Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
Study finds high rates of resistant E coli in young Kenyan children
A study of Escherichia coli isolates from young hospitalized children in western Kenya found high levels of antimicrobial resistance (AMR), researchers reported yesterday in PLOS Neglected Tropical Diseases.
For the cross-sectional study, researchers with the Kenya Medical Research Institute and the University of Washington cultured and analyzed E coli fecal samples collected at the time of hospital discharge from 406 children ages 1 to 59 months. Most of the children (87.2%) had received antibiotics in the hospital, and the most frequent diagnoses at admission and discharge were pneumonia, diarrhea, anemia, and malaria.
The researchers performed antimicrobial susceptibility testing on the isolates and tested for extended-spectrum beta-lactamase (ESBL) production, and they used multivariate regression models to identify risk factors for the presence of ESBL-producing E coli.
All 406 children had reduced susceptibility to at least 1 of the 12 antibiotics tested; 92.6% had E colithat lacked susceptibility to ampicillin, 46.1% harbored isolates that were non-susceptible to ceftriaxone, and 43.8% had isolates resistant to gentamicin. ESBL-producing E coli was found in 44.3% of children.
Multivariate analysis showed that receipt of antibiotics during the hospitalization was associated with the presence of ESBL-producing E coli (adjusted prevalence ratio [aPR], 2.23; 95% confidence interval [CI], 1.29 to 3.83), as was being hospitalized within the prior year (aPR, 1.32; 95% CI, 1.07 to 1.69). Defecating in the open (aPR, 2.02; 95% CI, 1.39 to 2.94), having a toilet shared with other households (aPR, 1.49; 95% CI, 1.17 to 1.89), and being female (aPR, 1.42; 95% CI, 1.15 to 1.76) were also associated with carriage of ESBL E coli.
The authors say the high rates of AMR carriage observed in the study may be particularly problematic during the post-discharge period, when children are at high risk of subsequent illness, and has potential implications for the broader population, given that resistant organisms and genetic elements can be spread to others in households and communities.
"AMR is increasing globally, and the public health relevance of these findings is likely significant, both for individual children and for communities," they wrote. "Health care exposure appears to be a major driver of AMR, and interventions to prevent and reduce AMR transmission and acquisition in the health care setting are urgently needed."
Mar 31 PLOS Negl Trop Dis study
GARDP announces new North American branch
Originally published by CIDRAP News Mar 30
The Global Antibiotic Research and Development Partnership (GARDP), based in Geneva, Switzerland, this week announced the formation of a new sister organization in the United States.
GARDP and GARDP North America will work together on a common portfolio of projects that aim to accelerate the development and delivery of treatments for antibiotic-resistant infections caused by the priority pathogens identified by the World Health Organization (WHO) and the Centers for Disease Control and Prevention, according to a GARDP news release.
Created by the WHO and the Drugs for Neglected Diseases Initiative, GARDP works with partners in government, the private sector, academia, and civil society to develop and ensure sustainable access to new antibiotics. Likewise, GARDP North America will champion new drug development and global access and promote policies aimed at incentivizing antibiotic development, while focusing on strengthening ties with current and future partners in the United States.
"It will tap into the U.S.'s strong tradition of partnerships between the public, non-profit, and private sectors to realize global and public health objectives," GARDP says.
Mar 28 GARDP North America news release
Study finds high levels of resistance in US urine isolates
Originally published by CIDRAP News Mar 30
A study of Enterobacterales urine isolates from more than 650 US healthcare facilities found high levels of AMR, with clear geographic variations, US researchers reported yesterday in the International Journal of Infectious Diseases.
For the retrospective study, researchers examined more than 1.3 million non-duplicate, non-contaminant Enterobacterales urine isolates collected from ambulatory and hospitalized adult patients at 321 inpatient and 338 ambulatory care facilities from 2018 through 2020. They evaluated the percentage of non-susceptible isolates overall, by geographic region, and by inpatient and ambulatory populations.
Nationwide, high rates of resistance to antibiotics used for urinary tract infections (UTIs) were observed, including beta-lactams (60.8% and 55.8% for inpatient and ambulatory settings, respectively), fluoroquinolones (27.5% and 21.6%), trimethoprim/sulfamethoxazole (25.4% and 22.4%), and nitrofurantoin (27% and 21.6%). Isolates with an extended-spectrum beta-lactamase (ESBL)-producing phenotype (13.2% and 8.6%) and multidrug resistance (23.4% and 17.7% for ≥2 drugs; 9.9% and 6.4% for ≥3 drugs) were also common.
Statistically significant differences by geographic region were observed for all AMR classes in both inpatient and ambulatory settings, with the highest rates generally observed in the East South Central region.
The study authors note that while there were clear geographic variations, all regions showed AMR levels high enough to negate the use of common empiric UTI therapies according to Infectious Diseases Society of America recommended thresholds (>20% for trimethoprim/sulfamethoxazole and >10% for nitrofurantoin).
"The elevated levels of resistance to commonly used empiric UTI therapies highlight the need for new oral antibiotics effective against resistant uropathogens," they wrote. "Until such therapies are available, appropriate UTI management may require judicial use of pathogen diagnostic tests and antimicrobial susceptibility panels along with antimicrobial stewardship programs designed to reduce resistance in uropathogens."
Mar 29 Int J Infect Dis study
ECDC: Antibiotic resistance to common foodborne pathogens still high
Originally published by CIDRAP News Mar 29
New data from the European Centre for Disease Prevention and Control (ECDC) show that antibiotic resistance in Salmonella and Campylobacter bacteria—two of the most common foodborne pathogens in humans—is still high, but resistance to critically important antibiotics remains low for E coli, Salmonella, and Campylobacter in samples from both humans and food-producing animals.
The findings are published in a new report of antimicrobial resistance in 2019–2020 in Salmonella, Campylobacter, and indicator E coli isolates in poultry, pigs, and cows and subsequent human infections.
For all human Salmonella infections in 2019 and 2020, resistance to ampicillin, sulfonamides and tetracyclines was observed at overall high levels, while resistance to third-generation cephalosporins in 2020 was noted at overall very low levels of 0.8% for both cefotaxime and ceftazidime, which are both deemed critically important antibiotics.
"Combined resistance to critically important antimicrobials (cephalosporins and fluoroquinolones) was generally uncommon in E. coli in all animal categories," the authors wrote.
"Furthermore, in more than half of the European Union countries, a statistically significant decreasing trend in the prevalence of extended-spectrum β-lactamase (ESBL)-producing E. coli was observed in food-producing animals. This is an important finding as particular strains of ESBL-producing E. coli are responsible for serious infections in humans."
Mar 29 ECDC report
Multidisciplinary stewardship tied to less antibiotic use in a NICU
Originally published by CIDRAP News Mar 28
A team of researchers from Drexel University determined that a multidisciplinary antibiotic stewardship team, coupled with a consensus for antibiotic therapy duration, prescriber justification of antibiotic necessity, and use of antibiotic stop dates can effectively reduce unnecessary antibiotic use in the neonatal intensive care unit (NICU). The study was published today in Antimicrobial Stewardship & Healthcare Epidemiology.
The goal of the study was to reduce unnecessary antibiotic use by 20% in St. Christopher's Hospital for Children's 39-bed level IV NICU.
To do so, the researchers conducted a retrospective chart review to determine common indications and treatment duration for antibiotics. A multidisciplinary stewardship team conducted several educational interventions, and providers in the NICU were subject to manual antibiotic stop dates and justification of antibiotic use .
The percentage of unnecessary antibiotic days, defined as days beyond the consensus guidelines, dropped from 42% to 12% during the year-long intervention. In total, 139 of 250 neonates (55%) were exposed to at least 1 antibiotic in the baseline period, compared with 123 of 264 (46%) in the postintervention period, the authors said.
"Developing evidence-based guidelines with infectious disease input was key to engage the neonatologists and create consensus," the authors concluded.
Mar 28 Antimicrob Steward Healthc Epidemiol study