Stewardship / Resistance Scan for Nov 16, 2018

Improper prescribing in the ER
Hospital stewardship in China
Antibiotic use in Poland
Swiss AMR-related illness, deaths

Australian data show a third of emergency room antibiotics not needed

An observational study in Australia has found that a third of antibiotic prescriptions in an emergency department (ED) were deemed inappropriate, according to a study yesterday in the Journal of Antimicrobial Chemotherapy.

Researchers at Gold Coast University Hospital assessed 1,019 patient presentations that involved an antibiotic prescription in the ED during 4 separate weeks throughout 2016, one each in February, May, August, and November.

They determined that 640 antibiotic prescriptions (62.8%) were appropriate, 333 (32.7%) were inappropriate, and 46 (4.5%) were not assessable. Adults were more likely to receive an inappropriate antibiotic prescription than children (36.9% vs. 22.9%). Patients who likely had sepsis-related organ failure were also more likely to be prescribed improper antibiotics (56.7% vs. 36.1%).

The researchers found no difference in inappropriate prescribing rates in the ED based on patient gender, hospital admission status, reason for antibiotic administration (treatment vs. prophylaxis), or time of shift (day vs. night).

The authors conclude, "With over one in three antibiotic prescriptions in the ED being assessed as inappropriate, there is a pressing need to develop initiatives to improve antibiotic prescribing to prevent antibiotic-associated patient and community harms."
Nov 15 J Antimicrob Chemother study


Hospital in China cuts antibiotics markedly after stewardship initiation

A single-center study in China reports that, after instituting an antimicrobial stewardship program, the use of antibiotics was cut by almost two-thirds and rates of methicillin-resistant Staphylococcus aureus (MRSA) dropped dramatically, according to a study today in Epidemiology & Infection.

Scientists explored the trends and correlations between antibiotic consumption and resistance of S aureus in a tertiary hospital at Jiaotong University in northwest China from 2010 to 2016. They found that antibiotic use dropped from 951.9 to 346.5 defined daily doses per 1,000 patient-days, a 63.6% reduction. The decrease was statistically significant for several antibiotic classes, including cephalosporins, monobactams, aminoglycosides, imidazole derivatives, and macrolides.

The incidence of MRSA among S aureus isolates declined from 73.3% in 2010 to 41.4% in 2017, and the decrease was significantly correlated with lower consumption of several classes of antibiotics. The authors note that, since the end of the study, resistance rates of S aureus have remained significantly reduced, and MRSA rates have dropped even further.
Nov 16 Epidemiol Infect study


Decade-long study shows high antibiotic consumption in Poland

A 10-year study of antibiotic consumption in Poland published yesterday in Antimicrobial Resistance & Infection Control discovered high use of the drugs compared with the rest of Europe, and consumption has climbed 8% since 2007.

Study investigators used data from the Healthcare-Associated Infections Surveillance Network within the European Centre for Disease Prevention and Control (ECDC), combined with a literature review. They measured consumption in daily doses per 1,000 inhabitants per day (DIDs).

They found that antibiotic use nationwide rose from 22.2 DIDs in 2007 to 23.9 in 2016, an 8.3% increase, though down from a high of 26.2 in 2015. That compares with a low of 10 DIDs in the Netherlands and a high of 36 DIDs in Greece, according to ECDC data. The figure places Poland as having the 19th highest consumption rate among 23 European nations.

The report also notes that rates of broad-spectrum antibiotic prescribing are also high, at 25.8% of total antibiotics, placing Poland at 16 of the 23 countries. The rate of broad-spectrum prescribing, however, is falling in Poland.

The authors say that, although the high rate of antibiotic consumption does not bode well for antibiotic resistance, the 8% increase is much lower than the 36% global increase worldwide in the past decade.

The authors conclude, "Since the limited educational activities among physicians and dentists may play an important role in the current antibiotic consumption patterns, integrated actions focusing on appropriate antibiotic prescribing in the pre- and post-graduate training should be instigated and followed up at [the] national level."
Nov 15 Antimicrob Resist Infect Control study


Swiss researchers report 7,000 AMR cases, almost 300 AMR deaths a year

Swiss researchers estimate that antibiotic-resistant bacteria in the country cause more than 7,000 illnesses and almost 300 deaths a year, according to a letter in The Lancet Infectious Diseases.

To duplicate a study using ECDC data in 2015 for European Union nations, the researchers applied the same methodology to data from the ECDC and the Swiss Centre for Antibiotic Resistance for the same year.

They estimated that 7,156 cases of infections with antibiotic-resistant bacteria occurred in 2015, including 276 deaths and 7,400 disability-adjusted life-years (DALYs) lost. That corresponds to 85.0 cases, 3.3 deaths, and 87.8 DALYs per 100,000 people. The highest proportion of the infections was caused by third-generation cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae.
Nov 15 Lancet Infect Dis letter

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