Stewardship / Resistance Scan for Sep 14, 2017

Antibiotic use and VRE infections
European AMR initiative
Antibiotic-resistant brucellosis

Specific antibiotics linked to risk of hospital-acquired VRE infections

German researchers have found indications that the risk of acquiring healthcare-associated vancomycin-resistant enterococci (HA-VRE) is linked to the use of specific antimicrobial agents, according to a study yesterday in Antimicrobial Resistance and Infection Control.

The study, conducted at a hospital in Berlin from January 2014 through December 2015, included data on more than 200,000 patients from 61 wards, including surgical wards, medical wards, intensive care units (ICUs), and hemato-oncology wards. VRE isolates, both from clinical infection samples and colonized patients, were labeled as HA-VRE if they were identified 3 days or later after hospital admission, and otherwise as community-acquired (CA-VRE). The researchers also collected data on all antibacterials for systemic use to calculate ward-specific antibiotic consumption

Overall, 1,430 VRE cases were identified, with 409 (28.6%) considered hospital-acquired. The highest HA-VRE rates were observed in ICUs, and the lowest rates were on medical wards. Median antibiotic use on all wards was 76.8 defined daily doses (DDD) per 100 patient-days (PD), with use of broad-spectrum antibiotics (carbapenems, third-generation cephalosporins, and glycopeptides) 3 to 13-fold higher on ICUs compared with medical wards.

Using a multivariable regression model, the researchers determined that carbapenem use in the current month and glycopeptide use in the previous month increased the risk for HA-VRE by 1% per 1 DDD/100 PD and 3% per 1 DDD/100 PD, respectively. When just clinical VRE samples were considered, only glycopeptide use showed a statistically significant association. Detection of at least one patient on a ward with CA-VRE in the current month was found to nearly double the risk of having HA-VRE, a finding that suggests person-to-person transmission.

The authors say the study indicates that a multifaceted approach to lowering HA-VRE rates is required, "including prudent use of antimicrobial agents as well as implementation of and strict compliance to infection control measures to prevent VRE transmission."
Sep 13 Antimicrob Resist Infect Control study

EU initiates Joint Action to combat resistance continent-wide

A European Union Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections (EU-JAMRAI) was launched yesterday at the French Ministry of Health in Paris. More than 44 partners and 22 collaborating stakeholders participated, according to a news release from the EU Consumers, Health, Agriculture and Food Executive Agency (CHAFEA).

"The Joint Action EU-JAMRAI aims to bring together the participating EU member states and international organizations, institutes, universities in order to contribute towards tackling antimicrobial resistance and healthcare-associated infections," CHAFEA said in the release. "It will capitalize on existing initiatives and propose concrete steps to reduce the burden of antimicrobial resistance."

EU-JAMRAI will identify the best programs for combating antimicrobial resistance (AMR) currently in use and examine how cooperation at the EU level can improve national AMR-related policies, according to a Science/Business story. The effort will also identify and test evidence-based measures to address AMR and hospital-acquired infections in different contexts and provide recommendations to policymakers.

EU-JAMRAI has a €4 million ($4.8 million) budget to support EU member states in developing and implementing national strategies, ensure a common approach in Europe to the global AMR action plan, and produce guidance documents and tools for member states, among other goals, the story said.
Sep 6 CHAFEA news release
Sep 12 Science/Business story
Sep 13 agenda of kickoff meeting


Antibiotic-resistant brucellosis case tied to raw milk

A person who consumed raw milk from the K-Bar Dairy in Paradise, Texas, is hospitalized with brucellosis, caused by a rifampin/penicillin-resistant strain of RB51 Brucella, the Centers for Disease Control and Prevention (CDC) said in a Health Alert Network (HAN) statement yesterday. The Texas Department of State Health Services and the CDC are investigating the case.

According the CDC, milk samples from the dairy tested positive for the RB51 Brucella strain. People who consumed milk from the dairy between Jun 1 and Aug 7 should receive appropriate post-exposure prophylaxis, which is a combination of doxycycline and trimethoprim/sulfamethoxazole, for 21 days, the agency said.

Brucellosis is a serious infection that can lead to swelling of the heart, liver, and spleen. It commonly causes fever, sweating, malaise, and joint pain.
Sep 13 CDC HAN statement

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