Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
Study finds high prevalence of antibiotic use in Latin American hospitals
Originally published by CIDRAP News Dec 29
A point prevalence survey (PPS) conducted in hospitals in five Latin American countries showed that more than half of hospitalized patients received an antibiotic on the day of the survey, researchers reported this week in the Journal of Antimicrobial Chemotherapy.
The Latin-PPS, conducted in hospitals in Cuba, Paraguay, El Salvador, Mexico, and Peru from December 2018 through August 2019, included a total of 5,444 patients at 33 hospitals. Researchers used an adaptation of the World Health Organization (WHO) model for conducting a PPS on antibiotic use, collecting data on patients, antibiotics, and indications. Hospital wards were divided into medical (MED), surgical (SUR), intensive care units (ICUs), gynecology and obstetrics (GO), high-risk (HR), and mixed wards (MIX).
Of the 5,444 patients, 54.6% received at least one antibiotic, with variations within and between hospitals. The lowest antibiotic use was found in Cuban hospitals (47.6%) and the highest in Paraguayan hospitals (81.1%). Antibiotics were most frequently used in ICUs (67.2%), followed by SUR (64.5%) and MED wards (54.2%). Overall, community-acquired infections (CAIs) were the most frequent reason for prescribing antibiotics (51.2%), followed by healthcare-associated infections (HAIs, 22.9%), surgical prophylaxis (11.1%), and medical prophylaxis (4.0%).
Main diagnoses were similar among countries, with pneumonia being the most frequent (26.4%), followed by urinary tract infections (15.3%), non-surgical infections involving skin or soft tissue (12.7%), and intra-abdominal infections, excluding gastrointestinal infections (11.7%) and clinical sepsis (7%).
Adherence to prescribing guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs, and 44.3% for prophylaxis). Third-generation cephalosporins were the most frequently used antibiotic (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases.
The study authors note the prevalence of antibiotic use observed in the PPS is significantly higher than previously found in Latin America by the WHO in its 2015 Global-PPS (31%), and higher than has been observed in Europe (28%) and the United States (46%).
"There is an urgent need to promote and strengthen the antimicrobial stewardship programs in Latin America," they wrote.
Dec 27 J Antimicrob Chemother abstract
Study finds racial disparities in antibiotic treatment for skin infections
Originally published by CIDRAP News Dec 28
Researchers studying antibiotic treatment for skin and soft tissue infections (SSTIs) found a potential racial disparity in antibiotic choice, according to a study published last week in JAMA Network Open.
Using multisite, cross-sectional data on hospitalized patients treated for SSTIs at 91 acute care hospitals, the researchers looked at antibiotic use by race. Little is known about racial disparities in SSTI treatment, but because racial differences in treatment for several medical conditions exist, the researchers hypothesized that there would be racial difference in the management of SSTIs.
Of the 1,242 patients treated for SSTIs from October 2018 to January 2019, 494 (45%) were female, 224 (18%) were Black, and 854 (69%) were White. The mean age was 58 years. History of penicillin allergy was more frequent in Black inpatients than White inpatients (23% versus 18%). Cefazolin, the first-line therapy for SSTIs caused by Staphylococcus aureus and Streptococcus species, was more commonly used in White inpatients than in Black inpatients (13% vs 5%), while clindamycin, an alternative treatment, was more frequently used in Black inpatients than White (12% vs 7%).
Adjusting for multiple factors, including methicillin-resistant S aureus (MRSA) infection and penicillin allergy, White inpatients were nearly three times as likely to be treated with cefazolin (adjusted odds ratio [aOR], 2.82; 95% confidence interval [CI], 1.41 to 5.63) and almost half as likely to be treated with clindamycin (aOR, 0.54; 95% CI, 0.30 to 0.96).
The study authors note that clindamycin is not recommended given frequent dosing and high potential for adverse effects, including Clostridioides difficile infection.
"Future work should evaluate the determinants of this observed difference and devise interventions to achieve pharmacoequity," they concluded.
Dec 23 JAMA Netw Open research letter
