Stewardship / Resistance Scan for Jun 28, 2018

Antibiotic stewardship financial incentives
New drug-resistant UTI treatment
Updated infectious disease lab testing guide

Financial incentives helped curb unnecessary antibiotic prescribing in NHS doctors

A financial incentive program for United Kingdom National Health Service (NHS) local groups reduced antibiotic prescribing by general practitioners for common respiratory infections by 3%, a research team based at Imperial College London reported today in the Journal of Antimicrobial Chemotherapy.

In 2015, UK officials introduced a quality premium program to improve services at NHS locations that included financial incentives for meeting different criteria, which included measures to reduce antibiotic prescribing by 1% and reduce broad-spectrum antibiotic prescriptions by 10%. Today's report is the first to describe the impact of the plan.

In reviewing data from general practices across England from 2011 to 2017, the authors focused on antibiotic prescribing for uncomplicated respiratory tract infections (RTIs), the majority of which are caused by viruses and don't respond to antibiotics. They saw the expected seasonal peaks and troughs in incidence, but antibiotic prescribing rates decreased over the 6-year period. In April 2015, a time that marked the launch of the antibiotic-prescribing incentive plan, antibiotic prescribing rates declined by 3%, or 14.65 prescriptions per 1,000 RTIs. The team also saw a 2% relative reduction in the broad-spectrum antibiotic prescribing rate.

The greatest reductions occurred in patients who had sore throats and in younger patients, with a 6% reduction in prescribing for children, a group for whom the number of doctor visits for RTIs is higher.

Sabine Bou-Antoun, MSc, the study's first author and an epidemiologist at Imperial College London, said in a press release from the school, "It is important to reduce unnecessary and inappropriate antibiotic prescribing as it is a known driver of antibiotic resistance. It's also important to measure the impact of national interventions targeted at improving the use of antibiotics so we can evaluate and identify what is working."

The group is currently investigating whether reduced antibiotic prescribing has led to any negative impacts, including increased frequency of illnesses. Alison Holmes, MD, MPH, study coauthor who is with the National Institute for Health Research and is professor of infectious diseases at Imperial College London, said, "National-level schemes such as these are important tools in our efforts to reduce antibiotic prescribing, but it is critical that these interventions are objectively and expertly evaluated."
Jun 27 Imperial College London press release
Jun 28 J Antimicrob Chemother abstract


New antibiotic approved for drug-resistant UTIs

The US Food and Drug Administration approved the use of plazomicin as a new treatment for complicated, drug-resistant urinary tract infections (UTIs).

Plazomicin, marketed under the name Zemdri, is not a new antibiotic class, but has been developed to treat drug-resistant Enterobacteriaceae, identified as one of the World Health Organization's top three difficult-to-treat superbugs.

"This new antibiotic will be a vital last-resort treatment for patients with complicated and life-threatening urinary tract infections," said Tim Jinks, head of Wellcome's drug-resistant infections program in a press release. The Wellcome Trust helped fund Zemdri's development.

Zemdri is given as an intravenous infusion, administered once daily, according to Achaogen, Inc, the drug’s manufacturer. Recent phase 3 clinical trials showed that greater than 99% of Escherichia coli, Klebsiella pneumoniae and Enterobacter cloacae in US surveillance are susceptible to Zemdri.

Each year, the United States sees approximately 3 million cases of complicated urinary tract infections, many caused by Enterobacteriaceae, a family of gram-negative bacteria that are becoming increasingly resistant to first-line antibiotics.
Jun 27 Wellcome press release
Jun 26 Achaogen press release


IDSA and ASM update lab diagnosis guide for health providers

In an update to recommendations from 2013, the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM) today unveiled their latest guide for using microbiology lab tests to diagnose infectious diseases. The full report appears in the latest edition of Clinical Infectious Diseases.

J. Michael Miller, PhD, the guide's lead author and director of Microbiology Technical Services in Dunwoody, Ga., said in an IDSA press release, "As fast as technology is moving, especially with the genetic and molecular tests, this update was necessary."

The guide details the precise steps for collecting and managing blood, urine, tissue, and other specimens and contains tables that provide detailed information on the use and limitations of tests, organized by type of infections (such as urinary tract or upper respiratory) to help health providers order the best test and collect the appropriate sample. It also includes expanded information on pediatric testing, tests for tick-borne diseases, and information on diagnostic advancements, such as nucleic acid amplification tests that can identify organisms faster and less expensively, the IDSA said.

Melvin P. Weinstein, MD, guide coauthor and chief of infectious diseases at Rutgers Robert Wood Johnson Medical School, said, "Instead of using a shotgun approach and prescribing broad spectrum antibiotics, these new rapid diagnostic tests can help health care providers target the specific organism causing the infection much sooner than traditional microbiologic tests."
Jun 28 IDSA press release
Jun 28 Clin Infect Dis

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