Stewardship / Resistance Scan for Mar 19, 2020

Antibiotic allergies in Aussie nursing homes
Drug for recurrent C diff

Study: Antibiotic allergies prevalent in Australian nursing homes

A study today in Infection Control & Hospital Epidemiology reports a high prevalence of antibiotic allergy labels (AALs) in Australian nursing homes.

In a point-prevalence survey conducted in 407 Australian aged-care facilities on a single day from Jun 1, 2018 through Aug 31, 2018, a team of Australian researchers found that among 1,489 residents prescribed an antibiotic, 24% (356) had one or more documented AALs. The most common AAL was for penicillin (28.3%), followed by amoxicillin or amoxicillin/clavulanic acid (10.5%), cefalexin (7.2%), and trimethoprim (7.0%).

The presence of an AAL was associated with significantly less prescribing of penicillins (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.31 to 0.62, P < .001) and significantly more prescribing of lincosamides (OR, 4.81), macrolides (OR, 2.03), and tetracyclines (OR, 1.54). Seven residents (1.9%) were prescribed an antibiotic that was listed on the allergy section of their health record.

The authors of the study say the observed prevalence is high compared with similar reports for Australian hospital patients, which have reported AAL rates of 14% to 24%. They're particularly concerned about the increased use of lincosamides, macrolides, and tetracyclines among nursing home residents, since these broad-spectrum antibiotics contribute to increased risk of Clostridioides difficile infection (CDI) and infections caused by antibiotic-resistant pathogens.

"Future studies must evaluate the impact of prescribing second-line agents and the benefits of developing and implementing AAL delabelling programs tailored to aged-care settings," they write.
Mar 19 Infect Control Hosp Epidemiol abstract


Bezlotoxumab shows high efficacy against recurrent C diff

The results of a multicenter study show that bezlotoxumab had a success rate of more than 84% in preventing recurrent CDI (rCDI), US researchers reported today in Open Forum Infectious Diseases.

The retrospective study evaluated the records of 200 patients who received infusions of bezlotoxumab, a human monoclonal antibody, in combination with standard of care (SoC) antibiotics at 34 US infusion centers from April 2017 through December 2018.

While two large phase 3 clinical trials (MODIFY I and II) found that patients treated with bezlotoxumab and SoC therapy had a significantly lower rate of rCDI at 12 weeks, validation of these results in real-world settings is limited. In this study, investigators assessed rCDI at 90 days post-infusion.

Of the 200 patients, 173 (86%) had prior CDI episodes, and 79% had more than two risk factors for rCDI. SoC antibiotics included vancomycin (137, 68%), fidaxomicin (60, 30%), and metronidazole (3, 2%), all prescribed in combination with bezlotxoumab.

The median time intervals from positive C difficile test to bezlotoxumab and initiation of SoC to bezlotoxumab were 15 days and 11 days, respectively. Within 90 days, 31 of 195 patients (15.9%) experienced rCDI, corresponding to a success rate of 84.1%. Patients with two or more CDI recurrences before infusion had a higher risk of rCDI than those who had one recurrence or primary CDI (hazard ratio, 2.77; 95% CI, 1.14 to 6.76, P = 0.025).

The authors note that the findings of their rCDI study were comparable with those reported in the MODIFY trials, despite the presence of a sicker, higher-risk population with an extensive CDI history.

The study was funded by Merck & Co., which owns the license for bezlotoxumab.
Mar 19 Open Forum Infect Dis abstract

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