ASP Scan (Weekly) for Nov 19, 2021

Decline in European antibiotic use
Trends in Staph bloodstream infections
Joint statement on antibiotic resistance
UK antibiotic use, resistance report
Scottish antibiotic stewardship
African antibiotic treatment guidelines
Antibiotic Rx in UK amid COVID
Appropriate antibiotic treatment for pneumonia

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

European data show big drop in antibiotic use during the pandemic

New data from the European Centre for Diseases Prevention and Control (ECDC) show a dramatic drop in community antibiotic use across Europe during the first year of the COVID-19 pandemic.

In a report published yesterday in Eurosurveillance, ECDC researchers looked at data reported to the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) by 27 European Union/European Economic Activity (EU/EEA) countries and found that overall community antibiotic consumption fell by 18.3% from 2019 to 2020—the largest annual decline in ESAC-Net's two-decade history. By comparison, community antibiotic use fell by only 1.8% per year from 2016 to 2019.

The largest decreases were observed for penicillins, followed by other beta-lactam antibiotics, including macrolides, cephalosporins, lincosamides, and streptogramins. Only 1 of the 27 countries—Bulgaria—reported an increase in community antibiotic use from 2019 to 2020.

Although the reasons for the dramatic decline are unclear, the authors suggest it's likely related to the low-incidence of non-COVID respiratory infections in 2020, which in turn is linked to COVID-19 mitigation measures, including physical distancing, masking, and hand hygiene. In addition, reduced access to primary care may have resulted in fewer antibiotic prescriptions.

Another ECDC surveillance report, also based on ESAC-Net data, found a significant, though not as dramatic, decline in hospital antibiotic consumption, which fell by 4.5% from 2019 to 2020. Combined hospital and community antibiotic use fell by 17.6%.

EU officials cautioned, however, that resistance rates for pathogens like Escherichia coli and Klebsiella pneumoniae continue to rise, and that countries will need to remain focused on antibiotic stewardship once the pandemic ends.

"Antimicrobial resistance remains a serious challenge globally," Stella Kyriakides, EU Commissioner for Health and Food Safety, said in an ECDC press release. "Antimicrobial resistance is a silent pandemic that is happening here and now. Although antibiotic consumption generally decreased during the pandemic in the EU/EEA, we must increase our public health response."
Nov 18 Eurosurveill rapid communication
Nov 18 ECDC surveillance report
Nov 18 ECDC press release


Staphylococcus bloodstream infections rising in Europe, study finds

In another surveillance study published yesterday in Eurosurveillance, European researchers reported a significant increase across the continent in Staphylococcus aureus bloodstream infections (BSIs), despite a decline in BSIs caused by methicillin-resistant S aureus (MRSA).

The analysis of data from the European Antimicrobial Resistance Surveillance Network (EARS-Net) for 2005 through 2018 found that, in the 25 EU/EEA countries that consistently reported data on S aureus BSIs, the proportion of BSIs caused by MRSA declined from 30.2% in 2005 to 16.3% in 2018. The percentage of MRSA BSIs declined across all age-groups.

During the same period, however, the total number of S aureus BSIs increased by 57%, driven by an 84% increase in BSIs caused by methicillin-susceptible S aureus (MSSA). The number of MRSA BSIs fell by 31%.

The study authors suggest the increase in S aureus BSIs could by linked to an aging population and the increased risk of infection among elderly patients, although they note that aging cannot alone explain the dramatic increase. They say the findings also indicate the possible increasing role of MSSA as a healthcare-associated pathogen.

"This increasing trend in the number of MSSA BSI in the EU/EEA needs further attention since MSSA BSI have high case fatality rates and there are still issues regarding their optimal treatment," they wrote. "Further studies at local, national, or supranational level, based on different data sources, are necessary to answer the questions raised by our results, in particular to identify all the factors associated with the described trends in MSSA and MRSA BSI."
Nov 18 Eurosurveill study


G7 governments urged to do more to boost antibiotic development

Originally published by CIDRAP News Nov 17

A coalition of organizations from academia, healthcare, and the pharmaceutical industry sent a letter today to G7 governments calling for greater engagement in tackling antimicrobial resistance (AMR) and boosting the pipeline for new antibiotics.

The joint statement, issued ahead of World Antimicrobial Awareness Week, calls on G7 governments to explore a range of options, in collaboration with the private sector, to strengthen the antibiotic research and development pipeline from beginning to end. That includes support for basic research, funding to help companies transition from early-stage trials to late-stage clinical development, and development of financial pull incentives to ensure investment into innovative new antibiotics is rewarded.

The signatories, including the AMR Action Fund and the Global Antibiotic Research & Development Partnership, also call on G7 governments to develop new reimbursement models for novel antibiotics for drug-resistant infections to help ensure that patients in all countries have fast access to them, and to capitalize on the potential of vaccines to protect against infections and reduce the need for antibiotics.

"Only if we set these recommendations into immediate action, we will be able to build an innovative and sustainable ecosystem to effectively fight AMR," the groups said in the statement.
Nov 17 joint statement


UK report shows drop in antibiotic-resistant bloodstream infections

Originally published by CIDRAP News Nov 17

A new surveillance report released today by UK health officials shows that the number of antibiotic-resistant BSIs fell in England from 2019 to 2020, a decline that likely reflects the impact of the COVID-19 pandemic and masks the rising burden of resistance.

Data from the eighth annual English Surveillance Programme for Antimicrobial Use and Resistance (ESPAUR) report indicates that the number of antibiotic-resistant BSIs fell from 65,583 in 2019 to 55,384 in 2020, a 15% decline. But that's mainly because the overall incidence of BSIs caused by key bacterial pathogens declined in 2020, led by a 59% decline in Streptococcus pneumoniae BSIs and a 14% reduction in E coli BSIs. The report suggests that decline was due in part to reduced contact between individuals, improved hand hygiene, reduced antibiotic prescribing, and fewer interactions with healthcare during the pandemic.

But the report also shows that among the bacteria that commonly causes BSIs (including E coli and Klebsiella pneumoniae), resistance to several key antibiotics rose from 2016 to 2019 before falling in 2020. And the number of BSIs caused by resistant pathogens rose annually over that period. Even with the 2020 declines, roughly 1 in 5 people with a BSI in 2020 had an antibiotic-resistant infection.

The UK's Health Security Agency says these findings suggest drug-resistant infections will likely climb once the pandemic is over.

"Antimicrobial resistance has been described as a hidden pandemic and it's important that we do not come out of COVID-19 and enter into another crisis," UKHSA chief medical advisor Susan Hopkins, MB BCh, said in a press release.

The ESPAUR report highlighted continuing declines in antibiotic prescribing in English healthcare. From 2016 to 2019, total antibiotic consumption fell by 6.6%, with an additional 10.9% reduction from 2019 to 2020. The greatest decline was observed within the General Practice (GP) setting, where prescribing fell by 10.4% from 2016 to 2019, with a further 9.4% reduction from 2019 to 2020.

Antibiotic use in hospitals, however, increased by 1.9% from 2016 to 2019, with an additional 4.8% increase from 2019 to 2020.
Nov 17 ESPAUR report
Nov 17 UKHSA
 press release


Scottish report shows 5-year decline in human antibiotic use

Originally published by CIDRAP News Nov 16

A report today from Scotland highlights reduced antibiotic use in the country since it adopted a One Health approach to combatting antimicrobial resistance (AMR).

The report, from Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland, shows that total antibiotic use in people was 19.2 defined daily doses per 1,000 population per day in 2020, a 17.1% reduction since 2016. The report notes that the 11.8% reduction from 2019 to 2020 likely reflects the impact of the COVID-19 pandemic, which affected antibiotic use in all healthcare settings.

The vast majority of antibiotic use (84.2%) in Scotland in 2020 occurred in primary care settings, while acute care hospitals accounted for 13.2% and non-acute hospitals for 2.6%. Antibiotic use in primary care fell by 20.9% from 2016 to 2020, but rose by 2.3% in acute care settings, despite a decline in use during the pandemic.

"Access" antibiotics—the antibiotics classified by the World Health Organization (WHO) as first-line treatments for common infections—accounted for 61.2% of all antibiotics used in people in 2020, and 76.8% of all antibiotics dispensed in primary care. Use of Watch and Reserve antibiotics, which are broad-spectrum drugs that the WHO recommends should be restricted to more severe, drug-resistant infections, fell by 10.4% in acute care settings since 2016.

Surveillance data show that gram-negative bacteria continue to be a common cause of serious infections in both healthcare and community settings in Scotland, with Escherichia coli accounting for most drug-resistant infections. Nearly a quarter of E coli bacteremia cases in Scotland in 2020 were resistant to one or more key antibiotics.

On the animal side, the report shows that the percentage of companion animal veterinary consultations that resulted in an antibiotic prescription was 16.2% in 2020, down from 19.2% in 2016. Scotland is still in the process of developing systems to collect data on antibiotic use in livestock.

"Tackling AMR, which has been described as a slow burning pandemic, remains vitally important," the report states. "Sustained action to preserve antibiotics and reduce drug resistant infections is crucial to secure the future delivery of healthcare through and beyond the COVID-19 pandemic."
Nov 16 ARHAI Scotland report


Africa CDC issues antibiotic treatment guidelines for common infections

Originally published by CIDRAP News Nov 16

The Africa Centres for Disease Control and Prevention (Africa CDC) and the Center for Disease Dynamics, Economics & Policy (CDDEP), based in Washington, D.C., last week published the first edition of Africa-specific guidelines for antibiotic treatment of common bacterial infections.

Developed by an interdisciplinary panel of infectious disease clinicians, pharmacists, and public health experts, the guidelines aim to provide African healthcare workers with expert recommendations on antimicrobial selection, dosage, and duration of treatment for common bacterial infections and syndromes in African adults and children. They are designed to promote appropriate use of antimicrobials to limit the spread of drug-resistant pathogens.

They're based on a systematic review of existing national treatment guidelines, available AMR data, and expert opinion, and are intended to complement existing national and international clinical guidelines.

Africa CDC notes that the guidelines fill a long-existing gap. With the exception of infectious diseases like HIV, tuberculosis, and malaria, many countries in Africa lack guidelines that define appropriate treatment for common infections, and healthcare providers often have to rely on their own judgment or guidelines developed outside of Africa.

The agency says it hopes the guidelines serve as a standardized model for other jurisdictions or healthcare facilities in Africa to develop their own guidelines.
Nov 12 African Antibiotic Treatment Guidelines
Nov 12 CDDEP blog post


English study finds less antibiotic prescribing amid pandemic

Originally published by CIDRAP News Nov 15

Antibiotic prescribing in general practice in England fell significantly during the first 12 months of the COVID-19 pandemic compared with the previous year, according to data released last week by Antibiotic Research UK (ANTRUK).

Analysis of prescription data from the England's National Health Service showed that from March 2020 through February 2021, antibiotic prescribing by general practitioners (GPs) declined by 17% compared with the previous 12 months, and the decline occurred in almost all areas of the country. The analysis also found that the rise in antibiotic prescribing that typically occurs in the winter in England was considerably lower for the winter of 2020 to 2021.

While antibiotic prescribing has risen by 21% on average from the summer (June to August) to the winter (December to February) in previous years, antibiotic prescribing from December 2020 to February 2021 only rose by 4%.

"The dramatic fall in antibiotic prescribing during the COVID pandemic could be due to many factors including less infection transmission during lockdowns and fewer visits to GPs," ANTRUK Chief Executive Colin Garner, PhD, said in a press release.

"More work is needed to understand the extent to which each of these factors has resulted in this drop in antibiotic prescribing, but the data does tell us that antibiotic prescribing can be reduced to help protect us all from the danger of the growing threat of antibiotic resistance."
Nov 11 ANTRUK press release


Michigan hospital project tied to shorter antibiotic course for pneumonia

Originally published by CIDRAP News Nov 15

Participation in a prospective collaborative quality initiative (CQI) was associated with more appropriate use of short-course antibiotic therapy for pneumonia, according to a study published last week in Clinical Infectious Diseases.

The study looked at data from a 3-year project undertaken by 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a statewide collaborative quality initiative. The project targeted appropriate 5-day antibiotic treatment for uncomplicated community-acquired pneumonia (CAP), using benchmarking, sharing of best practices, and pay-for-performance metrics.

To evaluate the impact of the program, researchers assessed appropriate receipt of a 5-day antibiotic duration and 30-day post-discharge composite adverse events (mortality, readmission, urgent visit, antibiotic-associated adverse events) for patients with uncomplicated CAP.

Overall, 6,553 patients with uncomplicated CAP were eligible for 5-day treatment at the 41 hospitals from February 2017 through February 2021. Over the study period, the percentage of patients treated with a 5-day course of antibiotics rose from 22.1% to 45.9%. Each quarter was associated with higher odds of receiving an appropriate 5-day course of antibiotics (adjusted odds ratio, [aOR], 1.10; 95% confidence interval [CI], 1.07 to 1.14), for an annual aOR of 1.49 per year.

Thirty-day composite adverse events occurred in 18.5% of patients over the entire study period and decreased over time (aOR, 0.98 per quarter; 95% CI, 0.96 to 0.99) due mainly to a decrease in antibiotic-associated adverse events (aOR, 0.91; 95% CI, 0.87 to 0.95). Mortality, readmission, urgent visits, and Clostridioides difficile infections did not change over time.

The study authors suggest other states and healthcare systems should consider adopting this three-pronged method for improving antibiotic treatment.

"Participation in a stewardship CQI may not only improve antibiotic use, but also patient outcomes," the study authors wrote. "The observation that all hospitals, including small hospitals, benefited from CQI participation suggests that the CQI model could be one way to advance antibiotic stewardship even in small, rural hospitals with fewer resources."
Nov 13 Clin Infect Dis abstract

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