Stewardship / Resistance Scan for Nov 05, 2018

AMR prevalence in Canadian hospitals
Antibiotic dispensing in Spanish pharmacies

Rate of drug-resistant organisms in Canadian hospitals remains steady

A point prevalence survey conducted at Canadian hospitals shows that national prevalence rates for infection or colonization with antimicrobial-resistant organisms (AROs) saw little change from 2010 to 2016, according to a study today in Infection Control and Hospital Epidemiology.

The survey of adult inpatients in Canadian hospitals with more than 50 beds was conducted in February 2016. Patients colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile infection (CDI), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs) were included. Previous surveys had been conducted in 2010 and 2012.

In total, 160 hospitals from 9 of 10 provinces with 35,018 adults patients participated in the survey. Hospitals reported a total of 3,117 patients colonized or infected with at least one ARO, for a prevalence of 8.9 per 100 patients. Median prevalence per 100 patients was 4.1 for MRSA, 1.1 for CDI, 0.8 for VRE, 0.8 for ESBLs, and 0 for CREs. Hospitals in western Canada had the highest median prevalence of MRSA and VRE, while hospitals in central Canada had a higher median prevalence of CDI. Among the 106 hospitals that participated in all three surveys, no significant changes were detected in the prevalence of any of the AROs from 2012 to 2016.

Although CREs remained infrequently identified, they were reported from more hospitals in 2016 (15%) compared to 2012 (7%). The authors of the study also note that the true prevalence of VRE in Canadian hospitals is likely higher because routine screening for VRE on admission decreased from 94% in 2010 to 74% in 2016.

The authors say ongoing national surveillance for AROs will be important for evaluating potential changes in the epidemiology of diseases caused by these bacteria.
Nov 5 Infect Control Hosp Epidemiol study


Spanish study: Nearly 20% of pharmacies dispense antibiotics without  prescription

A study today in the Journal of Antimicrobial Chemotherapy reports that nearly 20% of pharmacies in a region of Spain dispense antibiotics without a prescription, especially under patient pressure.

In the cross-sectional "simulated patient" study, conducted in two provinces of northwestern Spain from December 2016 through January 2017, four actors visited 977 pharmacies simulating symptoms of a respiratory infection. Each visit began with a request for medication to relieve symptoms, then gradually escalated to a request for stronger medication than what was originally offered, followed by a request for an antibiotic and a specific request for amoxicillin. The result of the demand process was recorded, along with other data (including the area where the pharmacy was located and the sex and education level of the person dispensing the antibiotic).

An antibiotic was obtained in 18.83% (95% confidence interval [CI], 16.5% to 21.4%) of the visits, with the number of antibiotics dispensed increasing with the level of pressure. Analysis of the effect of independent variables showed that there was greater likelihood of antibiotic dispensing in rural areas (odd ratio [OR], 1.79; 95% CI, 1.20 to 2.68) or semi-rural areas (OR, 1.66; 95% CI 1.13 to 2.44) than in urban areas. No association was found with the sex or training of the person who dispensed the antibiotic. 

The authors of the study say the findings indicate that interventions aimed at reducing dispensing of non-prescribed antibiotics should be carried out, with a priority placed on rural pharmacies. Spain has one of the highest rates of antibiotic consumption in the European Union.
Nov 5 J Antimicrob Chemother study

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