Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

VHA says its stewardship efforts have cut antibiotic use 12%

Originally published by CIDRAP News Jan 26

More than 90% of Veterans Health Administration (VHA) hospitals have developed written antimicrobial stewardship policies, and the agency's Antimicrobial Stewardship Initiative has cut antibiotic use 12% overall so far, VHA officials noted yesterday in an analysis in Infection Control and Hospital Epidemiology.

The analysis of the 140-plus VHA medical facilities in the United States found that 92% had written stewardship policies by 2015. The investigators also noted that, while the proportional distribution of antibiotics did not change, inpatient antibiotic use decreased significantly (P < .0001) after the VHA stewardship initiative activities were implemented. They reported a 12% decrease in antibiotic use overall.

The analysis also noted significantly declining use overall of antimicrobials prescribed for resistant gram-negative organisms, including carbapenems, and declining hospital readmission and mortality rates. They also reported decreased rates of Clostridium difficile infection.

The VHA's stewardship efforts include continuing education, disease-specific guidelines, and development of example policies.
Jan 25 Infect Control Hosp Epidemiol study

European experts call for innovation on antimicrobial use in food animals

Originally published by CIDRAP News Jan 26

European health and food safety experts say in a new report that while efforts to reduce the use of antimicrobials in food-producing animals have had an impact, innovative solutions are needed to further protect animal and public health.

In a joint report issued this week, experts from the European Medicines Agency (EMA) and the European Food Safety Authority (EFSA) reviewed the measures that have already been taken by European Union (EU) nations and concluded that the wide range of control strategies implemented have produced favorable results, especially in northern European countries. These strategies use a multifaceted approach, take into account the local livestock production system, and have certain elements in common, such as national targets for reducing antimicrobial use.

But the authors note that while it's reasonable to assume that these efforts have had an impact on antimicrobial resistance in food-producing animals and food, assessing that impact has been difficult.

Beyond continuing efforts to encourage responsible antimicrobial use in food-producing animals, the authors conclude that more antimicrobial reduction strategies are necessary, including improved disease prevention measures to stop the spread of microorganisms within and between farms. In addition, they argue that antimicrobial alternatives, such as vaccines, probiotics, and bacteriophages, should be considered. And they suggest that alternative farming systems that require fewer antimicrobials without sacrificing animal health should be explored.

"It is clear that strategies that are already available can be implemented immediately and will have a positive impact on levels of antimicrobial resistance," EFSA Executive Director Bernhard Url, DVM, says in a press release. "At the same time, there is a need for innovative solutions—we need to find alternative ways to prevent and treat bacterial infections in animals." 
Jan 24 EMA and EFSA joint scientific opinion
Jan 24 EMA and EFSA press release

Study shows high MDR Staph capitis levels in French NICUs

Originally published by CIDRAP News Jan 26

The multidrug-resistant Staphylococcus capitis clone, NRCS-A, that has been isolated from neonatal intensive care units (NICUs) in 17 countries is plaguing some NICUs in France, according to a research letter in Emerging Infectious Diseases today.

The French team conducted a lab-based retrospective epidemiologic probe of 47 of the country's 57 NICUs to estimate NRCS-A prevalence. The researchers found that only 4 NICUs were completely free of the bacterium. Of the 43 affected NICUs, NRCS-A strains accounted for up to 46% of cases of positive blood cultures from newborns, with a median of 13%.

The authors conclude that these data and other global data "unquestionably demonstrate the unusual worldwide endemicity of the multidrug-resistant NRCS-A clone in NICUs. In addition, the epidemiologic data from France highlight the propensity of NRCS-A to invade and settle in most NICUs on a national scale.

"Once endemic in a NICU, NRCS-A strains expose infected neonates to a risk of therapeutic failure because treatment of neonatal sepsis involving methicillin-resistant coagulase-negative staphylococci is usually based on vancomycin and aminoglycosides, to which NRCS-A isolates are not susceptible."
Jan 26 Emerg Infect Dis research letter

Study shows nasal MRSA in med students before healthcare exposure

Originally published by CIDRAP News Jan 25

A small study from Israel showed that carriage of methicillin-resistant Staphylococcus aureus (MRSA) can occur in the noses of medical students even before they have healthcare exposure, indicating community acquisition of hospital strains, according to the findings in Antimicrobial Resistance and Infection Control.

The investigators followed 58 medical students for 19 months, noting that S aureus carriage steadily increased in their nasal specimens, from 33% at baseline to 38% at 13 months and 41% at 19 months. They also noted that 7 students (12%) carried 13 MRSA isolates, and that MRSA was found in 4 of them before they began their clinical rotations. Two of those students carried different MRSA strains at various times, and 1 had persistent nasal carriage of MRSA.

The authors concluded, "Compared with previous reports, higher rates of MRSA carriage were evident. . . . carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains."
Jan 23 Antimicrob Resist Infect Control study

Analysis: Rapid screening tests can lower MRSA surveillance costs

Originally published by CIDRAP News Jan 24

Rapid screening tests can help hospital intensive care units (ICUs) reduce unnecessary surveillance costs for methicillin-resistant MRSA, according to a new study in the American Journal of Infections Control.

For the study, investigators set out to analyze the costs associated with two surveillance approaches commonly used in ICUs to mitigate MRSA infections. One approach is universal preemptive isolation, in which all patients are screened upon admission and isolated until the absence of MRSA carriage is shown. This strategy, the authors explain, can result in some non-colonized patients being unnecessarily isolated, which leads to excess costs.

As a result, some hospitals use a targeted isolated strategy, in which all patients are screened but only MRSA-positive patients are isolated. The downside of this approach, however, is that delaying the isolation of colonized individuals while waiting for the results of screening tests could lead to MRSA transmission to other patients.

The question investigators were trying to answer was whether rapid screening tests, though more expensive than conventional screening methods, can help enhance both these surveillance approaches and reduce costs by providing quicker screening results and removing non-colonized patients from isolation sooner or reducing the number of days a MRSA-positive patient is not isolated.

Four screening tests were evaluated, including conventional culture and chromogenic agar 48-hour test, which generate results in a few days, and chromogenic agar 24-hour and polymerase chain reaction (PCR) screening tests, which produce results within 24 hours

In their cost and sensitivity analysis, the investigators found that the total cost of universal preemptive isolation was lowest when PCR screening tests were used, resulting in a cost of $82.51 per patient. For targeted isolation surveillance, they found that the total cost was lowest when using the chromogenic agar 24-hour test, which produced a cost of $8.54 per patient.

"With knowledge of the screening test that minimizes inappropriate and total costs, hospitals can maximize the efficiency of their resource use and improve the health of their patients," the authors conclude.
Jan 23 Am J Infect Control study

Antibiotic shows early promise against bacteremia, infective endocarditis

Originally published by CIDRAP News Jan 23

Drugmaker Theravance Biopharma, Inc., of Dublin, reported today that telavancin, a US Food and Drug Administration–approved antibiotic for the treatment of skin infections and pneumonia caused by S aureus, has demonstrated positive clinical responses in patients with bacteremia and infective endocarditis (IE).

In an ongoing observational study designed to evaluate how telavancin—sold under the brand name Vibativ—is being used by physicians to treat patients in real-world clinical settings, researchers reported that the drug demonstrated positive clinical responses in 64.4% of 45 patients with diagnoses of bacteremia or IE, with 6.7% of patients failing treatment and 28.9% considered non-evaluable. Positive clinical response was defined as cure or improvement leading to step-down oral therapy.

The researchers also reported that 53% of the patients had bacteremia or IE that was caused by MRSA, while 13% were sickened by methicillin-susceptible S aureus (MSSA). Other pathogens included coagulase-negative staphylococci (9%) and Enterococcus (7%). The median telavancin daily dose and duration of treatment were 750 mg and 14 days. 

The results were presented at the Society of Critical Care Medicine's 46th Critical Care Congress and have not yet been peer reviewed.

Co-author Kerry Cleveland, MD, a professor of medicine at the University of Tennessee Health Science Center, said in a company press release. "Based on these results, we believe that Vibativ may represent an alternative treatment option for these patients." 
Jan 23 Theravance Biopharma press release