Stewardship / Resistance Scan for Sep 18, 2018

News brief

New York study finds need for stewardship programs in outpatient clinics

Few outpatient clinics in New York City—one of the nation's most densely populated cities—have antibiotic stewardship programs, according to a study that focused on prescriptions written for acute respiratory infections. A team from several facilities in the city published its findings today in Infection Control & Hospital Epidemiology.

The goal of the study was to determine baseline data for clinic-based antibiotic stewardship programs, an initial step in improving outpatient prescribing practices as part of the United Hospital Fund's efforts to improve the city's healthcare system.

The team surveyed 31 hospital-owned clinics from nine hospitals and health systems about their current stewardship practices and performed chart reviews of 30 randomly selected adult acute respiratory illness (ARI) patients, collecting their data from June to August 2016.

Few sites had outpatient stewardship activities. Though 68% of practices had stewardship programs in their health systems, only 25% of the clinics had institutional guidelines for antibiotic use and selection and only 11% had ambulatory-specific guidance.

A review of 1,004 patient charts found that 37.3% overall had received antibiotics for ARIs, but sites varied from 17.4% to 71%. Antibiotic prescriptions for bronchitis and sinusitis was also high—doctors prescribed the drugs for nearly 67% of patients who had acute bronchitis and more than 80% with acute sinusitis.

Macrolides were the most commonly prescribed antibiotics. Most of the 302 respondents acknowledged the need for tools to help guide prescribing. "It remains unclear whether the pervasive reliance on macrolides results from gaps in knowledge of [the] antibiotic spectrum and the common causes of ARIs or the convenience of macrolides," the authors wrote.

The authors said the second stage of the United Hospital Fund's initiative will use the baseline findings to help form site-specific plans to improve outpatient prescribing practices.
Sep 18 Infect Control Hosp Epidemiol abstract


Study finds outpatient antibiotic prescribing in US seniors remains steady

A new study by researchers from the US Centers for Disease Control and Prevention (CDC) has found that outpatient antibiotic prescribing among older adults did not change much from 2011 to 2014, though significant regional variations were noted. The findings appeared yesterday in the Journal of the American Geriatrics Society.

Using a database that collects information on outpatient prescribing from US pharmacies, the researchers conducted a chi-square trend analysis to assess annual changes in antibiotic prescribing among US adults aged 65 and older. They also calculated prescribing rates by antibiotic, age-group, sex, state, census region, and provider specialty.

The results showed that prescribing rates remained stable overall (P = 0.89) during the study period, with adults aged 65 and over receiving 46 million outpatient antibiotic prescriptions in 2011 (1,113 prescriptions per 1,000 persons) and 51.6 million in 2014 (1,115 prescriptions/1,000 persons). In 2014, the prescribing rate was higher in women than in men (1,225 vs. 974 prescriptions/1,000 persons) and in patients older than 75 compared with those aged 65 to 74 (1,157 vs. 1,084 prescriptions/1,000 persons). The highest prescribing rate was in the South census region (1,228 prescriptions/1,000 persons), which was 44% higher than the rate in the West (854 prescriptions/1,000 persons).

Quinolones were the most widely prescribed antibiotic class, followed by penicillins and macrolides, and azithromycin was the most commonly prescribed antibiotic drug, followed by amoxicillin and ciprofloxacin. Internists and family physicians prescribed 43% of antibiotic courses.

The researchers conclude that future efforts to optimize outpatient prescribing in US seniors should focus on reducing quinolone and azithromycin use and targeting primary care providers in the South.
Sep 17 J Am Geriatr Soc abstract


High levels of resistant gut bacteria tied to bloodstream infection risk

New research from Rush University and the University of Michigan shows that patients with higher levels of Klebsiella pneumonia–carbapenemase-producing K pneumoniae (KPC-Kp) within the gut microbiota had a higher risk of bloodstream infection in the long-term acute care hospital (LTACH) setting. The research is published in Clinical Infectious Diseases.

The study is based on weekly rectal swabs collected from 506 patients of an LTACH in Chicago from May of 2015 through May of 2016. The swab samples were cultured and tested for KPC-Kp.

Almost half the patients (255, or 45.4%) provided samples that were colonized with KPC-Kp, and 11 (4.3%) had KPC-Kp bacteremia. In an analysis, the researchers concluded that a relative abundance cutoff of 22% predicted KPC-Kp bacteremia with sensitivity of 73%, specificity of 72%, and relative risk of 4.2 (95% confidence interval [CI], 1.3-14.0, P = 0.01).

"Among antibiotics analyzed, only preceding carbapenem use was associated with a relative abundance of KPC-Kp ≥22% (HR [hazard ratio], 2.19; 95% CI, 1.06-4.55; P = 0.036)," the authors said.  
Sep 18 Clin Infect Dis study

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News Scan for Sep 18, 2018

News brief

Uptake of MMR vaccine falls to 91.2% in the UK

For the fourth year in a row, uptake of the measles, mumps, and rubella (MMR) vaccine has fallen in the United Kingdom, and now stands at 91.2%, well below the 95% uptake recommended to prevent transmission of the communicable diseases.

The statistics are published in a new report from the National Health Service (NHS). The data includes information on nine childhood vaccines offered by the age of 24 months. Only rotavirus uptake increased, from 89.6% in 2016-17 to 90.1% in 2017-18.

According to a story in The Guardian, the effects of this drop are already being seen, as 876 measles cases have been confirmed so far in 2018, more than three times the number recorded in all of 2017. Experts say the decline is because of logistical failures, a confusing recommended vaccine schedule, and growing anti-vaccine rhetoric in Europe.

The UK numbers  are part of the bigger story of the resurgence of measles in Europe. According to the World Health Organization (WHO), more than 41,000 cases of measles were reported in Europe between January and June of 2018, compared with about 24,000 cases in all of 2017.

But new data from the European Centre for Disease Prevention and Control (ECDC) said the rate of measles cases have been dropping since March of this year.

"Since March, the number of [new] measles cases in the EU/EEA have dropped steadily, which is of course a positive development," said Tarik Derrough, the ECDC senior expert on vaccine-preventable diseases. "However, measles continues to spread across Europe because vaccination coverage in most European countries remains sub-optimal."
NHS 2017-2018 vaccine statistics
Sep 18 Guardian story
Aug 20 CIDRAP News scan, "Measles cases in Europe top 41,000, smash records"

Sep 17 ECDC report


FDA, USDA approve PhageGuard-E for protecting against E coli

The United States Department of Agriculture (USDA) and Food and Drug Administration (FDA) have approved PhageGuard-E, a new food processing aid used to prevent contamination with Escherichia coli O157 in the meat processing industry.

PhageGuard-E is made of natural phages, and is used in a spray formulation to decontaminate surfaces and carcasses in food processing plants.

"Unlike harsh chemical interventions, phages are harmless to plant workers and do not damage equipment, concrete floors and water-treatment installations," said a press release from Micreos, the Netherlands-based producer of PhageGuard-E. Micreos also said the spray can be used on beef carcasses, various cuts of meat, and trimmings.

Pathogenic Shiga toxin–producing E coli in food products resulted in almost 5,000 US illnesses in 2017.
Sep 18 Micreos press release

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