Stewardship / Resistance Scan for May 07, 2019

Candida auris death rate
Shorter antibiotic course for UTI

Pakistani study finds high mortality rate in patients with Candida auris

A study yesterday in BMC Infectious Diseases by Pakistani researchers describes the wide range of invasive infections and high mortality rate associated with the multidrug-resistant fungus Candida auris.

The retrospective study, conducted at a university hospital in Karachi, included 92 patients who had C auris strains isolated from September 2014 through March 2017. Overall, 193 C auris strains were collected; 65 of the patients were infected and 27 were colonized.

Among the infected patients, bloodstream infections (candidemia) accounted for 38 cases (58%), most of them central line-associated bloodstream infections, followed by urinary tract infections (19 cases, 29%). Other infections included peritonitis, empyema, nosocomial ventriculitis, otitis externa, and surgical site infections. Antifungal susceptibility testing on 63 isolates found resistance to fluconazole in all isolates, voriconazole resistance in 18 isolates (28.6%), and amphotericin resistance in 5 isolates (7.9%). No isolates were resistant to all classes tested.

The crude in-hospital mortality rate among the patients was 42.4%, with 19 deaths directly related to C auris, while 14-day mortality was 31.5%. Mortality was similar among infected and colonized patients (46.2% vs 33.3%) and higher in candidemia patients than non-candidemia patients (60.5% vs 25.9%). On multivariate analysis, candidemia (adjusted odds ratio [AOR], 4.2%; 95% confidence interval [CI], 1.09 to 16.49, P = 0.037) and older age (AOR, 4.5; 95% CI, 1.09 to 18.9, P = 0.038) were associated with greater mortality. Source control was found to be a protective factor (AOR, 0.22; 95% CI, 0.05 to 0.92, P = 0.038).

The mortality figures are in line with previous C auris studies, which have found mortality rates ranging from 30% to 60%.
May 6 BMC Infect Dis study


Study supports shorter antibiotic treatment for UTIs in men

The findings from a multi-clinic study support shorter antibiotic therapy for men with uncomplicated urinary tract infections (UTIs) in outpatient settings, researchers from Baylor College of Medicine and elsewhere reported yesterday in Open Forum Infectious Diseases.

In the retrospective cohort study, the researchers examined the administrative and billing records of adult men who were diagnosed as having a UTI and prescribed an antibiotic at three different types of outpatient clinic from January 2011 through September 2015. For eligible visits in which an antibiotic was prescribed, the team extracted data on the antibiotic used, the treatment duration, recurrent UTI episodes, and patient medical and surgical history. The primary exposure was treatment duration, characterized as short (7 days or less) or long (more than 7 days) based on expert recommendation.

Overall, 637 visits were included for 573 unique patients with a mean age of 53.7 years. Fluoroquinolones were the most commonly prescribed antibiotics (69.7%), followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%), and beta-lactams (3.8%). Thirty-two patients had UTI recurrence, with 7 having early recurrence and 25 having late recurrence. Antibiotic choice was not associated with UTI recurrence.

In the overall cohort, longer treatment duration was not significantly associated with UTI recurrence (odds ratio [OR], 1.95; 95% CI, 0.91 to 4.21). But an assessment of the association between treatment duration and recurrence in four subgroups found that longer treatment was associated with more than twice the risk of recurrence in the group that excluded men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis, and benign prostatic hyperplasia (OR, 2.62; 95% CI, 1.04 to 6.61).

Although the authors note that the results need to be interpreted with caution, they say the study adds to evidence that men with UTIs and no additional complications can be treated with a 7-day antibiotic course. "Shorter duration of antibiotic treatment for male UTI may lead to decreased risk of antibiotic resistance, fewer adverse effects, and lower costs," they write.
May 6 Open Forum Infect Dis abstract

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