Stewardship / Resistance Scan for Jun 29, 2022

Global decline in animal antimicrobial use
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Excessive antibiotic durations at discharge

Antimicrobial use in animals on the decline globally, new report finds

A new report from the World Organisation for Animal Health (WOAH, formerly OIE) shows global use of antimicrobials in animals fell by 27% from 2016 through 2018.

The sixth annual report on animal antimicrobial use, which focuses on drugs given to animals raised for human consumption and is based on data provided by WOAH member-states, found that, among the 72 nations that provided consistent data (representing 65% of global animal biomass), antimicrobial use fell from 120 milligrams of antimicrobials per kilogram of estimated animal biomass (mg/kg) in 2016 to 88 mg/kg in 2018. The declining trend was observed across all WOAH regions and confirms trends observed on the fifth report.

Analysis of trends by antimicrobial class showed a 21% decline in the use of tetracyclines (the most widely used antimicrobial in food-producing animals), a 43% decline in macrolide use, and a 62% decline in polypeptides. Data provided for 2018 by 109 countries showed that the total amount of antimicrobials intended for use in animals oscillated between 69,445 and 76,704 tons. Bovine species like cattle accounted for 43% of total use, followed by swine (20%), poultry (18%), and aquatic species (8%).

The report also found that, among the 157 countries that provided data for 2020, 108 (69%) no longer use antimicrobials for growth promotion. In addition, progress has been made in phasing out the use of high-priority critically important antimicrobials in animals, such as colistin.

WOAH officials say the data indicate that a growing number of farmers, animal owners, and animal health professionals are adapting their practices to use antimicrobials more judiciously. They note that a new interactive information technology system for data collection, scheduled to be delivered later this year, could help provide more granular data for future reports on global and regional trends and help countries develop national guidance.

"We are on the right track in the animal sector—we must now seize this momentum and continue to use antimicrobials prudently if we want to preserve their efficacy for future generations," WOAH Director-General Monique Eloit, DVM, said in a press release.
Jun 27 WOAH report
Jun 27 WOAH press release

 

Discharged patients may be getting antibiotics longer than necessary

An analysis of patients treated for common infections at an academic medical center found that antibiotics were given for longer than necessary on discharge for multiple conditions, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The retrospective chart review included 300 adult patients discharged from Temple University Hospital who were on oral antibiotics for acute infections from January to March 2019. The infections included community- and hospital-acquired pneumonia, cystitis, pyelonephritis, skin and other soft-tissue infection (SSTI), intra-abdominal infection (IAI), chronic obstructive pulmonary disease exacerbation, bronchitis, and pharyngitis.

The primary outcome was total prescribed duration of antibiotic therapy, compared with the duration recommended by Infectious Diseases Society of America (IDSA) guidelines, the minimum supported by clinical guidelines and trials, and the duration beyond the point of clinical stability.

Of the 300 patients, 171 (57%) were women, and the median age was 59 years; 73% of inpatients received intravenous therapy, 76% received oral antibiotics, and 70% of those prescribed oral antibiotics were transitioned to these patients prior to discharge. The most common antibiotics prescribed were fluoroquinolones (30%), amoxicillin-clavulanate (18%), and azithromycin (18%).

Overall, patients received a median of 8 total days of antibiotics—a median of 2 days of excessive antibiotics compared with IDSA guidelines, 3 days compared with the minimum possible duration based on clinical guidelines and published literature, and 6 days past the point of clinical stability. The most inappropriate prescription durations were seen with SSTI, IAI, and cystitis.

"This finding supports the results from several other studies; despite the growth of data supporting shorter courses of therapy for multiple common infections and the inclusion in clinical guidelines, patients are often prescribed longer courses than clinically indicated," Temple University School of Pharmacy researchers wrote.

The authors said a pilot program targeting transitions of care has been initiated at the hospital to address the problem.
Jun 29 Antimicrob Resist Healthc Epidemiol study

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