Stewardship / Resistance Scan for Oct 27, 2020

C diff guidelines for low-income countries
COVID-19 antibiotic stewardship

Panel issues C difficile guidance for low- and middle-income countries

A panel of experts convened by the International Society for Infectious Diseases (ISID) has released a set of recommendations for preventing Clostridioides difficile infections in hospitals in low- and middle-income countries (LMICs).

While epidemiologic studies suggest that the prevalence of C difficile in LMICs is similar to that in higher income countries and may be even higher, existing guidelines for control and prevention of the pathogen in healthcare settings do not specifically address LMICs and the challenges they might face due to insufficient testing capability and overcrowded healthcare facilities. The panel was convened by ISID to address some of these challenges and make evidence-based recommendations for infection prevention that are broadly applicable.

The recommendations, published yesterday in the International Journal of Infectious Diseases, acknowledge that resource-limited settings face distinct challenges in diagnosing and preventing C difficile. The panel recommends that diagnosis of C difficile only be pursued in symptomatic patients with clinical evidence of infection, that surveillance for C difficile infections be conducted to understand local burden and epidemiology, and that hand hygiene following the World Health Organization's 5 Moments of Hand Hygiene be performed.

Other core recommendations from the panel include isolation of patients who have C difficile infection, use of gowns and gloves for care of infected patients, daily cleaning of high-touch hospital surfaces, cleaning of shared medical equipment after each use, terminal cleaning of patient rooms upon discharge, and implementation of antimicrobial stewardship programs to limit unnecessary use of antibiotics.

"The recommendations for C. difficile prevention outlined here support a tailored approach that acknowledges local resources and needs," the authors write. "Individual components of a C. difficile prevention bundle remain valuable in isolation, and should be pursued aggressively even if other components are not feasible to implement in a given setting."
Oct 26 Int J Infect Dis paper


Multispecialty clinical teams tied to less antibiotic use in COVID-19 patients

Implementation of a multispecialty COVID-19 clinical guidance team helped a Tennessee hospital reduce antibiotic use in COVID-19 patients following an initial increase, researchers reported yesterday in Infection Control and Hospital Epidemiology.

In an observational study conducted at Vanderbilt University Medical Center in Nashville, the researchers examined weekly antibiotic use among internal medicine (IM) and medical intensive care unit (MICU) teams treating COVID-19 patients at the hospital and those treating non-COVID-19 patients.

They looked at three different periods: a pre-COVID period (Dec 1, 2019, to Feb 29, 2020) and two post-COVID periods (Mar 1 to Mar 22 and Mar 22 to May 15). The initial post-COVID period started a week after the first confirmed COVID-19 patient in Tennessee, and the second started with the implementation of the COVID-19 clinical guidance team, which included infectious disease physicians with antibiotic stewardship experience who made case-by-case antibiotic recommendations.

When compared with the pre-COVID period, the IM COVID team had an initial increase in weekly antibiotic use of 145.3 days of therapy (DOT) per 1,000 days in the first post-COVID period, and the MICU COVID team had an increase of 204 DOT/1,000 days, compared with non-COVID IM and MICU teams. In the second post-COVID period, the IM and MICU COVID teams saw significant weekly decreases in antibiotic use of 362.3 DOT/1,000 days and 226.3 DOT/1,000 days, respectively. Of the 131 COVID-19 patients treated at the hospital from Mar 1 to May 15, 65.5% received antibiotics.

"This study is the first to describe significant reductions in team-based AU [antibiotic use] after COVID-19 in the context of an institutional systems-based approach, utilizing infectious diseases and stewardship guidance for COVID-19 providers," the authors wrote. "This may be a strategy to mitigate unnecessary AU and optimize COVID-19 patient care moving forward."
Oct 26 Infect Control Hosp Epidemiol abstract

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