Stewardship / Resistance Scan for Jan 07, 2019

Antibiotics and joint replacement
MDR Shigella in Australia
Resistant-infection alert in RI

Study indicates pre-op antibiotics may ward off joint replacement infection

Researchers in Finland report in a study yesterday in Clinical Microbiology and Infection that the use of oral antibiotics before joint replacement surgery is common and may lower the risk for periprosthetic joint infection (PJI), but indiscriminate use of antibiotics before such surgeries cannot be recommended.

The investigators analyzed data on 23,171 hip or knee replacements that took place at a tertiary care hospital at the University of Tampere from September 2002 through December 2013. They noted that 4,106 patients (17.7%) received at least one course of antibiotics before surgery, and 158 patients (0.68%) developed a PJI.

The incidence of PJI for those with preoperative antibiotics was 0.29%, compared with 0.77% for those who did not take antibiotics. Depending on the method used, the risk of PJI was reduced 34% to 40% in those receiving antibiotics.

The authors conclude, "The use of oral antibiotics before elective joint replacement surgery is common and has a potential effect on the subsequent risk for PJI. Nevertheless, indiscriminate use of antibiotics before elective joint replacement surgery cannot be recommended, even though treatment of active infections remains an important way to prevent surgical site infections."
Jan 6 Clin Microbiol Infect study


Australian researchers note high rates of MDR Shigella in MSM in Victoria

Australian scientists are reporting high rates of multidrug-resistant (MDR) Shigella infections among men who have sex with men (MSM) in the state of Victoria, according to a study today in Clinical Infectious Diseases.

The burden of shigellosis in urban Australia is typically either in travelers returning from Shigella-endemic regions or in MSM, the authors note. They explored genomic data on 545 clinical isolates and comprehensive epidemiologic data collected from Jan 1, 2016, through Mar 31, 2018, to determine the spread of MDR Shigella lineages.

They discovered high rates of antimicrobial resistance—17.6% of isolates were resistant to ciprofloxacin and 50.6% were resistant to azithromycin. They also identified two major MSM-associated Shigella lineages, one affecting 159 men and the other 105. Among the first lineage, 92.4% of isolates harbored mutations associated with reduced susceptibility to azithromycin, trimethoprim-sulfamethoxazole, and ciprofloxacin. MDR plasmids were predominantly associated with MSM isolates.

The authors conclude, "Our contemporary data highlight the ongoing public health threat posed by resistant Shigella, both in Australia and globally. Urgent multidisciplinary public health measures are required to interrupt transmission and prevent infection."
Jan 7 Clin Infect Dis abstract


Rhode Island warns of antibiotic-resistant infected picked up overseas

The Rhode Island Department of Health (RIDOH) late last week warned residents about the potential risk of traveling abroad for medical treatment, highlighting an increase in cases of serious antibiotic-resistant infections, especially in residents who traveled to the Dominican Republic.

Although the RIDOH did not list case numbers, it said in a news release, "Rhode Island hospitals have seen an increase in the number of Rhode Islanders who have traveled to other countries for medical procedures and returned with serious, antibiotic-resistant infections that require months to years of treatment. These infections have been associated with wounds that are painful, slow to heal, and often require draining. Such infections can also lead to permanent disfigurement."

The department specifically mentioned "several patients" who had procedures done in the Dominican Republic, including breast augmentation, tummy tucks, liposuction, eyelid surgery, nose jobs, oral surgery, and heart procedures.

"Various factors can sometimes make traveling for a procedure risky," said Nicole Alexander-Scott, MD, MPH, RIDOH director. "When it comes to procedures that are done for the sake of appearance, instead of to treat health needs, it's often not worth the risk."

Rhode Island officials also posted several tips for those planning to travel for medical procedures, such as consulting with the healthcare provider well in advance of the trip.
Jan 3 RIDOH news release

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