Stewardship / Resistance Scan for Jul 10, 2019

UK antibiotic prescribing decline
MCR-1 E coli in Michigan

Study shows decline in antibiotic prescribing in English primary care

The rate of antibiotic prescribing and the proportion of patients receiving antibiotics in primary care settings in England declined consistently from 2014 through 2017, researchers from King's College London reported yesterday in BMJ Open.

Analyzing data from 102 general practices in England, the researchers found that total antibiotic prescribing declined from 608 prescriptions per 1,000 person-years in 2014 to 489 per 1,000 person-years in 2017, with an estimated relative rate reduction (RRR) of 6.9% per year. And broad-spectrum beta-lactam antibiotic prescribing decreased from 221 prescriptions per 1,000 person-years to 163 (RRR, 9.3% per year).

The proportion of registered patients prescribed antibiotics in each year declined from just over 1 in 4 (25.3%) to just over 1 in 5 (21.1%). Declines in prescribing were similar for men and women and were seen in all age-groups, but the rate of decline was lower for patients over the age of 55 years than for younger patients.

When broken down by indication, antibiotic prescribing declined by 9.8% per year for respiratory infections, 5.7% for genitourinary infections, and 3.8% for no recorded indication. Overall, 38.8% of antibiotic prescriptions were associated with codes that did not suggest specific clinical conditions, and 15.3% of antibiotic prescriptions had no medical codes recorded.

The authors say the results show that declines in antibiotic prescribing in English primary care are broad-based, but they note that the slowest decline was seen in antibiotic prescriptions associated with no medical codes, and suggest this might be a target for future stewardship efforts.
Jul 9 BMJ Open study


MCR-1−carrying E coli identified in 4 Michigan patients

A colistin resistance surveillance program in a Michigan health system has identified four patients carrying the mobile colistin-resistance gene MCR-1, researchers reported today in Infection Control and Hospital Epidemiology.

From January 2016 through April 2017, the Michigan Medicine Clinical Microbiology Laboratory tested more than 15,000 clinical Enterobacteriaceae isolates and found that 95 patients had colistin-resistant isolates. Of the 36 isolates tested for the presence of MCR-1 gene, four (all Escherichia coli) were positive. Two isolates belonged to the same sequence type (ST 263), and two carried additional antibiotic-resistance genes.

Colistin is considered a last-resort antibiotic for treating multidrug-resistant infections.

The four patients included a 70-year-old woman with diabetes mellitus and nonalcoholic steatohepatitis, a 19-year-old man with spina bifida and recurrent urinary tract infections (UTIs), a 22-year-old healthy woman with a UTI, and a 77-year-old man with a history of cystectomy and ileal conduit for bladder cancer who was being treated for a complicated UTI. Transmission of MCR-1 between the patients was not identified. Epidemiologic investigation found that all four had travelled internationally and had antibiotic exposure within 6 months prior to MCR-1 identification.

"Further study is required to define mcr-1 prevalence in community and healthcare settings, to identify risk factors for mcr gene acquisition, and to describe the natural history of mcr-1 gene carriage," the authors write.

As of November 2018, 53 human cases of MCR-1−producing Enterobacteriaceae have been reported in 19 US states, including Michigan.
Jul 10 Infect Control Hosp Epidemiol abstract

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