Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
UK study finds CRP tests tied to lower antibiotic prescribing for cough
The use of point-of-care C-reactive protein (CRP) tests in primary care practices reduced the odds of prescribing antibiotics for cough by 21%, a non-significant but clinically relevant reduction, researchers reported yesterday in Eurosurveillance.
Using a pragmatic randomized controlled trial design, researchers from Public Health England allocated the top 19 antibiotic prescribing general practices in Northern England to an intervention group that used CRP point-of-care tests (POCTs) for patients who had symptoms of acute cough, and a control group using standard practice. The eight practices allocated to the intervention arm, with a patient population of 47,000, were given a CRP-POCT machine and 100 CRP tests to use over 6 months.
The primary objective of the study was to determine if the intervention practices had reduced odds of prescribing for lower respiratory tract infection, acute cough, bronchitis, and chest infection. The researchers also evaluated patient satisfaction questionnaires.
The eight practices undertook 268 CRP tests over 6 months. A strong majority of CRP results (78%; 209 of 268) indicated no infection, and management of these patients mainly followed National Institute for Health and Care Excellence (NICE) guidance for self-care and no antibiotics (90%; 188/209). But only 12 (22%) of 54 CRP results that indicated a delayed antibiotic should be considered were managed in line with NICE guidance.
Patients reported that CRP testing was comfortable (88%), convenient (84%), useful (92%), and explained well (85%). Patients believed CRP POCT aided clinical diagnosis, provided quick results, and reduced unnecessary antibiotic use. In consultations for which the diagnosis mentioned cough, intervention practices had an estimated 21% reduction (95% confidence interval: 0.46 to 1.35) in the odds of prescribing an antibiotic compared with the controls.
"In routine general practice, CRP POCT use was variable," the authors wrote. "Non-significant reductions in antibiotic prescribing may reflect small sample size due to non-use of tests. While CRP POCT may be useful, primary care staff need clearer CRP guidance and action planning according to NICE guidance."
Nov 5 Eurosurveill study
Bacteriophages used in COVID patients with resistant bacterial infections
Originally published by CIDRAP News Nov 3
Eight COVID-19 patients in Texas who have secondary carbapenem-resistant Acinetobacter baumannii (CRAB) infections are receiving investigational bacteriophage therapy from biotechnology company Adaptive Phage Therapeutics (APT), company officials announced yesterday.
In collaboration with the Walter Reed Army Institute of Research, Bacterial Diseases Branch, APT scientists identified two bacteriophages from the company's PhageBank library that were active against bacterial isolates from the hospitalized patients, and they are using those phages to treat the patients under Food and Drug Administration (FDA) emergency Investigational New Drug requests. The company also says it's receiving and analyzing CRAB isolates from new patients daily to identify other potential bacteriophage matches.
The use of bacteriophage therapy in the eight patients came in response to requests in late September from the Rio Grande Valley Collaborative (RGVC), a network of 11 healthcare facilities in south Texas treating COVID-19 patients. RGVC data revealed that mortality rates were more than twice as high in COVID-19 patients with secondary CRAB infections than those without secondary CRAB infections.
"We are pleased to have been able to successfully deploy our investigational PhageBank therapy in response to this outbreak in COVID-19 patients in Texas," Greg Merril, APT's CEO and co-founder, said in a press release. "Our PhageBank deployment represents the first time our technology, originally developed by the Department of Defense, has been used to treat multidrug-resistant secondary bacterial infections in COVID-19 patients."
Merril said the company is working with the FDA to expand early access to PhageBank–based therapies for COVID-19 patients.
Nov 2 APT press release
ED study finds high rate of antibiotics for asymptomatic bacteriuria
Originally published by CIDRAP News Nov 3
A study of hospitalized patients admitted through the emergency department (ED) for asymptomatic bacteriuria (ASB) at more than 40 hospitals found that nearly 75% received antibiotics, US researchers reported today in Open Forum Infectious Diseases.
The study, which included 43 hospitals participating in the Michigan Hospital Medicine Safety Consortium, looked at all patients with ASB who were admitted through the ED February 2018 through February 2020. ASB is frequent among hospitalized patients and is commonly treated with antibiotics, even though national guidelines recommend against antibiotic therapy. Because unnecessary antibiotic treatment is common in EDs, the researchers wanted to evaluate how often antibiotic treatment for ASBs is initiated by emergency medicine (EM) clinicians.
The primary outcomes was the percentage of patients who had antibiotic treatment initiated by an EM clinician, and secondary outcomes included length of hospitalization and Clostridioides difficileinfection within 30 days. The researchers also assessed factors associated with antibiotic treatment and length of antibiotic therapy.
Of the 2,461 patients admitted through the ED and ultimately determined to have ASB, 1,830 (74.4%) were treated with antibiotics, with a median treatment duration of 6 days. Urine cultures were ordered by EM clinicians in 1,970 patients (80%), and antibiotic treatment was initiated by an EM clinician in 68.5% of those treated with antibiotics (1,253 of 1,830). When antibiotic treatment was initiated by EM clinicians, 79.2% (993 of 1,253) of patients remained on an antibiotic for 3 or more days.
Predictors of EM clinician treatment of ASB versus no treatment included dementia (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.11 to 1.84), spinal cord injury (OR, 5.92; 95% CI, 1.36 to 25.72), presence of a urinary catheter (OR, 1.54; 95% CI, 1.17 to 2.03), incontinence (OR, 1.81; 95% CI, 1.40 to 2.33), and altered mental status (OR, 2.34; 95% CI, 1.82 to 3.00). Patients treated with antibiotics were more likely to have C difficile infection than those who didn't receive antibiotics (0.9% vs 0%) and have longer hospital stays (5.1 vs 4.2 days).
"These findings identify the ED as a key target to reduce antibiotic use and improve outcomes in hospitalized patients with ASB," the authors wrote.
Nov 3 Open Forum Infect Dis abstract
Study highlights role of hospital floors in spread of healthcare pathogens
Originally published by CIDRAP News Nov 2
Hospital room floors could be an underappreciated source of healthcare-associated pathogen spread, including those resistant to antibiotics, according to a study today in Infection Control and Hospital Epidemiology.
In the abstract from the March 2020 Decennial International Conference on Healthcare-Associated Infection, researchers from the Northeast Ohio Veterans Administration (VA) Healthcare System and Cleveland VA Medical Center observed the interactions of patients, hospital workers, and portable equipment in thoroughly cleaned hospital rooms of 17 newly admitted patients who had tested negative for carriage of methicillin-resistant Staphylococcus aureus (MRSA). They then collected cultures from patient skin and room surfaces, including the floors, one to three times a day, focusing on surfaces in contact with personnel and portable equipment.
One or more environmental cultures were found to be MRSA-positive in the rooms of 10 patients (59%), while Clostridioides difficile and vancomycin-resistant Enterococci were each found in the rooms of two patients. Patients interacted with an average of 2.4 hospital workers and 0.6 portable devices per hour of observation. In a subset of patients, MRSA appeared on the hospital room floors within hours of admission, and was subsequently found on patient beds, high-touch surfaces, and patient socks within 24 hours.
Molecular typing conducted in several patient rooms found that the spa type of the MRSA isolates on the floors was the same as isolates recovered from other sites, but the direct transfer of pathogens to personnel or equipment to high-touch surfaces was not detected.
"Hand hygiene is critical, but we need to develop practical approaches to reduce under-appreciated sources of pathogens to protect patients," senior author Curtis Donskey, MD, an epidemiologist at the Cleveland VA Medical Center, said in a press release from the Society for Healthcare Epidemiology of America (SHEA), which sponsors the journal.
Nov 2 Infect Control Hosp Epidemiol abstract
Nov 2 SHEA press release