Stewardship / Resistance Scan for Oct 26, 2017

Antibiotic use, resistance indicators
Prolonged antibiotics for sepsis
Resistant bacteria in seafood

European officials establish indicators for progress on AMR

European health and food safety agencies have established a set of indicators to assess progress in combating antimicrobial resistance (AMR) and reducing antimicrobial use in humans and food-producing animals.

According to a news release today from the European Food Safety Authority (EFSA), health officials will be monitoring the proportion of Staphylococcus aureus bacteria that are resistant to methicillin and the proportion of Escherichia coli bacteria that are resistant to third-generation cephalosporins to assess AMR in human medicine. For veterinary medicine, the indicator will be the proportion of E coli in food-producing animals that are susceptible or resistant to a number of antibiotics.

In terms of consumption, the indicators are the human consumption of all antimicrobials and the overall sales of veterinary antibiotics.

"Without these indicators, we would not be able to assess our progress in tackling the serious health threat posed by AMR," European Commissioner for Health and Food Safety Vytenis Andriukaitis said.

The indicators were agreed to by members of EFSA, the European Medicines Agency, and the European Centre for Disease Prevention and Control, based on data gathered through existing European Union monitoring networks.
Oct 26 EFSA news release


Review supports long-term over short-term beta-lactams for sepsis

A meta-analysis by Greek experts that included 22 studies has found that prolonged infusion of antipseudomonal beta-lactam antibiotics for treating sepsis is associated with significantly lower mortality than short-term infusion, according to their review yesterday in The Lancet Infectious Diseases.

Because the findings of randomized controlled trials (RCTs), observational studies, and previous meta-analyses have varied, the team aimed to pinpoint the effectiveness of the therapy by pooling data from 22 of the highest-quality RCT studies they found via a literature search.

The researchers found that, based on the Grading of Recommendations Assessment, Development, and Evaluation tool, the quality of evidence for mortality was high among the studies. They also determined that prolonged infusion of beta-lactams was associated with a 30% lower risk of all-cause mortality compared with short-term infusion. And they found no evidence of publication bias.

An accompanying commentary by scientists not involved in the study said, "With current evidence it seems that we should standardise prolonged dosing of beta-lactams in ICUs."
Oct 25 Lancet Infect Dis study
Oct 25 Lancet Infect Dis commentary


Resistant bacteria identified in German seafood

Berlin researchers have identified carbapenemase-producing bacteria in Enterobacteriaceae isolated from German retail clams and shrimp, they note in a report today in Eurosurveillance.

The investigators analyzed 160 seafood samples (80 shrimp, 49 blue mussels, 15 Venus clams, 11 razor shells and five cockles) taken from 12 retail outlets in Berlin from December 2015 to August 2016. They found 45 Enterobacteriaceae from the samples, with Klebsiella pneumoniae (13), E coli (12), Enterobacter cloacae (6), and Citrobacter freundii (5) the most common.

The team found several resistance genes among the isolates, most notably the carbapenemase gene blaVIM-1 in E coli from a Venus clam harvested in the Mediterranean Sea near Italy. The bacterium contained other resistance genes, as well. The researchers note, "It has to be taken into account that Venus clams are also served as a raw appetiser and that seafood is preferred raw in some regions, providing ideal conditions for the transmission and spread of the carbapenemase-producing bacteria or a transfer of the respective plasmids."

The authors conclude, "These results confirm previous observations that carbapenemase-producing bacteria have reached the food chain and are of increasing concern for public health."
Oct 26 Eurosurveill report

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