ASP Scan (Weekly) for Mar 17, 2017

Animal antibiotic use
Antibiotic-resistant eye infections
Antibiotic misconceptions
Sexual spread of resistant bacteria
New gram-negative antibiotic
MDRO screening, isolation

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

Report: More oversight, data needed on antibiotic use in food animals

Originally published by CIDRAP News Mar 16

A report today from the US Government Accountability Office (GAO) is calling on the two federal agencies responsible for ensuring the safety of the food supply to address oversight gaps and collect more information on the use of antibiotics in food-producing animals.

The report, requested by members of Congress, notes that since 2011, when the GAO last reported on the issue, the Department of Health and Human Services (HHS) and the US Department of Agriculture (USDA) have increased veterinary oversight of antibiotic use in food-producing animals and made several improvements in collecting data on antibiotic use and resistance in food animals. But in reviewing documents, interviewing stakeholders, and reviewing steps taken by Canada and the European Union, the GAO found that more needs to be done, particularly in regard to establishing appropriate durations of use on drug labels and collecting farm-specific data.

The GAO report includes six recommendations, in which they call on HHS and the USDA to develop a process for establishing appropriate durations of use for medically important antibiotics, collect more farm-specific data on antibiotic use and antibiotic resistance in food animals, and to develop metrics for assessing progress on those goals. They also recommend that HHS develop a framework with the USDA to decide when to conduct on-farm investigations of foodborne-illness outbreaks from antibiotic-resistant bacteria. 
Mar 16 GAO report


High prevalence of drug-resistant bacterial eye infections noted in Ethiopia

Originally published by CIDRAP News Mar 15

A study yesterday in BMC Infectious Diseases found a high prevalence of bacteria in Ethiopian patients with eye infections, with a significant amount of multidrug resistance.

In the study, which was conducted at a hospital in Ethiopia in 2015, researchers cultured ocular specimens from 270 patients who presented with suspected ocular infections, including conjunctivitis, keratitis, periorbital cellulitis, and blepharitis. The investigators also conducted antimicrobial susceptibility testing and collected data on sociodemographic and risk factors.

Of the 270 patients, 180 (66.7%) were culture-positive for bacterial isolates, with 113 (60.7%) bacterial isolates identified as gram-positive and 87 (39.3%) as gram-negative. The dominant bacterial isolates were Staphylococcus aureus (21.5%), coagulase-negative staphylococci (16.7%), Pseudomonas aeruginosa (11.3%), and Escherichia coli (8%).

Antimicrobial susceptibility testing showed that a strong majority of isolates were susceptible to amikacin (93.2%), ciprofloxacin (89.2%), gentamicin (131, 89.1%), and doxycycline (71.9%). But 22.5% of bacterial isolates were resistant to at least one antimicrobial agent, 53.9% were resistant to two or more antimicrobials, and 34.8% were resistant three or more.

Ocular surface disease, ocular trauma, hospitalization, and cosmetic application practices were significantly associated with the occurrence of bacterial infection.

"Identification of the specific etiologic agent and antimicrobial susceptibility testing should be practiced during the management of ocular infections to reduce the further emergence of multidrug-resistant bacteria," the authors conclude.
Mar 14 BMC Infect Dis study 


Australian parent survey finds misconceptions about antibiotics

Originally published by CIDRAP News Mar 14

A large survey of Australian parents has found significant misconceptions about antibiotic use for acute respiratory infections.

The study, published yesterday in the Annals of Family Medicine, describes the results of a telephone survey in which 401 parents of at least one child aged 1 to 12 years were asked questions about the benefits and harms of antibiotic use for three acute respiratory infections or related conditions: acute otitis media, sore throat, and acute bronchitis. The respondents were also asked to recall the last time their child visited a doctor from treatment of one of these conditions, including any discussion about antibiotics.

The results showed that most of the parents believed that antibiotics can (at least sometimes) help all three conditions, with 92% believing antibiotics can help acute otitis media (middle ear infection), 70% believing they can help sore throat, and 55% believing they can help cough. Many parents, however, also agreed that not using antibiotics for these conditions is an option, especially in the case of cough (99%) and sore throat (97%), but less so for acute otitis media. In addition, 78% said they knew antibiotics could potentially harm, with roughly half mentioning antibiotic resistance.

But parents also grossly overestimated the extent to which antibiotics could reduce illness duration, compared with benefits seen from current empirical evidence, and many believed that antibiotics could help avoid complications from acute respiratory infections—such as hearing loss and perforated eardrum in cases of acute otitis media.

In recalling their most recent visit to a pediatrician for treatment of one of these conditions, 44% of parents reported some discussion about why antibiotics might be used, but 72% reported little or no discussion about why antibiotics might not be used, and 78% did not recall any discussion of potential antibiotic harm. Nearly all parents (93%) said they would like to be involved in future decisions about antibiotic use.

"These findings suggest opportunities for improving acute respiratory infection visits by adopting shared decision making," the authors write. 
March/April Ann Fam Med study


HIV study indicates potential for sexual spread of drug-resistant bacteria

Originally published by CIDRAP News Mar 14

Findings from a study yesterday in BMC Infectious Diseases suggest the potential for sexual transmission of multidrug-resistant gram-negative (MDRGN) bacteria in men with HIV.

For the study, researchers at University Hospital Frankfurt retrospectively investigated the MDRGN organism prevalence in rectal swabs of 109 HIV-positive men and 109 HIV-negative men who had been admitted to the hospital from November 2014 through March 2016. They were looking to evaluate whether sexual intercourse could be a potential means of transmission for MDRGN organisms. Their hypothesis was that microbiota, including MDRGN, is exchanged during mucous membrane contact.

The researchers theorized that MDRGN prevalence might be higher in HIV-positive men than in HIV-negative men in part because pre- or co-existing sexually transmitted diseases can be a marker for identifying individuals who have engaged in unprotected sexual intercourse. In addition, they cite recent investigations that have documented the spread of pathogenic E coli and Shigella species in men who have sex with men.

Among the 208 men evaluated, the researchers found a total of 35 MDRGN isolates, with 26 detected in the HIV-positive men and 9 detected in the HIV-negative men (for an overall prevalence of 23.9% vs. 8.3%). The most frequently detected MDRGN species was E coli with resistance due to extended-spectrum beta-lactamase (ESBL) production and additional resistance to fluoroquinolones, which accounted for 25 of the 35 isolates.

"These findings suggest that HIV positive men might be more susceptible to acquire MDRGN," the authors write. But they also acknowledge that a stronger history of antibiotic pre-treatment and the presence of pre-existing comorbidities in HIV positive men are other factors that need to be evaluated in future investigations of sexual transmission of MDRGN. 
Mar 13 BMC Infect Dis study


New antibiotic combo announced for gram-negative bacterial infections

Originally published by CIDRAP News Mar 14

Drugmaker Pfizer, Inc. today announced that a novel combination antibiotic for the treatment of serious gram-negative bacterial infections is now available in the United Kingdom and Germany.

The fixed-dose combination of ceftazidime and avibactam, sold under the brand name Zavicefta, is indicated for the treatment of complicated intra-abdominal infection, complicated urinary tract infection, and hospital-acquired pneumonia. It's also indicated for the treatment of two of the MDRGN organisms—P aeruginosa and Enterobacteriaceae—recently identified by the World Health Organization as "priority pathogens."

"Multidrug-resistant (MDR) infections are an increasing global threat," Matteo Bassetti, MD, PhD, chief of the infectious diseases clinic at University of Udine in Italy, said in a company news release. "The availability of Zavicefta is a major step forward for physicians faced with the challenge of treating patients with known or suspected MDR infections."

Zavifecta was approved for marketing in June 2016 by the European Medicines Agency. 
Mar 14 Pfizer news release 


Study supports targeted contact precautions for MDR organism carriage

Originally published by CIDRAP News Mar 13

A new study in the American Journal of Infection Control suggests that isolation-targeted screening is non-inferior to universal screening and isolation for detecting carriage of multidrug-resistant organisms (MDROs).

In the single-center observational study, investigators at a French university-affiliated hospital compared two consecutive 6-month periods at the hospital's 20-bed medical and surgical intensive care unit (ICU). During the first period (June 2012-November 2012), rectal swabs were obtained for all ICU patients on admission, and additional contact precautions (including hand hygiene upon entering and leaving patient rooms and wearing gloves and gowns) were implemented for all patients pending culture results. The screening was focused on extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) and carbapenem-resistant Enterobacteriaceae (CRE).

During the second period (February 2013-August 2013), all consecutively admitted patients were screened on admission with rectal swabs, but additional contact precautions were implemented only for patients who had at least one risk factor for MDRO carriage. The primary outcome was the rate of MDRO acquisition during ICU stay.

Overall, 327 and 297 admissions were analyzed during the two periods, with 33 patients (10%) in the first period and 30 patients (10%) in the second period having a positive MDRO screening on admission. A second screening conducted with 147 patients from the first period and 127 patients from the second period found that the rate of acquired MDRO was similar in both groups (10% and 11.8%, respectively). A prior hospitalization of more than 5 days was the only factor associated with MDRO carriage on ICU admission.

"Further searches on risk factors for MDRO carriage are needed to improve targeted screening and/or isolation on ICU admission," the authors conclude.
Mar 10 Am J Infect Control study 

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