Stewardship / Resistance Scan for Jun 13, 2019

Antibiotic stewardship in Canada
Carbapenem-resistant Pseudomonas

Canada's public health chief offers prescription for preserving antibiotics

Canada's chief public health officer, Theresa Tam, BMBS, issued a report this week aiming to raise awareness among both the public and healthcare professionals about the needless use of antibiotics and how to preserve the drugs' effectiveness.

The avowed goal of the "public health spotlight" report is "to describe why unnecessary antibiotic use sometimes happens and what we can do about it." The report is presented online in a single 24-page document and separately in a set of six chapters with larger type and graphics. The focus is on antibiotic use and prescribing in the community (non-hospital settings), where 92% of antibiotic prescriptions are written.

"When we better understand the many social and cultural reasons behind why unnecessary antibiotic use happens, we can begin to see some of the actions that each of us can take to help fight antibiotic resistance," Tam said in a statement about the report. "Canadians can help by keeping their vaccinations up to date, protecting themselves from infection, speaking to their health care providers before using antibiotics, and taking their antibiotics as prescribed."

Healthcare providers can help by talking with their patients about antibiotics, staying current on prescribing guidelines, and promoting appropriate use of antibiotics through tools like delayed prescriptions, meaning ones intended to be used only if symptoms don't improve within a few days, Tam added.

The report says that antibiotic resistance rates in Canada are lower than in many other countries, but not all is well. For two examples, cases of carbapenem-resistant bacteria in people without infections have quintupled, suggesting that those bacteria are becoming more common, and more than 50% of gonorrhea cases now involve bacteria with resistance to at least one antibiotic.

Included in the report are several real-life stories about patients' and providers' experiences with the prescribing and use of antibiotics.

In the conclusion, Tam says, "I look forward to using the findings from this Spotlight Report and the forthcoming Pan-Canadian Action Plan to work with leaders across the country" to preserve the effectiveness of antibiotics.
Jun 11 Tam statement
Full report in one document
First part of chapter-by-chapter version


Study reveals snapshot of carbapenem-resistant Pseudomonas burden

A surveillance study based in five United States metropolitan areas to flesh out the epidemiology of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the United States found that the burden is high, but carbapenemase-producing CRPA were rare. A team from the Center for Disease Control and Prevention (CDC) Emerging Infections Programs (EIP) sites reported their findings yesterday in Emerging Infectious Diseases.

From July to October of 2015 they began lab surveillance for CRPA at sentinel sites in Georgia, New Mexico, Oregon, Tennessee, and Monroe County, N.Y. They defined a case as the first P aeruginosa isolate resistant to carbapenems in a patient in a 30-day period from any source except for the nares, rectum or perirectal area, or feces.

Overall, they found 384 (9.1%) CRPA cases among 4,243 P aeruginosa isolates. The team identified 294 incident cases among 274 patients, with isolates most commonly found in respiratory sites (40.8%) and urine (37.8%). CRPA—an opportunistic pathogen—was found mainly in patients with underlying health conditions. Nearly 80% occurred in patients who had been hospitalized in the previous year. They found genes encoding carbapenemases in only 2.3% of 129 isolated tested.

Of 280 cases with available healthcare exposure history, 91.8% were healthcare-associated and 8.2% were community linked. And of cultures collected in acute care settings, most (83.5%) were from short-stay hospitals and 16.5% were from long-term care facilities. Of 155 hospitalized patients with information available, 65.2% had received antimicrobial drugs within 14 days of culture collection, and of those, 82.2% had received one or more β-lactam antimicrobial drug.

Resistance testing found one-third were not multidrug-resistant, and more than half were susceptible to ceftazidime or cefepime. The authors said the surveillance findings provide a snapshot of CRPA epidemiology and that based on the findings, surveillance at eight EIP sites began in 2016 to monitor changes in CRPA incidence and carbapenemase-producing CRPA strains.
Jun 12 Emerg Infect Dis report

In a related research development, researchers from California who looked at antimicrobial susceptibility test results from California hospitals between 2014 and 2017 found 3.2% of Enterobacteriaceae were resistant to carbapenems and 26.9% were resistant to cephalosporins. They reported their findings yesterday in Emerging Infectious Diseases.

Also, they found that the proportion of cephalosporin-resistant Escherichia coli increased 7% per year during the study period. They said some decreasing trends in carbapenem resistance, often the focus of containment efforts, affirm the potential effectiveness of prevention strategies. "Nonetheless, increases and regional variation in carbapenem-resistant and ESCR E. coli highlight the urgent need for ongoing, local infection prevention and antimicrobial stewardship efforts."
Jun 12 Emerg Infect Dis report

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