Stewardship / Resistance Scan for Oct 11, 2019

Probiotics and C diff risk
MCR genes on Algerian farms

Probiotics associated with increased C difficile risk in NY hospital study

Patients who received probiotics concurrently with antibiotics were more likely to have an incident of Clostridioides difficile infection (CDI) than those who didn't receive probiotics, researchers reported yesterday in the American Journal of Infection Control.

The retrospective study analyzed a cohort of patients at NYU Winthrop Hospital who received at least one dose of antibiotics associated with a high risk of inducing CDI, including some who were on or started probiotics when antibiotics were administered. While it is common in hospitals to administer probiotics concomitantly with antibiotics based on the theory that they might prevent CDI, there is conflicting evidence that probiotics have this benefit. To determine whether probiotics are effective as CDI prophylaxis, the researchers grouped patients according to probiotic use and examined the association between probiotic use and incident CDI.

Of the 3,266 patients analyzed, 167 (5.1%) received probiotics within 24 hours of antibiotic initiation, and an additional 216 (6.6%) received probiotics during the 12-week follow-up period. A total of 150 patients (4.6%) had CDI within 12 weeks of antibiotic initiation.

Of those patients who initiated probiotic use on or before the start of antibiotics, 9.6% had an incident CDI within 12 weeks compared with 4.2% of those not on probiotics at the start of their antibiotics (relative risk, 2.3; 95% confidence interval [CI], 1.4 to 3.7; P = .001). In time-dependent Cox models accounting for probiotic initiation and adjusting for potential confounders, a positive association between probiotics and CDI remained significant (hazard ratio, 2.7; 95% CI, 1.74 to 4.08; P < .001).

Use of proton pump inhibitors and histamine 2 receptor antagonists was also associated with an increased risk of CDI, as was the administration of several antibiotics simultaneously. Sex and age were not found to have a significant impact on CDI incidence.

"Although our finding of increased CDI in those patients who took probiotics was unexpected, patients are vulnerable to CDI when their bowel flora is disrupted," the authors of the study write. "Perhaps further disruption with various bacterial species thought to be protective is, in fact, equally disruptive and potentially harmful."

Based on the findings, the authors do not recommend administration of probiotics to prevent CDI.
Oct 10 Am J Infect Control study


MCR genes found in soil, water, manure on Algerian farms

Environmental sampling conducted on farms in northwest Algeria has detected strains of Escherichia coli carrying colistin-resistance genes, French and Algerian researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

Of the 40 environmental samples collected from eight farms, 103 colistin-resistant bacterial strains were isolated from agricultural soil, irrigation water, and horse, sheep, and cow manure. Further analysis identified eight of the strains as E coli, including six carrying the MCR-1 gene and two carrying the MCR-3 gene.

All E coli strains were non-susceptible to amoxicillin, amoxicillin-clavulanate, ticarcillin, nalidixic acid, ciprofloxacin, gentamicin, trimethoprim-sulfamethoxazole, and rifampicin. Two of the strains were also non-susceptible to cefotaxim, cefepim, and aztreonam and were carrying the extended-spectrum beta-lactamase gene blaTEM-12 in addition to MCR-1.

The 6 E coli isolates carrying the MCR-1 gene were assigned to three sequences types (STs), including ST10 (n = 3), ST405 (n = 2) and ST345 (n = 1), whereas the two strains carrying MCR-3 gene were assigned to ST155.

The authors of the study say the findings suggest farms could be an important reservoir of colistin-resistant E coli, and that the transfer of bacteria from animal manure to soil and irrigation water has the potential to spread multidrug-resistant pathogens.
Oct 10 J Glob Antimicrob Resist abstract

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