Stewardship / Resistance Scan for Dec 18, 2017

Candida auris cases rise
Reduced antibiotics in fast-food beef
MDRO readmission

More Candida auris infections recorded in US

According to an updated case count from the Centers for Disease Control and Prevention (CDC), there are now 174 cases of Candida auris infections in the United States, 17 more than the CDC reported last month.

As of Nov 30, the multidrug-resistant (MDR) fungus has been identified in healthcare facilities in 10 states, with New York (110), New Jersey (38), and Illinois (12) all reporting new cases since the last update. Cases have also been reported in California (1), Connecticut (1), Florida (2), Indiana (1), Maryland (2), Massachusetts (6), and Oklahoma (1).

"U.S. C. auris cases are a result of inadvertent introduction into the United States from a patient who recently received healthcare in a country where C. auris has been reported or a result of local spread after such an introduction," the CDC explained.

All cases represent laboratory-confirmed C auris infections, and the CDC said 257 other patients have been colonized with C auris detected through targeted screening in four states with clinical cases.

In patients with compromised immune systems, C auris can cause serious invasive infections affecting the bloodstream, heart, brain, ear, and bones.
Dec 15 CDC update


Wendy's to reduce antibiotic use in beef supply

Fast-food chain Wendy's says it will take steps to reduce the use of antibiotics in its beef supply, according to a company press release.

In its annual update on corporate social responsibility initiatives, Wendy's said that starting in 2018, it will source about 15% of its beef from a group of producers that have each committed to a 20% reduction in the amount of the one medically important antibiotic routinely fed to their cattle. According to Reuters, that antibiotic is Tylosin, a broad-spectrum macrolide. The company said it's committed to increasing the amount of beef purchased from these producers.

The company also announced that it has eliminated all medically important antibiotics from chicken production, fulfilling a pledge it made last year, and that it plans to decrease the use of antibiotics in its pork supply.

Wendy's is one of several major fast-food and fast-casual restaurant chains that have committed to removing medically important antibiotics from their poultry supply in recent years, in response to growing consumer demand for antibiotic-free chicken. The movement to reduce the use of medically important antibiotics in the beef and pork supplied to these chains has been slower to develop.

Earlier this month, data released by the US Food and Drug Administration showed that the amount of medically important antibiotics sold for use in livestock and poultry fell by 14% from 2015 to 2016, the first decline since the agency began collecting the data in 2009.
Dec 15 Wendy's press release
Dec 15 Reuters story


Study finds high rate of hospital readmission for MDRO-infected patients

A single-center study published yesterday in Infection Control and Hospital Epidemiology found that over a 10-year period, more than 60% of patients with multidrug-resistant organisms (MDROs) were readmitted to the hospital within a year of the initial infection.

The purpose of the retrospective study, conducted at a 1,250-bed academic tertiary referral center in St. Louis, MO, was to determine incidence of and risk factors for readmission with MDROs among patients with previous MDRO infection. Investigators from Washington University School of Medicine identified patients with MDROs obtained from the bloodstream, bronchoalalveolar lavage (BAL)/bronchial wash, or other sterile sites from January 2006 to October 2015. They then evaluated all readmissions less than a year from the index hospitalization for bloodstream, BAL/bronchial wash, or other sterile sites positive for the same or different MDROs.

Of the 4,429 patients with a positive culture for an MDRO, 2,127 (61.6%) were readmitted more than once within a year, and 512 patients (24.1%) had the same or a different MDRO isolated from blood, BAL/bronchial wash, or another sterile site during readmission. Bone marrow transplant, end-stage renal disease, lymphoma, methicillin-resistant Staphylococcus aureus, or carbapenem-resistant Pseudomonas aeruginosa during index hospitalization were factors associated with increased risk of an MDRO isolated during a readmission. MDROs isolated during readmissions were in the same class of MDRO as the index hospitalization 9% to 78% of the time, with variation by index pathogen.
Dec 17 Infect Control Hosp Epidemiol abstract

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