Stewardship / Resistance Scan for Apr 07, 2021

European AMR declaration
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Antibiotic use on UK organic farms
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VA stewardship intervention

European health groups release antimicrobial resistance declaration

Health First Europe (HFE) and the European Patient Group on Antimicrobial Resistance (AMR Patient Group) today launched their 2021 Declaration on AMR.

The document aims to raise awareness among European citizens about the real-world impact of AMR and healthcare-associated infections (HAIs) and to encourage patients to speak out. It also lists a range of interventions that European Union (EU) policymakers and national governments should make to address AMR from a One Health perspective.

"Drug-resistant infections know no borders—they can easily cross from humans to animals and spread from one geographic location to another," the declaration states.

The groups call for EU policymakers and member states to increase awareness and understanding of AMR and HAIs among health professionals through communication, education, and training; establish clear governance arrangements at all levels to ensure leadership, accountability, and coordination around the issue; improve infection prevention and control measures in human and animal healthcare settings; create national targets for surveillance of antibiotic use in humans and animals; and implement antibiotic stewardship programs in primary and secondary care settings.

The document also recommends that governments invest in and promote medical technologies that prevent AMR and HAIs, promote equitable access to appropriate treatments, and support activities that raise public awareness of antibiotic resistance.

The groups are inviting other European patient associations to promote the declaration.
Apr 7 HFE-AMR Patient Group declaration on AMR

 

Antibiotic use is significantly lower on UK organic farms

A survey published yesterday by the UK-based Alliance to Save Our Antibiotics and the Soil Association indicates that antibiotic use on organic livestock farms in the United Kingdom is much lower than the national average for all livestock farming.

The survey, involving data from 248 organic farms certified by the Soil Association, found that overall antibiotic use in animals on those farms (7.46 milligrams per population correction unit [mg/pcu]) was four times lower than the national average of 31 mg/pcu. On organic dairy farms, the average was less than half the level found in a national survey of dairy farms (10.66 mg/pcu vs 22.5 mg/pcu), while organic beef farms used less than a third of the antibiotics found in a national survey of beef farms (7.22 mg/pcu vs 24.5 mg/pcu).

Significantly lower antibiotic use was also found on organic sheep (five times lower), pig (77 times lower), and poultry farms (six times lower in broiler chickens), but the small sample sizes for pig and poultry farms make those figures less reliable, the report notes. Antibiotic use varied widely among the farms in the survey.

Interviews with organic farmers revealed that organic rules on antibiotic use in livestock, good nutrition, a low-stress environment, breeding specifically for health traits, and minimizing the period when animals are kept indoors during the winter were among the factors that kept antibiotic use low on their farms.

"British farmers have voluntarily cut their antibiotic use by nearly 50% in the last five years, which is very welcome, but these findings show that much lower use could still be achieved," Alliance scientific adviser Cóilín Nunan said in a press release from the group. "Organic farming has stricter rules on antibiotics which do not permit routine use or preventative mass medication. If the government is serious about tackling the antibiotic-resistance crisis, it should immediately move to end these practices on all British livestock farms."
Apr 6 Alliance to Save Our Antibiotics survey
Apr 6 Alliance to Save Our Antibiotics press release

 

Stewardship intervention linked to reduced fluoroquinolone use

Cascade reporting at a Veterans Affairs (VA) medical center in Virginia was associated with a significant decline in ciprofloxacin consumption, researchers reported yesterday in Infection Control & Hospital Epidemiology.

Cascade reporting is a strategy of only reporting antimicrobial susceptibility results for secondary, broad-spectrum agents if an organism is resistant to primary, narrow-spectrum antibiotics. The strategy, which aims to reduce unnecessary use of broad-spectrum antibiotics, was implemented at the Hunter Homes McGuire VA Medical Center in 2018 to reduce inappropriate fluoroquinolone and carbapenem use. To determine the strategy's effectiveness, researchers collected antibiotic consumption data across eight inpatient units for the 12 months before and after implementation (April 2017 through March 2019).

An interrupted time series analysis showed that consumption of ciprofloxacin, a fluoroquinolone, fell by 2.16 days of therapy per 1,000 days present per month after implementation of cascade reporting, but no significant change in levofloxacin consumption was observed. Mean monthly meropenem consumption also declined, but the slope of consumption did not significantly change, a result the study authors suggest could reflect the hospital's restriction on meropenem use during the study period. No significant changes in hospital-onset Clostridioides difficile infection rates were observed.

"Cascade reporting is a valuable tool that ASPs [antibiotic stewardship programs] can deploy to encourage prescribers to select more narrow-spectrum antimicrobial agents," the authors wrote. "Further investigation is warranted to determine how cascade reporting strategies affect rates of C. difficile, antimicrobial resistance, and clinical outcomes."
Apr 6 Infect Control Hosp Epidemiol abstract

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