Stewardship / Resistance Scan for Jun 30, 2022

Resistant E coli in UK retail meat
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Cost of carbapenem-resistant infections

UK report finds low level of resistant E coli in beef, pork

A report yesterday from the United Kingdom's Food Standards Agency (FSA) shows that that the prevalence of antibiotic-resistant Escherichia coli in retail beef and pork samples remains low.

The survey of E coli in retail meat analyzed 105 beef and 105 pork samples sold in stores in England, Scotland, Wales, and Northern Ireland for resistance to 20 antibiotics and for the presence of extended-spectrum beta-lactamase (ESBL) and AmpC enzymes, which mediate resistance to third-generation cephalosporin antibiotics and are carried on mobile genes that can be transferred to other bacteria. Commensal bacteria like E coli can be a reservoir for these genes; yearly surveys of E coli in retail meat have been conducted in the United Kingdom since 2015.

The analysis revealed that one beef sample (0.95%) and four pork samples (3.81%) were positive for ESBL- and/or AmpC-producing E coli. None of the five samples were resistant to the three carbapenem antibiotics tested, or to the last-resort antibiotic colistin. The report also notes that none of the meat samples prior to bacterial enrichment had "background" AmpC- or ESBL-phenotype E coli counts above European Union (EU) detection levels, which indicates there were low numbers of these bacteria on the samples.

The results are similar to surveys conducted in 2015, 2017, and 2019, the FSA said, and compare favorably to results from EU countries.
Jun 29 FSA surveillance report

 

Carbapenem-resistant infections linked to higher costs, longer hospital stays

A study of hospitalized patients in Japan found that carbapenem-resistant infections were associated with higher costs and longer hospital stays than carbapenem-susceptible infections, researchers reported yesterday in BMC Infectious Diseases.

Using data from electronic medical records of patients treated at 55 Japanese hospitals from April 2016 through March 2020, researchers estimated the impact of carbapenem resistance on cost, length of hospital stay, and in-hospital mortality in patients diagnosed with pneumonia, urinary tract infection, biliary infection, and sepsis. Among 9,517 patients included in the study, 86 (0.9%) had carbapenem-resistant (CR) infections and 9,431 had carbapenem-susceptible (CS) infections.

Compared to CS infections, the patients with the CR infections were significantly more likely to receive mechanical ventilation (37.2% vs 21.2%), antibiotics (88.4% vs 63.0%), and carbapenem antibiotics (31.4% vs 8.3%) before the bacterial culture test. CR infections also had significantly higher costs (measured in US dollars) than CS infections in the categories of medications ($3,477 vs $1,609), laboratory tests ($2,498 vs $1,845), and hospital stay ($14,307 vs $10,560).

In a multivariable regression analysis, the length of stay was 42.1% longer and the cost was 50.4% higher in the CR infections than in the CS infections. The risk of in-hospital mortality did not differ between the two groups (odds ratio ,1.24; 95% confidence interval [CI], 0.72 to 2.11), due to the small sample size. A propensity score analysis using the inverse probability treatment weighting method produced similar results.

The study authors note that patients with longer hospital stays are more likely to experience inappropriate antibiotic use, which may increase the chance for CR bacteria to emerge and in turn prolong hospitalization and increase costs.

"Our results suggest that reducing unnecessary hospital stays and using antimicrobial agents appropriately are rational ways to reduce the incidence of carbapenem-resistant organisms, control costs, and shorten hospital stays," they wrote.
Jun 29 BMC Infect Dis study

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