Stewardship / Resistance Scan for Jan 23, 2019

Benefit of C diff prevention
Prescribing drop in England
Candida auris increase

CDC experts say US-wide C diff prevention could net $25 billion in benefits

Experts from the US Centers for Disease Control and Prevention (CDC) estimated yesterday in Antimicrobial Resistance & Infection Control that establishing nationwide antibiotic stewardship programs to prevent Clostridioides difficile infections in hospitals would result in an annual net benefit of $25.5 billion.

The investigators used new Department of Health and Human Services guidelines for their cost-benefit analyses of a national in-hospital C difficile prevention program to improve health and preserve antibiotics. They included estimates of antibiotic stewardship staffing and incorporated value-of-statistical-life estimates to derive economic values associated with decreasing morbidity and mortality risk.

They estimated that, if they were to ignore the benefits from reducing the risk of illness and death, net benefits of such a nationwide intervention would range from $300 million to $7.6 billion from 2015 to 2020. But if they include the value of such risk reduction, the net social benefits jump from $21 billion to $624 billion. The authors say the most likely outcome scenario would realize a net benefit of $25.5 billion per year.

The experts conclude, "As the US federal government intensifies its efforts to control antibiotic resistant infections, our results suggest that these ambitious goals can produce very large net societal benefits. As these benefits accrue mostly to patients, policy makers can address how the burden for the additional prevention costs should be shared among patients, third party payers and healthcare providers."
Jan 22 Antimicrob Resist Infect Control study


UK study: Antimicrobial resistance strategy linked to drop in prescribing

Researchers with the University of Oxford report today in the Journal of Antimicrobial Chemotherapy that antibiotic prescribing has dropped by 14% in England since the government implemented its 5-year antimicrobial resistance strategy.

Using annual prescription cost analysis data from 1998 to 2017 and monthly prescribing data from 2010 to 2018, the researchers calculated the volume of antibiotic prescriptions and measured the change in prescribing rate after the strategy was implemented in 2013. The strategy, introduced in a report by England's Chief Medical Officer (CMO), included optimizing prescribing practice by reducing unnecessary prescribing and creating a website that provides clinicians with prescribing data by practice and month.

The researchers found that while the annual prescribing rate was stable from 1998 through 2012, there was a downward change after 2013, despite an increase in population. The annual rate dropped from 1,378 per 1,000 Specific Therapeutic group Age-Sex Related Prescribing Units (STAR-PU) per year in 2013 to 1,184 per 1,000 STAR-PU in 2017. Applying the pre-2013 prescribing rate to the period from July 2017 to June 2018, the researchers estimated that an additional 9.7 million antibiotic prescriptions would have been dispensed had the strategy not been implemented.

Though they note that they cannot firmly say that the 5-year antimicrobial resistance strategy caused the reduction in prescribing, the authors of the study say the magnitude and timing of the change are noteworthy.

"National strategic public health interventions are an important and potentially effective way to modify clinical practice," they write. "The CMO report and Antimicrobial Resistance Strategy appears to have had a substantial impact on prescribing of antibiotics at the population level in England."
Jan 23 J Antimicrob Chemother study


CDC says 2018 Candida auris cases topped 550

Confirmed and probable Candida auris cases in the United States through Dec 31 rose to 551, an increase of 88 from the end of October, the CDC said in an update yesterday.

Illnesses caused by the deadly, multidrug-resistant fungus have been reported in 12 states, though 90% are in New York (280), Illinois (118), and New Jersey (100). Of the 551 cases, 520 are confirmed and 31 are listed as probable.

In comparison, from when the fungus was first identified in the country in June 2016 through Aug 31, 2017, US states reported 153 clinical cases.

Screening for C auris in six states has found an additional 975 patients who are colonized. The testing is part of efforts to control the spread of the fungus, known to persist on surfaces in healthcare facilities and spread among patients. That total reflects an increase of 174 since the CDC's October update.

Since its first identification in 2009 in Japan, C auris has triggered outbreaks in health facilities in more than 20 countries and has shown resistance to three major antifungal drug classes. The fungus can cause serious invasive infections in patients who have compromised immune systems, and the CDC has estimated that C auris infections are fatal in 30% to 60% of patients.
Jan 22 CDC C auris case count page
Sep 18, 2017, CDC clinical update

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