoring system to identify febrile infants with a low probability of invasive bacterial infection (IBI), according to a paper yesterday in Pediatrics.

The team conducted a case-control study of febrile infants less than 60 days old who presented to 11 US emergency departments (EDs) from July 2011 through June 2016. Infants with IBI, which is defined by growth of a pathogen in blood or cerebrospinal fluid, were matched to two patients at the same hospital who did not have IBI. For each case and control patient, the researchers extracted medical record data on variables that could be associated with the presence of IBI. Using multiple logistics regression, they then identified predictors of IBI and developed a scoring system based on those predictors.

Of the 394 infants with IBI who presented to the 11 EDs over the 5-year study period, 181 met the inclusion criteria and were matched to 362 control patients. Among the 181 infants with IBI, 155 had bacteremia without meningitis and 26 had bacterial meningitis.

Four predictors were associated with the presence of IBI and incorporated into the scoring system: age of less than 21 days (1 point), maximum temperature recorded in the ED 100.4°F to 101.1°F (2 points) or higher than 101.3°F (4 points), abnormal urinalysis results (3 points), and absolute neutrophil count (ANC) of more than 5,185 cells per microliter. Infants with a score of less than 2—fever by history only, normal urinalysis, and an ANC of fewer than 5,185 cells per microliter—were considered a low risk for IBI.

Assessment of the scoring system in the 492 infants with available data found that an IBI score of 2 or higher had a sensitivity of 98.8% (95% confidence interval [CI], 95.7% to 99.9%) and a specificity of 31.3% (95% CI, 26.3% to 36.6%). Moderate-risk score of 3 or higher or 4 or higher had higher specificity (52.0% and 53.7%, respectively) but lower sensitivity (92.9% and 88.2%, respectively). All 26 infants with meningitis had scores of 2 or higher.

The authors of the study say the IBI score could be used to potentially avoid lumbar punctures, some antibiotics, and hospitalization in low-risk infants. But because of the limitations of the case-control design, they say external validation of the scoring system is needed.
Jun 5 Pediatrics abstract

Stewardship survey finds prescribers prefer education over restriction

A survey of French hospitals indicates French prescribers prefer antibiotic stewardship interventions that aim to improve their ability to make appropriate decisions about antibiotic prescribing over those that challenge their clinical authority, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

The cross-sectional survey was sent to all prescribers in 27 French hospitals from September 2016 through July 2017. All 27 hospitals had an antibiotic stewardship program (ASP) and an appointed antibiotic advisor (AA). Of the 1,963 questionnaires distributed, 920 (46.9%) were completed; the respondents were mainly attending physicians (71.7%) and medical specialists (61.3%).

The respondents identified two main objectives of their hospital's ASP: to limit the spread of antibiotic resistance in the hospital (77.8%) and to improve the care and prognosis of infected patients (76.1%). But only 36% thought the ASP aimed to prevent resistance in their patients. Most respondents acknowledged an AA's usefulness on therapeutic issues, such as choosing the appropriate antibiotic for a patient (84.7%) and adapting the antibiotic treatment to specific clinical situations (89.6%), but far fewer saw the AA as useful during the diagnostic process (31.4%).

When asked about the usefulness of different ASP interventions, 74% of respondents approved of information sessions for senior physicians, 73% approved of training sessions for residents, and 70% approved of staff meetings to discuss clinical cases. But far fewer approved of automatic stop orders (26.8%), removal of antibiotics from ward stocks (23.4%), or pre-approval from the AA (28.8%).

The authors of the paper conclude that for French ASPs to have a bigger impact on prescribing, they need to move beyond the current approach, where clinicians seek advice when they think they need it and confrontation with non-compliant prescribers is rare. They describe a need for restrictive measures alongside audits and individualized feedback and more educational outreach.
Jun 5 J Antimicrob Chemother abstract

News Scan for Jun 06, 2019

News brief

WHO: 1 million new STIs diagnosed each day

Rates of chlamydia, gonorrhea, syphilis, and trichomoniasis—four curable sexually transmitted infections (STIs)—have not declined significantly since 2012, according to a report today from the World Health Organization (WHO). In fact, as many as 1 million diagnoses of these STIs are made each day, representing an enormous public health burden.

The report estimated rates of STIs in 15- to 49-year-olds globally in 2016. There were 127 million new cases of chlamydia in 2016, 87 million of gonorrhea, 6.3 million of syphilis, and 156 million of trichomoniasis. This means that about 1 in 25 people globally has an STI at any given time, with many having more than one infection concurrently, the WHO said.

"We're seeing a concerning lack of progress in stopping the spread of sexually transmitted infections worldwide," said Peter Salama, MD, executive director for Universal Health Coverage and the Life-Course at WHO. "This is a wake-up call for a concerted effort to ensure everyone, everywhere can access the services they need to prevent and treat these debilitating diseases."

All four of the studied STIs are treatable with antibiotics, and preventable with correct condom use, the agency said. However, global shortages of benzathine penicillin have made treating syphilis challenging in some parts of the world, and drug-resistant gonorrhea is a persistent threat in many countries.
Jun 6 WHO news release
Jun 6 WHO report

Safe, sustainable food systems focus of first UN World Food Safety Day

Tomorrow the United Nations (UN), Food and Agriculture Organization (FAO) of the UN, and the WHO will mark the first World Food Safety Day, which aims to strengthen the safety and security of food.

Food contaminated by bacteria, viruses, parasites, or chemicals sicken 600 million people each year.

"Unsafe food kills an estimated 420,000 people every year. These deaths are entirely preventable," said Tedros Adhanom Ghebreyesus, PhD, WHO director-general, in a WHO news release. "World Food Safety Day is a unique opportunity to raise awareness about the dangers of unsafe food with governments, producers, handlers and consumers. From farm to plate, we all have a role to play in making food safe."

According to the WHO, children under age 5 carry 40% of the foodborne disease burden, with 125,000 deaths every year.

In a new report on the burden of foodborne diseases in the European region, WHO authors said that every minute 44 people in that region become sick after eating tainted food—or more than 23 million a year.

Diarrheal illnesses account for the largest percentage of foodborne diseases in Europe, with norovirus estimated to cause 15 million cases, followed by Campylobacter, which is responsible for almost 5 million illnesses annually. Overall diarrheal diseases are responsible for 94% of foodborne illnesses, 63% of related deaths, and 57% of the disease burden.
Jun 6 WHO press release
Jun 5 WHO European region report