Survey notes possibilities, barriers in nurses' stewardship role
An online survey of 180 nurses found that nursing professionals are well positioned to be integrated into antibiotic stewardship programs, but clinical practice and hospital culture influence perceptions of their role—and barriers include nurses not included in rounds, interdisciplinary power differentials, and nursing input not actively sought—according to a study yesterday in the American Journal of Infection Control.
The survey assessed 10 practices that fall within the responsibility of inpatient nurses and contribute to stewardship efforts.
Nurses were highly confident assessing for an adverse drug reaction history, obtaining cultures before antibiotic prescribing, and participating in patient education. They were less confident in reviewing microbiology results to determine antibiotic appropriateness. Clinical practice and hospital culture influenced perceptions of their stewardship role. Reported barriers to stewarding included exclusion from rounds, power differentials, and lack of coworkers not seeking their input.
The authors conclude, "Barriers to nurse engagement were identified and could be addressed by improving education in microbiology and principles of antibiotic use along with more consistent inclusion of nurses in bedside rounds while also cultivating an environment where nurse contribution is actively sought."
May 2 Am J Infect Control study
Study analyzes snapshot of K pneumoniae isolates in Germany
Whole-genome sequencing (WGS) of Klebsiella pneumoniae isolates from German hospital patients suggests the prevalence of classical K pneumoniae strains with widely distributed carbapenemase genes, researchers reported yesterday in Antimicrobial Resistance and Infection Control.
For the study, researchers with the Robert Koch Institute in Berlin compiled a representative subset of 107 carbapenemase-producing K pneumoniae isolates collected from 2008 through 2014 at hospitals throughout the country. The isolates possessed the four most prevalent carbapenemase types in Germany—KPC-2, KPC-3, OXA-48, and NDM-1.
WGS data showed that the isolates belonged to 21 different sequence types (STs) of K pneumoniae, with 27 of 34 (80%) KPC-2-producing isolates belonging to ST258—a prominent lineage in healthcare settings—and 21 of 26 (81%) KPC-3-producing isolates belonging to ST512 (a variant of ST258). The most prevalent carbapenemase type, OXA-48 (42 isolates), revealed 15 different STs, and the 5 NDM-1 producers were assigned to 4 STs.
One OXA-48 isolate in the collection contained an almost complete set of virulence genes and belonged to ST23, a hypervirulent strain which is frequently found in Asia. That strain appeared to be representative of an entire cluster of infections in a single German healthcare center in 2012.
"The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolate outside Asia is highly worrisome and requires intensive molecular surveillance," the authors write.
May 2 Antimicrob Resist Infect Control study
FDA panel OKs plazomicin for complicated urinary tract infections
A US Food and Drug Administration (FDA) advisory committee has voted unanimously in favor of Achaogen's plazomicin, an intravenous antibiotic, for the treatment of adults who have complicated urinary tract infections but not for the treatment of bloodstream infections.
San Francisco–based Achaogen said the FDA Antimicrobial Drugs Advisory Committee voted 15-0 that the company had "provided substantial evidence of the safety and effectiveness of plazomicin for the treatment of complicated urinary tract infections," but 11-4 against the same criterion for bloodstream infections in patients with limited or no treatment options.
"We are encouraged by the Committee's unanimous vote in favor of plazomicin for complicated urinary tract infections (cUTI). The discussion underscored the real-world challenges that healthcare providers face every day given limited or inadequate treatment options for certain pathogens," said CEO Blake Wise in the company release.
The FDA is not bound by the committee's votes but takes its input into consideration when reviewing marketing applications. Plazomicin has a Prescription Drug User Fee Act date of Jun 25. If the FDA approves the drug by this date, Achaogen expects to launch plazomicin in the United States soon thereafter, the company said.
Achaogen announced on Jan 2 that the FDA had accepted its New Drug Application for priority review for plazomicin.
May 2 Achaogen news release
Jan 2 Achaogen press release