ASP Scan (Weekly) for Jul 22, 2022

McDonald's antibiotic shift
;
Rapid antimicrobial susceptibility test
;
Saudi antibiotic overprescribing
;
Drug-resistant STIs in travelers

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

Groups say McDonald's is 'backtracking' on antibiotic commitment

A coalition of public interest, animal welfare, and environmental groups is criticizing McDonald's for backing away from a commitment to reduce the use of medically important antibiotics in its beef supply chain.

In a statement released yesterday, the Antibiotics Off the Menu coalition noted that the company's updated antibiotic policy for beef and dairy beef moves away from setting any concrete targets for the reduction of medically important antibiotics by suppliers in the 10 countries (Australia, New Zealand, France, Germany, Ireland, Poland, United Kingdom, Canada, United States, and Brazil) that supply most of its beef. In December 2018, McDonald's pledged that it would establish antibiotic reduction targets for beef suppliers in those countries by the end of 2020—a pledge it has yet to meet.  

The company now says that, after conducting pilot tests in those countries, it will collaborate with industry leaders, academics, suppliers, and experts to establish market-appropriate targets for responsible use of medically important antibiotics.

"McDonald's showed leadership in 2018 with a commitment to reduce antibiotics across its massive beef supply chain," the group said. "Disappointingly, it's clear that the company is backtracking on its commitment. By switching from targets for 'reducing use' to targets for 'responsible use,' McDonald's stopped leading and began following, because their latest approach leaves ample room for business as usual practices to continue."

McDonald's says its focus is on refining antibiotic selection and administration, reducing non-therapeutic antibiotic use, and, when possible, replacing antibiotics with "long-term solutions to proactively prevent disease and protect animal health and welfare."
Jul 21 Antibiotics Off the Menu statement

 

Rapid susceptibility test shortens time to oral antibiotics, hospital stay

A randomized clinical trial found that a rapid phenotypic antimicrobial susceptibility test for patients with gram-negative bloodstream infections decreased the time to oral antibiotics and the length of hospitalization, researchers reported today in Open Forum Infectious Diseases.

In the trial, which was conducted at two medical centers in Portland, Oregon, investigators randomly assigned positive blood cultures from 247 patients who had gram-negative bloodstream infections to undergo a rapid antimicrobial susceptibility test (rAST) or a conventional AST (cAST). The primary outcome was time to narrowest effective antibiotic therapy, and secondary outcomes included time to susceptibility results, time to oral therapy, and length of stay (LOS) in the hospital.

Among the 205 patients included in the analysis, time to susceptibility results was 23 hours shorter in the rAST group than in the cAST group (39 hours vs 62 hours), but the median time to the narrowest effective antibiotic therapy was not significantly different between the two groups (64 hours [rAST] vs 73 hours [cAST]), except in a subgroup analysis that excluded patients who were already on the narrowest therapy. But significant decreases were observed in the time to oral therapy (91 hours [rAST] vs 126 hours [cAST]) and median LOS (5 days [rAST] vs 7 days [cAST]). The investigators say the reduction in LOS resulted in an approximate $1.2 million cost-avoidance in the rAST group.

The study authors conclude that faster AST reporting, particularly in the context of an antimicrobial stewardship program, has the potential to facilitate early transitions to oral therapy and early discharge.
Jul 22 Open Forum Infect Dis abstract

 

Study spotlights overuse of broader-spectrum antibiotics in Saudi Arabia

Originally published by CIDRAP News Jul 20

An analysis of dental and pediatric primary care practices in Saudi Arabia found higher prescribing of broader-spectrum antibiotics and poor adherence to antibiotic prescribing guidelines, researchers reported yesterday in the American Journal of Infection Control.

The retrospective cross-sectional study, conducted from May through November 2020 at 24 primary healthcare centers in Saudi Arabia, assessed antibiotic prescribing patterns at family medicine and dental practices using the World Health Organization AWaRe (Access, Watch and Reserve) classification system and relevant clinical guidelines. The researchers also identified factors associated with the choice of Watch-group antibiotics, which are broader-spectrum agents with a higher resistance potential.

Of the 752 antibiotic prescriptions assessed, 84% were prescribed by general practitioners and 16% by dentists, most commonly for urinary tract (12.8%) and acute respiratory tract (12.2%) infections. Compared with Access-group antibiotics, Watch-group antibiotics such as second-generation cephalosporins and macrolides were more likely to be prescribed based on the number of prescriptions (51.1% vs 48.9%) and defined daily doses (DDDs) (52.2% vs 47.8%).

The percentages of Watch-group antibiotics for children and adults were 66.7% and 42.9%, respectively. The overall adherence to clinical prescribing guidelines for children, adults, and total prescribed antibiotics was 27.2%, 64%, and 49.5%, respectively, with dental clinics demonstrating better adherence than general practices.

Multivariable logistic regression analysis found that being a child (adjusted odds ratio, [aOR], 2.89; 95% confidence interval [CI], 1.46 to 5.78), diagnosis with acute respiratory tract infection (aOR, 2.62; 95% CI, 1.03 to 6.69), and urinary tract infection (aOR, 4.69; 95% CI, 2.09 to 10.56) were associated with higher prescribing of Watch-group antibiotics.

The study authors say the findings indicate national guidelines on antibiotic use are needed in Saudi Arabia, along with a surveillance system to track antibiotic use at the national level.

"The higher proportion of prescribing of Watch-group antibiotics in this study for both children and adults is a warning sign that may reflect inappropriate awareness of the optimum antibiotic selection as well as poor adherence to guidelines," they wrote. "This result may lead to a potential increase in bacterial resistance and overuse of broad-spectrum antibiotics, which consequently increases costs and the likelihood of adverse drug reactions or lowered therapy outcomes."
Jul 19 Am J Infect Control abstract

 

International travel linked to spread of multidrug-resistant STIs

Originally published by CIDRAP News Jul 18

International travel may play a critical role in the spread of multidrug-resistant (MDR) sexually transmitted infections (STIs), according to a study published late last week in Travel Medicine and Infectious Disease.

In a systematic review and meta-analysis of studies on gonococcal infection, antibiotic resistance, and international travel that were published from 2010 to 2021, a team of Spanish researchers found that 16 of 18 studies described a probable link between international travel and transmission of MDR Neisseria gonorrhoeae from the country of travel to the country of return, as the index cases reported unprotected sexual intercourse at their place of destination. Travelers mainly visited Southeast Asian countries (66.7%) and returned to the United Kingdom (38.9%).

Half of the studies (9) reported N gonorrhoeae strains with resistance to ciprofloxacin, while 7 described cephalosporin resistant and 4 described decreased sensitivity to penicillin and azithromycin. The most frequently prescribed antibiotic for treatment was ceftriaxone.

The meta-analysis also found that men in their 30s are more likely to be infected by an MDR STI.

"As no vaccinations are currently available for these infections, sexual education should therefore play an important role in the routine pre-travel consultation," the study authors concluded. "Returned travelers who present with gonococcal infection should be screened for antibiotic resistance to avoid transmitting drug-resistant pathogens to other worldwide locations."
Jul 16 Travel Med Infect Dis abstract

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