Stewardship / Resistance Scan for Oct 29, 2018

Decline in pediatric Staph, MRSA
Candida auris uptick

Study finds substantial decline in pediatric Staphylococcus infections

Staphylococcus aureus hospitalizations at US pediatric hospitals fell by 36% from 2009 to 2016, with methicillin-resistant S aureus (MRSA) declining by 52%, with a corresponding drop in antibiotic use, according to a study today in Infection Control and Hospital Epidemiology.

The retrospective cohort study was conducted at 39 US pediatric hospitals using the Pediatric Health Information Systems administrative database and was limited to patients under 18 years of age who had an S aureus infection indicated in the electronic medical record. Annual rates for S aureus overall, MRSA, and methicillin-susceptible S aureus (MSSA) were calculated per 1,000 admissions.

Among the 39 hospitals, investigators identified 116,152 S aureus hospitalizations from 2009 to 2016. During the period, the annual S aureus rate fell from 26.3 to 16.8 infections per 1,000 admissions (P < .001), with MRSA decreasing from 14.4 to 6.9 infections per 1,000 admissions (P < .001) and MSSA infections falling 17% (from 11.9 to 9.9 infections per 1,000 admissions; P < .001). The proportion of S aureus infections that were MRSA dropped from 55% in 2009 to 41% in 2016. In addition, days of therapy for anti-MRSA antibiotics declined from 38.0 to 24.4, with the most notable decreases for clindamycin (14.32 to 7.5) and vancomycin (16.6 to 10.8).

The authors of the study suggest that a number of factors may contribute to the decreases, including earlier recognition of S aureus infections and initiation of appropriate therapy in outpatient settings, but they say more research is needed to fully understand what's driving the epidemiologic changes.
Oct 29 Infect Control Hosp Epidemiol abstract


US Candida auris cases continue to rise

The number of confirmed and probable cases of Candida auris in the United States has jumped to 463, according to the latest update from the Centers for Disease Control and Prevention (CDC), up from 349 in July.

As of Sep 30, infections caused by the multidrug-resistant fungus have been identified in 11 states, with the vast majority of confirmed cases reported in New York (239), New Jersey (94), and Illinois (80). Cases have also been reported in Massachusetts (7), Florida (4), Maryland (3), Oklahoma (2), California (1), Connecticut (1), Indiana (1), and Texas (1). Of the 463 clinical cases identified, 433 are laboratory-confirmed and 30 are listed as probable.

The CDC also said that targeted screening in six states with clinical cases has identified an additional 801 patients who are colonized with C auris. The screening is being conducted as part of an effort to control the spread of the fungus, which can persist on surfaces in healthcare facilities and spread between patients.

Originally identified in Japan in 2009, C auris has caused outbreaks in healthcare settings in more than 20 countries and has shown resistance to the three major classes of antifungal drugs used to treat Candida infections. In patients with compromised immune systems, it can cause serious invasive infections affecting the bloodstream, heart, brain, ear, and bones. The CDC estimates that 30% to 60% of patients with invasive C auris infections have died.

C auris was made a nationally notifiable condition at the 2018 Council for State and Territorial Epidemiologists annual conference in August.
Oct 23 CDC C auris case count page

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