Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
New EU rules on antibiotic use on farms take effect
New rules limiting the use of antibiotics in food-producing animals in the European Union went into effect today.
The revamped legislation on veterinary medicinal products, adopted 3 years ago by the European Commission, bans the use of antibiotics—including those used in medicated feed—to prevent disease in groups of animals, and restricts the use of antibiotics to control the spread of disease. It also reinforces a ban on the use of antibiotics for growth promotion, obligates member states to collect data on sales and use of antibiotics in food-producing animals, and provides incentives to stimulate development of new veterinary medicines.
EU officials say the legislation will support reaching the goals of the European One Health Action Plan and the Farm to Fork Strategy against antimicrobial resistance (AMR), which aims to reduce sales of antibiotics for farmed animals in the EU by 50% by 2030.
"The new rules will ensure that, as of today, treatments by antimicrobials for animals will be administered when, and only when, there is a real need for them," Stella Kyriakides, EU Commissioner for Health and Food Safety, said in a press release. "Together with the new legislation on medicated feed, which will ban the preventive use and restrict prescriptions of antimicrobial in medicated feed, the new rules will significantly strengthen the fights against AMR."
In a related document released today, the European Public Health Alliance (EPHA) said that, while it welcomed the new regulations, it's concerned about the probability for widespread noncompliance because there's little indication Europe is moving away from the type of intensive farming systems that rely on the routine use of antibiotics.
To ensure that the new EU regulations are implemented in full, EPHA put forth 10 recommendations that it believes could help achieve significant cuts in livestock antibiotic use. These include limiting the use of antibiotics in livestock to individual treatments, collecting data on antibiotic use by species and farming system to identify factors linked to high antibiotic use, restricting use of highest-priority critically important antibiotics in livestock, improving hygiene on farms, and providing animals with access to the outdoors.
Jan 28 European Commission press release
Jan 28 EPHA report
New coalition to focus on antibiotic overuse in agriculture
Originally published by CIDRAP News Jan 27
US PIRG (Public Interest Research Group) Education Fund today announced the launch of a new coalition dedicated to reducing antibiotic use in agriculture.
The Coalition to Preserve Antibiotics includes physicians, farmers, and animal and public health professionals. The group says in it mission statement that while overuse of antibiotics in any setting can promote the development of antibiotic-resistant bacteria, its focus is on reducing antibiotic use in agriculture because roughly two thirds of the medically important antibiotics sold in the United States are for use in food-producing animals.
Coalition members believe that antibiotics can and should be used to treat sick animals, but they say the way the conventional food system raises animals for food often relies too heavily on the routine use of antibiotics to compensate for conditions that can lead to disease, and that this overuse breeds antibiotic-resistant pathogens that can threaten both animal and human health.
"Antibiotic resistant organisms are a dire public threat in our hospitals, food supply, communities and environment," infectious disease physician and coalition member Sameer Patel, MD, MPH, said in a press release. "Healthcare workers, farmers, restaurateurs, consumers—all of us can make changes now to reduce unnecessary antibiotic use and decrease the threat of antimicrobial resistance."
The coalition says it will work with stakeholders at all levels of government, industry, and academia to advance better antibiotic stewardship in agriculture.
Jan 27 US PIRG Education Fund press release
Study suggests shorter IV antibiotic durations for young infants with UTIs
Originally published by CIDRAP News Jan 25
A review and meta-analysis of studies on urinary tract infections (UTIs) in young infants suggests shorter intravenous (IV) antibiotic courses, with an early switch to oral antibiotics, should be considered, Australian researchers reported yesterday in Pediatrics.
While international guidelines recommend admitting all infants 90 days or younger with a UTI to the hospital for initial IV antibiotic therapy, there is no consensus on the optimal time for when young infants can be safely switched from IV to oral therapy, and considerable variation in IV antibiotic duration for UTIs in this age-group remains. To determine if a shorter IV course may be appropriate for young infants with UTIs, researchers screened 10,181 records and identified 18 studies involving 16,615 young infants that met the inclusion criteria.
The largest two studies on bacteremic UTI found no difference in the rates of 30-day recurrence or 30-day all-cause hospitalization between young infants who received 7 days or less of IV antibiotics and those who received more than 7 days.
For infants with non-bacteremic UTIs, there was no significant difference in the 30-day adjusted recurrence rate between those treated with 3 days or less of IV antibiotics and those treated with more than 3 days. Three studies used oral antibiotics alone and reported good outcomes, although only 85 infants in those studies were 90 days or younger.
"These findings have important implications for clinical practice, because shorter IV antibiotic courses with an early switch to oral therapy can improve the quality of life of children and their families, reduce the length of hospital stay, the risk of nosocomial infections, and health care costs," the review authors wrote.
The authors note that the recommendations are only for young infants when meningitis has been excluded and who have no features of sepsis.
Jan 24 Pediatrics abstract
Study highlights non-guideline adherent antibiotic treatment for C diff
Originally published by CIDRAP News Jan24
A review of Clostridioides difficile infection (CDI) treatments at 10 community hospitals found that only 50% of treatment regimens were adherent to guidelines regarding use of fidaxomicin, researchers reported today in Infection Control & Hospital Epidemiology.
The review looked at all adult non-hospice patients with confirmed CDI who received fidaxomicin at 10 community hospitals within the University of Pittsburgh Medical Center (UPMC) system from May 2018 through August 2019. Based on updated CDI treatment guidelines from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, UPMC in April 2018 broadened fidaxomicin use but did not recommend it for initial treatment of CDI.
The aim of the study was to better understand fidaxomicin use following introduction of the updated UPMC guidelines, which were communicated to pharmacy directors and local antimicrobial stewardship programs at all UPMC hospitals.
Average fidaxomicin use remained low but increased by 30% pre-updated guidelines to post-updated guidelines. Of the 104 fidaxomicin regimens prescribed, 52 were non-adherent to UPMC guidelines. The main reasons for non-adherence included use for fulminant CDI (36 prescriptions) and concurrent use with other CDI treatment (29), neither of which were recommended at the time by the UPMC guidelines. Infectious disease (ID) physicians accounted for 25 (48%) of the 52 non-adherent regimens.
The study authors say the findings highlight the importance of including ID consultants in antimicrobial stewardship programs.
"Although release of new or updated clinical guidelines provides opportunities to advance patient care, dissemination of this information is often slow," they write. "Antimicrobial stewardship programs play a critical role in dissemination and should ensure that all providers, including ID staff, exercise appropriate stewardship in their prescribing practices."
Jan 24 Infect Control Hosp Epidemiol abstract
Urgent care study finds decline in antibiotic prescribing during COVID-19
Originally published by CIDRAP News Jan 24
An analysis of antibiotic prescribing at two academic urgent care clinics found a sustained decline in antibiotic prescribing during the COVID-19 pandemic, despite a transition to telemedicine, researchers reported late last week in Open Forum Infectious Diseases.
In the study, researchers from Stanford University School of Medicine compared the proportion of clinic and telemedicine visits at two academic urgent care clinics during which antibiotics were prescribed before (December to January 2019) and during (January to December 2020) the pandemic. They extracted diagnoses and antibiotic data from the electronic medical record and assigned each encounter a disease category and an antibiotic prescribing tier based on whether antibiotics were almost always (tier 1), sometimes (tier 2), or almost never (tier 3) indicated.
A total of 69,842 encounters were analyzed, with 33,591 occurring before and 36,251 during COVID-19. Telemedicine visits rapidly increased in March 2020 and became the dominant visit modality thereafter. The pre-COVID-19 antibiotic prescribing rate was 17%, compared with 11% during COVID-19. The antibiotic prescribing rate was 9% in telemedicine and 15% in clinic visits during COVID-19. The overall decline in antibiotic prescribing was driven primarily by encounters for a respiratory diagnosis and was not observed in encounters for gastrointestinal, genitourinary, skin, or other infections.
Among respiratory encounters, antibiotics were prescribed less frequently across all tiers during COVID-19: tier 1 (63% vs 56%), tier 2 (37% vs 27%), and tier 3 (16% vs 5%). Less than 1% of COVID-19 encounters were associated with an antibiotic prescription.
The study authors say the reasons for the decline likely include changes in healthcare use, local epidemiology, and the impact of local masking and physical distancing measures on common respiratory pathogen transmission.
"Future studies are needed to investigate these factors with a goal of promoting optimal antibiotic prescribing for all viral respiratory conditions," they wrote. "The big question remains as to whether the lower antibiotic prescribing rates will be sustained beyond the COVID-19 pandemic."
Jan 22 Open Forum Infect Dis abstract