Stewardship in Scotland tied to lower broad-spectrum prescribing
Researchers in Scotland report in PLOS Medicine that implementation of an antimicrobial stewardship program (ASP) was associated with large, sustained reductions in the prescribing of three broad-spectrum antimicrobials and in a modest reduction of coliform bacteremia resistance rates.
The investigators analyzed data on all patients registered with a general practitioner in the Tayside region of east Scotland from Jan 1, 2005, through December 2015. A primary care ASP was implemented in 2009, and the authors measured prescribing rates for fluoroquinolones, cephalosporins, and co-amoxiclav, as well as resistance to the same three antimicrobials or classes among community-associated coliform bacteremia
Compared with pre-ASP prescribing, the relative reduction for fluoroquinolones was 68.8% and the absolute reduction was 6.3 people exposed per 1,000 population per quarter. For cephalosporins the reduction was 74.0% and 6.1, respectively, and for co-amoxiclav it was 62.3% and 6.8.
The researchers also found reductions in coliform bacteraemia resistance rates associated with the intervention that were significant for fluoroquinolones and cephalosporins 3.5 years after implementation of the ASP but not for co-amoxiclav. They note, "The reductions in resistance took much longer than reductions in prescribing to become evident, and relative reductions were more modest. The overall pattern was of flattening rather than reversal of previously rising resistance rates."
Jun 7 PLOS Med study
Study notes high resistance in Enterococcus in pigs at Thai-Laos border
A new study has found high levels of antimicrobial resistance in Enterococcus faecium and Enterococcus faecalis from pigs, pork products, and humans in Thai-Laos border provinces.
Thai researchers, in the Journal of Global Antimicrobial Resistance, wrote that they analyzed 648 human, pork product, and swine swabs—359 from border provinces in Thailand and 289 from similar provinces in Laos. In all, 75% contained E faecium and 74% E faecalis. All isolates were resistant to all antimicrobials tested except vancomycin.
The occurrence of E faecium in pig, pig carcass, retail pork, and humans in Thailand was 80.6%, 73.8%, 77.6% and 67.0%, respectively. The prevalence of E faecium was higher in Laos (65.7%) than Thailand (47.1%), while E faecalis was more common in Thailand (24.2%) than Laos (12.8%).The scientists first observed high levels of resistance to tetracycline, erythromycin, and streptomycin, followed by gentamicin, ampicillin, and chloramphenicol.
The authors conclude, "These pathogens may serve as potential reservoirs for the maintenance and widespread dissemination of AMR and virulence determinants from animals to humans via the food chain."
Jun 8 J Glob Antimicrob Resist abstract