Stewardship / Resistance Scan for Jun 13, 2022

Rotavirus vaccine and kids' antibiotic use
MDR-TB treatment in pregnant women
Antibiotic decline in Korea

Study ties rotavirus vaccination to fewer antibiotics for gastroenteritis

A study of data from insured US children found that rotavirus vaccination was associated with reduced antibiotic prescribing for acute gastroenteritis, researchers reported last week in Open Forum Infectious Diseases.

Using data from a large commercial database of people with employer-sponsored health insurance coverage, researchers from Oregon Health and Science University and Emory University School of Medicine constructed a cohort of children born from 2007 through 2018 and followed those children for 5 years. They then estimated the cumulative incidence of antibiotic prescriptions associated with acute gastroenteritis—which is frequently treated with antibiotics even when caused by rotavirus or other viruses—among children who had completed a full rotavirus vaccination series by 8 months and those who had not received any dose of rotavirus vaccine. The investigators adjusted for receipt of pneumococcal vaccine, provider type, and rural/urban status.

Of the 2,136,136 children in the data set, 69.9% completed the rotavirus vaccination series by 8 months, and 15.7% had no rotavirus vaccination. Overall, 17,318 children (1.7%) received an antibiotic following an acute gastroenteritis diagnosis.

At 5 years of age, the adjusted relative cumulative incidence of antibiotic prescription following an acute gastroenteritis diagnosis was 0.793 (95% confidence interval [CI], 0.761 to 0.827) among children with complete rotavirus vaccination compared with children without rotavirus vaccination—or 21% lower. Additionally, the adjusted relative cumulative incidence of receiving a second, unique antibiotic prescription within 28 days was 0.820 (95% CI, 0.750 to 0.905), or 18% lower.

Using annual US trends in rotavirus vaccination, the researchers estimated that rotavirus vaccination has averted 67,045 antibiotic prescriptions nationally among children born from 2007 through 2018.

"These results demonstrate an additional important, non-targeted benefit of rotavirus vaccination and bolster evidence for the use of rotavirus vaccines for reducing antibiotic prescribing for acute gastroenteritis," the study authors wrote. "The reduction of antibiotic prescribing likely contributes to the broader effort of reducing antimicrobial resistance. Thus, increasing rotavirus vaccination coverage should be encouraged both for its intended and non-targeted effects."
Jun 9 Open Forum Infect Dis abstract


Encouraging results found for MDR-TB treatment in pregnant women

A systematic review and analysis of studies on pregnant women with multidrug-resistant tuberculosis (MDR-TB) found some encouraging results, researchers reported late last week in JAMA Network Open.

A total of 10 studies containing 275 pregnant patients with available data were reviewed by a team of researchers from Australia, Ethiopia, and the United States to quantify treatment and pregnancy outcomes among pregnant women with MDR-TB, who currently have limited treatment options because of the potential harmful effects that second-line TB drugs can have on embryonic and fetal development. Their meta-analysis found that the pooled estimate was 72.5% (95% CI, 63.3% to 81.0%) for treatment success, 6.8% (95% CI, 2.6% to 14.2%) for death, 18.4% (95% CI, 13.1% to 24.2%) for loss to follow-up, and 0.6% (95% CI, 0.0% to 2.9%) for treatment failure.

Treatment success was significantly higher in studies in which the proportion of patients taking linezolid was greater than the median (20.1%) compared with studies in which this proportion was lower than the median (odds ratio, 1.22; 95% CI, 1.05 to 1.42). More than half of patients (54.7%; 95% CI, 43.5% to 65.4%) experienced at least one adverse event, most commonly liver function impairment, kidney function impairment, and hearing loss.

The pooled proportion of favorable pregnancy outcomes was 73.2% (95% CI, 49.4% to 92.1%). The most common types of adverse pregnancy outcomes were preterm birth (9.5%; 95% CI, 0.0% to 29.0%), pregnancy loss (6.0%; 95% CI, 1.3% to 12.9%), low birth weight (3.9%; 95% CI, 0.0% to 18.7%), and stillbirth (1.9%; 95% CI, 0.1% to 5.1%).

The study authors note that the treatment success rate of 72.5% is close to the World Health Organization's target of 75%, and higher than that found among non-pregnant adults with MDR-TB in previous studies (60% to 69%). They suggest that increasing use of recently recommended novel drugs like linezolid, bedaquiline, and pretomanid among pregnant women with MDR-TB could further improve the treatment success rate.

"Given the limited drug options available to treat individuals with MDR-TB, especially pregnant patients, the high proportion of patients with treatment success in our study compared with previously reported findings in the general adult population is encouraging," they wrote.
Jun 10 JAMA Netw Open study


Antibiotic use fell in South Korea after national action plan

An analysis of health insurance claims data in South Korea found a decline in overall antibiotic use after implementation of a national action plan (NAP) on antimicrobial resistance (AMR), researchers reported yesterday in the International Journal of Infectious Diseases.

For the retrospective, population-based study, researchers looked at data from the Korean National Health Insurance claims database from 2011 to 2020. South Korea established its first NAP on AMR in 2016, and it included guidelines for antibiotic use for several types of infection and stronger monitoring of antibiotic use. Total antibiotic consumption over the study period, both inpatient and outpatient, was measured using defined daily doses per 1,000 inhabitants per day (DID), and data were analyzed for each year, dimension, and category of the WHO's AWaRe (Access, Watch, and Reserve) antibiotic classification system.

Overall, the consumption of antibiotics increased from 25.78 DID in 2011 to 28.02 DID in 2016, then decreased in 2017 following the implementation of the NAP on AMR and fell to 26.35 DID in 2019.

Consumption of Access antibiotics increased from 12.51 DID in 2011 to 13.83 in 2016, followed by a decrease in 2017. In the Watch group, antibiotic use continuously increased over the study period, from 13.24 DID in 2011 to 15.69 DID in 2019, while the Reserve group showed a small downward trend beginning in 2017. Analysis of the most frequently used antibiotics found that, after implementation of the NAP, use of amoxicillin and beta-lactamase inhibitors fell from 7.18 DID in 2016 to 4.84 DID in 2017 , use of ciprofloxacin fell from 0.81 DID to 0.7 DID, and consumption of levofloxacin declined from 0.81 DID to 0.65 DID.

An interrupted time series analysis showed that the level and the slope of the trend of total antibiotic use decreased by 0.17 and 0.001, respectively.

The study authors say the findings are in line with similar studies in Japan and Italy, and suggest the NAP could further cut antibiotic use in South Korea by improving the understanding and awareness of AMR, strengthening AMR surveillance and research, and optimizing the use of antimicrobials.
Jun 12 Int J Infect Dis study

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