Stewardship / Resistance Scan for May 06, 2019

Nursing home stewardship
Candida auris funding

Nursing home stewardship intervention shows mixed results

Implementation of an antimicrobial stewardship program intervention at 27 nursing homes in North Carolina was associated with reductions in urine culture and culture-positive rates, according to a study today in Infection Control and Hospital Epidemiology. But high proportions of antimicrobial resistance were still observed among common urinary pathogens.

The intervention, which was implemented in June 2015, was designed to optimize antibiotic use and improve knowledge and understanding of urinary tract infections (UTIs) among staff, resident, and families, with training sessions on causes of antimicrobial resistance, urine culture reports, asymptomatic bacteriuria, and UTI management. To investigate the impact of the program, researchers collected and analyzed urine culture results before and after implementation, comparing culture rates, culture positive rates, and antimicrobial resistance patterns in urinary pathogens.

Of the 6,718 urine cultures studied, 68% were positive, 18% were negative, and 14% were recorded as polymicrobial. Both the urine and urine positive culture rates per 1,000 resident-days showed a decrease from baseline through the active antimicrobial stewardship intervention period, with low "P" values for both the urine culture rate (P = .014) and the positive culture rate (P ≤ .001). Most of the identified potentially uropathogenic isolates were Escherichia coli (38%), Proteus spp (13%), and Klebsiella pneumoniae (12%).

While resistance varied, a significant decrease was observed during the intervention period in nitrofurantoin resistance among E coli (P ≤ .001) and ciprofloxacin resistance among Proteus spp (P ≤ .001). But carbapenem resistance increased for Proteus spp (P ≤ .001). Multidrug resistance also increased for Proteus spp compared to the baseline. In addition, the high baseline resistance of E coli to the commonly prescribed antimicrobials ciprofloxacin and trimethoprim-sulfamethoxazole did not change during the intervention.

The authors note that while some downward reductions in resistance were observed, they were too small and scattered to conclude that the intervention significantly changed resistance patterns.
May 6 Infect Control Hosp Epidemiol abstract


NY senator urges CDC to declare Candida auris a public emergency

US Senator Chuck Schumer yesterday urged the Centers for Disease Control and Prevention (CDC) to declare a public emergency over Candida auris.

Schumer, D-NY, said in a press release that declaring a public emergency over the multidrug-resistant fungal infection would help New York, the state with the most cases, gain access to millions of dollars in public health crisis response funding. Schumer said the money would be available if the agency qualified "superbugs" as eligible for official emergency response funding, as it has done with Zika and Ebola. 

"While the CDC is doing a fine job honing in on the threat this superbug presents to New York and the country, with the wave of a pen, they can help beat back the wave of this fungus' spread across New York in an even tougher way," Schumer said. "And that is what they should do: deliver a new raid of resources to stop this superbug from spreading even more across New York, Long Island and Upstate."

Of the 643 confirmed and probable C auris cases in the United States, 323 are in New York. C auris can spread easily in hospitals and cause serious invasive infections in patients who have compromised immune systems. The CDC has estimated that 30% to 60% of patients with infections have died.

Schumer said the money could be used to boost state and local testing capacity, invest in more rapid detection technology, fund surveillance efforts, and develop a public awareness campaign.
May 5 Senator Schumer press release

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