Stewardship / Resistance Scan for Nov 15, 2017

ECDC CRE guidance
European research funding
Optimal MDR-TB treatment

ECDC publishes guidance on reducing CRE infections

The European Centre for Disease Prevention and Control (ECDC) today published guidelines on screening for and prevention of carbapenem-resistant Enterobacteriaceae (CRE) that include hospital stay, chemotherapy treatment, and link to a CRE carrier as risk factors.

CRE—predominantly drug-resistant Escherichia coli and Klebsiella pneumoniae—are responsible for many deaths and high healthcare costs. The ECDC noted in a surveillance report today that E coli resistance is on the rise in Europe (see related CIDRAP News story).

The ECDC published its CRE guidance in Antimicrobial Resistance and Infection Control "to raise awareness and identify the 'at-risk' patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE." A team of experts met twice to formulate the guidance after analyzing the current data and expert opinion.

The guidelines place any patient with one of these factors in the "at-risk" category: (1) overnight stay in a healthcare setting in the previous year, (2) dialysis-dependent or cancer chemotherapy in the past year, (3) known carriage of CRE in the past year, and (4) epidemiologic linkage to a known CRE carrier. The experts define "carrier" as anyone infected with a CRE or harboring one without showing symptoms.

Healthcare professionals should implement the following steps for prevention control for any at-risk patient: (1) pre-emptive isolation, (2) active screening for CRE, and (3) contact precautions. "Patients who are confirmed positive for CRE will need additional supplemental measures," the authors wrote.

The experts conclude, "This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources."
Nov 15 ECDC guidance


Europe's Joint Programming Initiative funds 10 AMR projects

In other European news, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) today announced funding of €11.5 million ($13.6 million) for 10 transnational research projects involving multidisciplinary studies on antimicrobial resistance (AMR), including One Health approaches.

Awardees include 47 funded research groups from 11 countries (Canada, Germany, Ireland, Israel, Latvia, the Netherlands, Norway, Poland, Romania, Sweden and Switzerland), and an additional 6 international partners in the Czech Republic, Israel, Romania, and United States.

Funded projects include preventing the spread of methicillin-resistant Staphylococcus aureus from livestock to people, improving prescribing for urinary tract infections in the elderly, AMR manure intervention, online stewardship efforts, and AMR transmission in the food chain.

The final funding decision will depend on national regulations and inspection of the formal proposals by the national funding organizations, the JPIAMR said in a news release.
Nov 15 JPIAMR news release


Brazil study finds standardized MDR-TB therapy effective

Patients with multidrug-resistant tuberculosis (MDR-TB) in Brazil who received standardized regimens had almost a third the rate of failure or relapse compared with those receiving individualized treatment, according to a study yesterday in BMC Infectious Diseases.

Brazilian scientists analyzed data on 1,972 MDR-TB patients from 2007 through 2013, of whom 60% were successfully treated. Success was more likely in patients who didn't have HIV, those were sputum-negative at baseline, had unilateral disease, and had no prior DR-TB.

After the researchers adjusted for these variables, they determined that MDR-TB patients receiving standardized regimens had a 2.7-fold odds of success compared with those receiving individualized treatments when failure/relapse were considered, and a 1.4-fold odds of success when death was included as an unsuccessful outcome. Patients who used levofloxacin instead of ofloxacin had 1.5-fold odds of success.

The authors concluded, "Our findings support the Brazilian recommendation for the use of standardized instead of individualized regimens for MDR-TB, preferably containing levofloxacin."
Nov 14 BMC Infect Dis study

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