Antimicrobial Resistance Scan for Nov 01, 2016

Pediatric fluoroquinolone guidelines
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Antiseptic-linked colistin resistance

AAP updates guidelines on fluoroquinolone use in children

The American Academy of Pediatrics (AAP) yesterday released updated guidelines on the use of fluoroquinolones in children. The clinical report, published in Pediatrics by the AAP Committee on Infectious Diseases, highlights the indications, adverse event profile, and practical prescribing information for pediatricians and includes new data available since the report was last published in 2011.

The core message of the updated AAP guidelines remains unchanged from 2011. It advises that fluoroquinolones are broad-spectrum agents that should not be used as first-line systemic therapy in children and should be considered selectively for children or adolescents only for specific clinical situations. Those situations include when an infection is caused by a multidrug-resistant pathogen for which there is no safe and effective alternative, or when oral therapy is preferable to parenteral therapy.

Currently, fluoroquinolones have limited Food and Drug Administration (FDA) approval for systemic use in children. Ciprofloxacin is FDA-approved for inhalation anthrax, plague, complicated urinary tract infections, and pyelonephritis in children. Levofloxacin is approved for inhalation anthrax and plague.

But the new guidelines also indicate that levofloxacin can be considered in lower respiratory tract infections when a child has a severe allergy to penicillin and in upper respiratory tract infections when the pathogens shows high resistance to penicillin. Ciprofloxacin is suggested as a viable alternative for gastrointestinal infections due to Salmonella or Shigella, but only when alternative antibiotics are unavailable. In addition, the report notes that several topical fluoroquinolones are approved for treatment of bacterial conjunctivitis and otitis externa.

"In the case of fluoroquinolones, as is appropriate with all antimicrobial agents, prescribing clinicians should verbally review common, anticipated, potential adverse events, such as rash, diarrhea, and potential musculoskeletal or neurologic events, and indicate why a fluoroquinolone is the most appropriate antibiotic agent for a child's infection," the authors conclude.
Oct 31 AAP clinical report

 

Study finds colistin resistance in bacteria exposed to common disinfectant

A study published yesterday in Antimicrobial Agents and Chemotherapy has found that Klebsiella pneumoniae bacteria exposed to an antiseptic commonly used in homes and healthcare settings can become resistant to the last-resort antibiotic colistin.

The study, conducted in England, builds on previous research showing that K pneumoniae strains are able to adapt to increasing concentrations of chlorhexidine, an antiseptic that is found in mouthwash, wound dressings, and solutions for skin antisepsis. The purpose was to determine whether adaptation to chlorhexidine can cause cross resistance to other antibiotics, and to determine the underlying mechanisms of resistance. To figure that out, investigators selected specific strains of K pneumoniae typically found in clinical settings and exposed them to increasing concentrations of chlorhexidine.

The investigators found that in five of six K pneumoniae strains, adaptation to chlorhexidine also led to resistance to colistin without significant loss of fitness or virulence. In addition, they found that adaptation to chlorhexidine and resistance to colistin appeared to be linked to specific gene mutations.

The findings are significant for several reasons. One is that chlorhexidine is a critical part of current infection control practices, especially the treatment of wounds. "The development of increased resistance to this compound has potential implications for our ability to prevent infections during routine and emergency surgery, and during admission to hospitals," study co-author J. Mark Sutton, PhD, of Public Health England, said in an American Society for Microbiology (ASM) news release.

Furthermore, the findings indicate another source of selection pressure for colistin, a powerful antibiotic that is becoming more necessary with the growth of multidrug-resistant organisms. The emergence of colistin resistance in Klebsiella—which is already increasingly resistant to several antibiotic classes, including carbapenems—could present healthcare providers with life-threatening infections that are extremely hard to treat.

In addition, there is concern that specific selective pressures from antiseptics could create similar mutations that confer increased resistance to antibiotics in different species of bacteria.
Oct 31 Antimicrob Agents Chemother study
Oct 31 ASM news release

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