Stewardship / Resistance Scan for Aug 31, 2018

C diff testing in the NICU
Resistant gonorrhea in Europe
ESBL bacteria in sprouts

SHEA experts: No routine testing for C diff in NICU patients

A new white paper from the Society for Healthcare Epidemiology of America (SHEA) advises against routine testing for Clostridioides difficile (formerly Clostridium difficile) infection (CDI) in neonatal intensive care unit (NICU) patients.

The paper, published yesterday in Infection Control and Hospital Epidemiology, suggests instead that in NICU patients under 12 months with suspected infectious diarrhea, clinicians should first perform a thorough investigation for non-infectious causes, then test the stool for common viral pathogens, including norovirus, rotavirus, enteroviruses, and adenoviruses. A test for CDI is recommended only if there is evidence of pseudomembranous colitis or if the patient has clinically significant diarrhea and other non-infectious and infectious causes have been ruled out.

The authors, who are current and former members of the SHEA guidelines committee, say they're making the recommendation because, while infants under 12 months have a 35% rate of colonization of toxigenic C difficile, infections are rare, possibly because of protective factors in their digestive systems. Furthermore, it is difficult for clinicians to be certain that a positive test result indicates CDI, as opposed to colonization.

If clinicians are considering testing for CDI, the paper advises using a stool toxin test as part of a multistep algorithm, rather than using a nucleic acid amplification test alone.

The paper also addresses hand hygiene, contact precautions, and cleaning and disinfection strategies for CDI in the NICU.
Aug 30 Infect Control Hosp Epidemiol white paper


ECDC reports slight increase in antibiotic-resistant gonorrhea in Europe

Neisseria gonorrhoeae, the bacterium that causes gonorrhea, continues to show high levels of resistance to azithromycin across Europe and resistance to it and another front-line antibiotic rose slightly, according to a report yesterday from the European Centre for Disease Prevention and Control (ECDC).

According to 2016 data from the European Gonococcal Antimicrobial Surveillance Programme (Euro-GASP), 7.5% of N gonorrhoeae isolates were resistant to azithromycin, up from 7.2% in 2015. And 2.1% were resistant to cefixime, up from 1.7% in 2015. In addition, more countries reported azithromycin resistance (21, up from 18) and cefixime resistance (14, up from 9) compared with 2015.

In good news, no isolates with resistance to ceftriaxone were detected, compared with 1 in 2015, 5 in 2014, and 7 in 2013.

"While the absence of ceftriaxone resistance among the tested isolates in 2016 is encouraging," the ECDC said in a news release, "the persistent level of resistance to azithromycin is of concern as it threatens to reduce the effectiveness of the recommended dual therapy with ceftriaxone and azithromycin." European guidelines recommend dual therapy with azithromycin plus either ceftriaxone or cefixime.

The agency added, "Among those patients for whom information on their treatment course was reported in 2016, 86% were administered ceftriaxone and more than half received combined treatment with azithromycin. The use of two antimicrobials for gonorrhoea treatment has likely contributed to increased susceptibility to ceftriaxone. However, Euro-GASP data completeness for the variable 'treatment used' has still some way to go overall with just 37% in 2016."
Aug 30 ECDC news release
Aug 30 ECDC full report


Dutch researchers find 1 in 5 bean sprout samples tainted with ESBL-E

A Dutch study in PLoS One yesterday found that 19% of bean sprout samples bought from 2013 to 2016 harbored extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E).

Because community-acquired ESBL-E infections are increasing worldwide and previous research has not studied their presence in retail bean sprouts, the researchers analyzed 131 sprout samples for the antibiotic-resistant pathogens. They found that 25 samples (19.1%) were contaminated with ESBL-E, which are resistant to beta-lactam antibiotics. The detected bacteria were almost exclusively (96.2%) Klebsiella species, and the scientists found co-resistance to other antibiotics to be common.

The investigators were surprised to find no Escherichia coli among the ESBL-E–positive samples.

The researchers observed substantial genetic diversity between isolates over time. "On the other hand, isolates from samples closely matched in time were frequently clonally related, indicative of batch contamination."

They conclude, "Further investigations to the points of entry of ESBL-E into the production process and countermeasures against these entry points are warranted."
Aug 30 PLoS One study

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