Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
Study finds high childhood antibiotic exposure in low-resource countries
A study this week in Clinical Infectious Diseases reveals high levels of childhood antibiotic exposure in low- and middle-income countries (LMICs).
For the study, Swiss and British researchers used the Demographic and Health Survey, which collects nationally representative household-level data on the health of women and children, to estimate the average number of antibiotic treatments received in the first 5 years of life in 45 LMICs. The 2-week point prevalence of fever, diarrhea, or cough and antibiotic treatment for these illnesses were estimated for ages 0 to 59 months and aggregated to estimate cumulative illness and antibiotic treatment for each country.
The researchers also estimated treatment rates and the contribution to total antibiotic use attributable to medical care, informal care, and self-medication.
The 45 countries contributed 438,140 child-observations. On average, 38.7% of children had experience illness in the 2 weeks before the survey, and 38.4% of children with illness received antibiotics, including 42.7% of febrile and 32.9% of non-febrile illnesses. Within countries, the proportion of sick children ranged from 10% in Niger to 72% in Jordan.
Across the 45 countries, the researchers estimate that children experienced an average of 50.6 illnesses over their first 5 years and received an average of 18.5 antibiotic treatments. The average number of antibiotic treatments ranged from 3.7 in Niger to 38.6 in the Republic of the Congo. A median of 68.7% of antibiotic treatments were attributable to medical care, 9% to informal care, and 16.9% to episodes for which no care was sought.
The study authors say a substantial proportion of the documented antibiotic use is likely inappropriate, and that the findings highlight the challenges in balancing access and excess antibiotic use in LMICs.
"Context-specific policies and tools to support appropriate empiric treatment and guideline adherence, limit inappropriate use, and stewardship programs that address health systems and informal drug sources are needed," they wrote. "Countries should consider care-seeking and community treatment practices to identify opportunities and ideal intervention points to support optimal antibiotic use."
Mar 23 Clin Infect Dis abstract
Rapid PCR tests for suspected Strep A infections tied to less antibiotic use
Originally published by CIDRAP News Mar 24
Implementation of point-of-care (POC) polymerase chain reaction (PCR) tests for patients with acute pharyngitis symptoms as part of a broader antibiotic stewardship initiative was associated with a significant reduction in inappropriate antibiotic use at outpatient clinics in California, researchers reported today in Open Forum Infectious Diseases.
The retrospective before-and-after study assessed the impact of switching from a rapid antigen detection test (RADT) to a rapid POC PCR assay for patients with suspected group A beta-hemolytic Streptococcus pyogenes (Strep A) infection at 15 outpatient clinics in the University of California (UC) Davis health system. RADTs are the standard-of-care for Strep A, but because they have low sensitivity and negative results require time-consuming microbiologic culture confirmation, patients frequently receive inappropriate empiric antibiotic therapy.
Using patient medical records, UC Davis researchers compared antibiotic use when RADTs were used (the control period, June 2017 to May 2018) with the first complete season when the POC PCR testing strategy was implemented (the intervention period, June 2018 to May 2019).
Analysis of 10,081 eligible patient records showed that rates of antibiotic prescribing within 14 days of the initial clinic visit were similar during the intervention and control period (25.1% vs 26.2%, respectively). But among the patients who had a negative POC PCR result, the researchers recorded a 44.1% reduction in the number of antibiotics prescribed during the intervention period (10.1% vs 18%, respectively). Rates of antibiotic prescribing varied across sites, ranging from 10.7% to 33.8% during the intervention period and 12.4% to 34.4% during the control period.
The use of POC PCR tests had no impact on prescription rates in patients with positive results compared with RADTs (76.2% vs 76.5%, respectively).
"The prescribing changes between the intervention and control periods demonstrate that the greater diagnostic accuracy of the POC PCR, compared with that of the RADT, allows clinicians to have greater certainty in the result, and reduces the likelihood of the clinician resorting to empiric antibiotic therapy," the authors write, adding that adherence to an algorithm directing appropriate management of suspected Strep A also likely played a role in the reduced prescribing.
Mar 24 Open Forum Infect Dis abstract
Project will analyze hospital wastewater for antibiotics, resistant bacteria
Originally published by CIDRAP News Mar 22
The Partnership for European Environmental Research (PEER) yesterday reported the launch of a new project that will use hospital wastewater to assess how antimicrobial stewardship programs are affecting levels of antibiotics and resistant bacteria released into the environment.
The £1.25 million ($1.65 million US) STRESST project (Antimicrobial Stewardship in Hospitals, Resistance Selection and Transfer in One Health context) will use a novel wastewater sampling technique developed by the UK Centre for Hydrology & Ecology (UKCHE) in response to the COVID-19 pandemic to collect and analyze wastewater from a hospital in Malawi. Investigators from UKCHE, the Liverpool School of Tropical Medicine, the University of Bergen, and Wageningen Bioveterinary Research will analyze the water for levels of antibiotics, susceptible and resistant bacteria, and rates of transfer of resistance genes.
The project will ultimately aim to determine if antibiotics present in the hospital wastewater promote selection and sharing of resistance genes among bacteria, how the release of this water into the environment affects microbial communities in the animals that drink it, and whether antimicrobial stewardship programs can reduce the flow of antibiotics and resistant bacteria into the environment.
"We are really excited to be field-testing several next-generation wastewater sampling kits in Malawi to understand the impact of different antibiotic management programmes on the presence of antimicrobial resistance (AMR) in the hospital population," principal investigator Andrew Singer of UKCHE said in a PEER news release.
Mar 21 PEER news release
Fewer antibiotics for non-COVID patients with fever, respiratory symptoms
Originally published by CIDRAP News Mar 21
Researchers at a hospital in China found an 8.3% decline in antibiotic use among patients with non-COVID fever and respiratory symptoms during the pandemic, likely because of heightened awareness of viral pathogens, according to a study published late last week in the Journal of Infection.
The retrospective study of 4,589 patients with fever and respiratory symptoms treated in the outpatient service at a hospital in Shanghai compared antibiotic use in the 2,617 patients treated in the pre-pandemic period (May 2019 to October 2019) with 1,972 treated in the peri-pandemic period (May 2021 to October 2021). The researchers hypothesized that there might be reduced antibiotic use under China's "dynamic zero-COVID policy," in which physicians were recommended to perform SARS-CoV-2 PCR tests, chest computed tomography (CT) scans, and C-reactive protein (CPR) and complete blood count (CBC) tests on all patients who had fever and respiratory symptoms.
The study found that rates of chest CT scans (45.3% vs 4.1%), CPR (60.3% vs 0.2%), and CBC (89.4% vs 63.5%) tests were higher in the peri-pandemic period than in the pre-pandemic period, and the rate of antibiotic use was lower (67% vs 73.1%). Receipt of combination antibiotics (11.5% vs 24.3%) and intravenous antibiotics (37.8% vs 52%) was also lower.
But multivariable logistic regression analysis found that neither CT scans (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.83 to 1.22) nor CRP (OR, 0.93; 95% CI, 0.78 to 1.11) tests were associated with the decrease in antibiotic use. Only treatment during the peri-pandemic period (OR, 0.76; 95% CI, 0.64 to 0.92) was associated with decreased antibiotic use.
"Therefore, reducing antibiotic use in the peri-pandemic cohort might be primarily explained as the increased awareness of viral pathogens through the education of COVID-19," the study authors wrote. "In conclusion, from the perspective of antimicrobial stewardship, only adding CRP test and chest CT scan on fever patients with respiratory symptoms cannot reduce the rate of antibiotic use in outpatient settings in mainland China."
Mar 18 J Infect study