ASP Scan (Weekly) for Jan 03, 2020

Antibiotic resistance in European ICUs
C diff carriers and hospital contamination
Clindamycin-resistant C diff
Fluoroquinolones for bloodstream infections

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Survey of European ICU docs finds concern over multidrug resistance

More than half of physicians in European intensive care units (ICUs) say multidrug-resistant (MDR) infections are a problem in their hospitals, according to a survey published yesterday in Antimicrobial Resistance and Infection Control.

The online survey, conducted in 2017 among members of the European Society of Intensive Care Medicine, included 20 questions on hospital and ICU characteristics, experience with infections caused by MDR bacteria, and experience with use of last-line antibiotics in the previous 6 months. For the analysis of regional differences, respondents were grouped into four European sub-regions.

Among the 1,062 physicians who completed the survey, infections with MDR bacteria were rated as a major problem by 257 (24.2%), a moderate problem by 360 (33.9%), and a minor problem by 391 (36.8%). Third-generation cephalosporin-resistant Enterobacteriaceae were the most frequently reported MDR bacteria, followed by methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococci. Bacteria resistant to all or almost all antibiotics were reported by 132 respondents (12.4%), and many respondents reported not having any access to last-line antibiotics.

The ranking of MDR infections differed by region, with MDR pathogens more often reported as a major problem by physicians in the Eastern and Southern European sub-regions, a result the authors of the paper say is in line with epidemiologic studies showing higher percentages of antibiotic-resistant bacteria being reported in those regions.

The authors also note that the substantial portion of respondents reporting bacteria resistant to all or almost all antibiotics is of concern.

"This is an indication that ICU physicians are already encountering situations where options for effective treatment of infections are very limited," they write. 
Jan 2 Antimicrob Resist Infect Control study


Study: Rooms of C diff carriers as contaminated as those of CDI patients

A study by Israeli researchers has found that the hospital rooms of asymptomatic Clostridiodes difficile carriers are as contaminated by the bacteria as those of patients with active C difficile infection (CDI).

In the study, published today in Clinical Microbiology and Infection, researchers from Tel Aviv University screened 10 high-touch sites in 117 rooms at a tertiary medical care center in central Israel. Seventy of the rooms were inhabited by C difficile carriers, 30 by active CDI patients, and 17 by non–C difficile carriers (the control group). To assess the level of C difficile contamination in each room, the researchers created a contamination scale that integrated the number of contaminated sites with the overall number of colony-forming units (CFUs) per room.

Of the 1,170 sites screened, C difficile was isolated in 214 (18%). Twenty-nine of the 70 carrier rooms (41%) had more than residual contamination, of which 17 (24%) were heavily contaminated, while 12 of the 30 CDI patient rooms (40%) had more than residual contamination, with 3 (10%) being heavily contaminated. Only 1 of the 17 control rooms (6%) had more than residual contamination, and none were heavily contaminated. The most heavily contaminated sites in carrier and CDI patient rooms were the floors.

A multivariate analysis to determine whether C difficile carriers are independently associated with higher environmental contamination found that the contamination score of rooms inhabited by carriers (odds ratio, [OR], 12.23; 95% confidence interval [CI], 1.5 to 99.6) did not differ from those inhabited by CDI patients (OR, 11.16; 95% CI, 1.19 to 104.49), but both were significantly more contaminated than those of non-carriers.

The authors say the study suggests unidentified C difficile carriers could be a major reservoir for C difficile transmission in hospitals, and adds to the accumulating data supporting the need to screen asymptomatic patients, identify carriers, and treat them similarly to CDI patients.  
Jan 3 Clin Microbiol Infect abstract


New clindamycin-resistant C difficile strain identified VA patients

Originally published by CIDRAP News Dec 30

A surveillance study of patients in a Veterans Administration (VA) long-term care facility and its affiliated acute care hospital detected the clonal outbreak of a newly recognized C difficile strain, researchers reported yesterday in Emerging Infectious Diseases.

The strain, which was detected in 15 patients at the Louis Stokes VA Hospital in Cleveland, was identified as restriction endonuclease analysis (REA) group DQ, ribotype (RT)591, and is closely related to the epidemic BI/RT027 strain associated with numerous healthcare facility outbreaks and an increasing number of illnesses and deaths. Whole-genome sequencing and multi-locus sequence typing (MLST) showed that the strains share several genetic and phenotypic characteristics and reside in the same clade (MLST 2), but form a separate cluster.

Antimicrobials susceptibility testing of the DQ/RT591 isolates revealed high-level resistance to clindamycin and azithromycin. The seven C difficile infections caused by DQ/RT591 were healthcare associated, and all patients in whom DQ/RT591 was confirmed had received antibiotics within 90 days before testing. DQ/RT591 did not appear to carry the same level of severity that BI/RT027 has exhibited.

"Because REA DQ/RT591 is closely related to BI/RT027, further monitoring is required to determine whether this strain carries increased risk for illness and death or has the capability of widespread dissemination," the authors of the study write.
Dec 29 Emerg Infect Dis study


Study: Empiric fluoroquinolones effective against bloodstream infections

Originally published by CIDRAP News Dec 30

A study conducted at a hospital in South Carolina has found that, in the absence of antibiotic resistance risk factors, empirical fluoroquinolones were as effective as broad-spectrum beta-lactams for treating gram-negative bloodstream infections (GN-BSIs), researchers reported late last week in the Journal of Global Antimicrobial Resistance.

In the retrospective, 1:2 matched cohort study, researchers from the University of South Carolina examined clinical outcomes in adults without risk factors for antibiotic resistance who were hospitalized with GN-BSIs and treated empirically with either fluoroquinolones (74 patients) or broad-spectrum beta-lactams (148 patients). The primary outcomes studied were early treatment failure at 72 to 96 hours, 28-day mortality, and hospital length of stay.

Early treatment failure rates were comparable in the fluoroquinolone and broad-spectrum beta-lactam groups (27% vs 30%, respectively; odds ratio, 0.82; 95% CI, 0.43 to 1.54; P = .53), as were 28-day mortality rates (8.9% vs 9.7%, respectively; hazard ratio [HR], 0.74; 95% CI, 0.26 to 1.90; P = 0.54). The median hospital length of stay was 6.1 days in the fluoroquinolone group and 7.1 days in the broad-spectrum beta-lactam group (HR, 0.73; 95% CI, 0.54 to 0.99; P = 0.04).

Transition from intravenous to oral therapy also occurred earlier in the fluoroquinolone group (3.0 vs 4.9 days, P < 0.001). The researchers suggest the earlier transition to oral therapy for fluoroquinolone patients may be the reason for the shorter hospital stays. 
Dec 27 J Glob Antimicrob Resist abstract

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