Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
CDC study finds no change in C diff rates during COVID-19 pandemic
A study by Centers for Disease Control and Prevention researchers found that, despite changes in infection control practices, antibiotic use, and healthcare delivery during the first year of the COVID-19 pandemic, Clostridioides difficile infection rates did not change. The findings were published yesterday in Infection Control & Hospital Epidemiology.
Using adult and pediatric inpatient records from 775 hospitals in the Premier Healthcare Database, the researchers estimated monthly incidence rates of hospital-onset C difficile (HO-CDI) per 10,000 patient-days (PD), community-onset CDI (CO-CDI) per 10,000 discharges, and C difficile testing rates per 10,000 discharges from January 2019 through December 2020, comparing monthly differences of the rates between years. They used an interrupted time series (ITS) design to describe level and trend changes in rates and percent positivity before and after the pandemic began on March 2020.
During the study period, 47,658 inpatients were diagnosed as having CDI, with CO-CDI representing 55% of all incident cases. In pairwise comparisons, overall CO-CDI rates decreased from 20.0 to 15.8 cases per 10,000 discharges from 2019 to 2020, but rates of HO-CDI per 10,000 PD were similar (3.3 in 2019 and 3.2 in 2020).
Using ITS, the researchers detected decreasing monthly trends in CO-CDI (−1% per month, P = .0036) and HO-CDI incidence (−1% per month, P < .0001) during the baseline period, prior to the COVID-19 pandemic declaration. But they detected no change in monthly trends for CO-CDI or HO-CDI incidence or percent positivity after March 2020 compared with the baseline period.
"Given the significant morbidity and mortality associated with CDI and the burden in US hospitals, ongoing monitoring of the trends in CDI as healthcare delivery returns to prepandemic levels is important to inform hospital antibiotic stewardship and infection control programs," the study authors concluded.
May 19 Infect Control Hosp Epidemiol abstract
College campus health providers report pressure for antibiotics
A survey of healthcare providers at student health centers on US college campuses found that they frequently feel pressure for antibiotics from patients with upper respiratory tract infections (URTIs), researchers reported today in the American Journal of Infection Control.
In the survey, which was completed by 103 student health center physicians and nurse practitioners who reported seeing an average of 43.9 URTI patients per week during cold and flu season, respondents reported that they perceived patients to want antibiotics in roughly 50% of visits.
The most frequently reported driver of desire for antibiotics were recovery from illness, past prescribing of antibiotics, patient misconceptions or misinformation, and social network influence. Discussion of antibiotics with patients, the providers reported, created an uncomfortable interaction in 21% of visits.
Patients' most common pressure tactic for getting antibiotics were reporting that they had received antibiotics for a prior infection (50%), emphasizing symptoms to imply a need for antibiotics (48%), suggesting a diagnosis (44%), and simply requesting antibiotics (35%). Respondents stated that the greatest discomfort arose when patients reported receiving antibiotics for a prior infection.
In visits where the provider perceived patient pressure for antibiotics for a URTI, the most frequent response was to explain the disease or diagnosis (56.3%), explain antibiotic utility and risk (51.5%), explain the treatment plan (46.6%), and explain antibiotic resistance (36.9%).
"While it remains possible that providers sometimes perceive more pressure than patients intend, the current study provides evidence regarding the diversity and ubiquity of patient influence tactics, indicating that patient expectation for antibiotics is a reality underlying many URTI visits," the study authors wrote.
"Faced with these and other influence efforts, providers need communication strategies that enable them to simultaneously withstand pressure, respond professionally and compassionately to maintain satisfaction with care, and educate patients in ways that reduce future efforts to obtain unnecessary antibiotics."
May 20 Am J Infect Control abstract
CARB-X receives new round of funding from BARDA, Wellcome
Originally published by CIDRAP News May 19
The Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) today announced renewed funding from the US government's Biomedical Advanced Research and Development Authority (BARDA) and UK charitable foundation Wellcome.
Under the renewed agreement, BARDA will provide CARB-X with up to $300 million over 10 years to support its existing portfolio of antibiotics, therapeutics, diagnostics, and preventive measures against antibiotic-resistant bacteria, and launch new funding rounds. Wellcome will provide an additional $70 million over 3 years. BARDA and Wellcome together had provided $355 million in funding to help launch CARB-X in 2016.
Since its launch, CARB-X has become a key player in efforts to revitalize the antibiotic pipeline and boost other methods of tackling the emergence and growth of antimicrobial resistance (AMR). Focusing on early-stage research and development (R&D), CARB-X has funded and provided technical support to 92 innovative projects in 12 countries, including 19 novel-class antibiotic candidates, 16 non-traditional therapeutics, 8 vaccines, 4 preventives, and 12 diagnostics.
"We are grateful for the leadership and commitment demonstrated by BARDA and Wellcome in addressing the global challenge of antimicrobial resistant bacteria," Kevin Outterson, JD, executive director of CARB-X, said in a press release. "AMR is a top-tier global killer. With today's funding announcements, CARB-X will continue to invest to support early-stage R&D for new antibacterial therapies, preventatives, and diagnostics."
May 19 CARB-X press release
Meta-analysis supports shorter antibiotic course for kids' pneumonia
Originally published by CIDRAP News May 18
A systematic review and meta-analysis of clinical trials of antibiotic treatment for children with community-acquired pneumonia provides further support for shorter treatment duration, Finnish researchers reported yesterday in Clinical Infectious Diseases.
Of the 541 studies screened, four randomized controlled trials involving 1,541 children were included in the analysis. The primary aim was to determine whether an antibiotic treatment duration of 3 to 5 days for CAP in children over 6 months of age was as effective as 7 to 10 days. International guidelines currently recommend the longer duration, but research in recent years has indicated a shorter course may prevent development of antibiotic resistance and lower the risk of antibiotic-related adverse events.
The main outcome assessed was treatment failure, defined as the need for re-treatment or hospitalization within 1 month. The secondary outcome was antibiotic-related harms.
All four studies assessed the composite outcome of treatment failures. The treatment failure rate was 7.9% for the short-course group and 8.0% for the long-course group, for an absolute risk difference (RD) of 0.1% (95% confidence interval [CI], –3.0% to 2.0%), with high quality of evidence. Among the two studies that assessed adverse events related to antibiotic treatment, the RD between the two groups was 0.0% (95% CI, –5.0% to 5.0%), with moderate quality of evidence.
"A short antibiotic treatment duration of 3–5 days was equally effective and safe compared to the longer (current) recommendation of 7–10 days in children aged over 6 months with CAP," the study authors concluded. "We suggest that short antibiotic courses can be implemented in treatment of pediatric CAP."
May 17 Clin Infect Dis abstract
Year 5 progress report highlights US actions on antibiotic resistance
Originally published by CIDRAP News May 17
The US Task Force for Combating Antibiotic-Resistant Bacteria (CARB) last week published a report on the fifth year of the US government's efforts to address drug-resistant infections.
The year 5 report details some of the actions taken under the National Action Plan for Combating Antibiotic-Resistant Bacteria 2015-2020, which was developed during the Obama administration and set out five interrelated goals for tackling the emergence and spread of drug-resistant pathogen in humans, animals, and the environment.
The report notes that these actions have helped guide the government's response to antibiotic resistance, leading to improved infection prevention and antibiotic stewardship in human and animal health, expanded surveillance for drug-resistant pathogens, and more support for new products to detect, prevent, and treat infections.
Among the highlighted programs are those established by the CDC to detect and prevent antibiotic-resistant infections and promote responsible antibiotic use, such as the National Healthcare Safety Network, the Emerging Infection Program, the Antibiotic Resistance Laboratory Network, and the Core Elements of Antibiotic Stewardship program.
Also highlighted is the Food and Drug Administration's Guidance for Industry #213, which banned medically important antibiotics from being used for growth promotion in food-producing animals and required veterinary oversight for all use of medically important antibiotics.
The report also addresses emerging issues, including the role that the environment, health equity, and other external factors play in increasing the risk of contracting an antibiotic-resistant infection.
"The CARB Task Force is currently working to better understand disparities related to antibiotic resistance across health care, the community, and the environment, as well as the relationship between health equity and antibiotic use and resistance to determine community- or population-level trends that could inform better stewardship or prescribing practices in high-risk communities," the report states.
The 2020 action plan developed by CARB maintains the five goals of the original plan and outlines aspirational targets that the US government can take to further reduce the spread and impact of antibiotic resistance and improve antibiotic stewardship.
May 13 CARB Year 5 report
Study finds MRSA and VRE can linger in nursing homes
Originally published by CIDRAP News May 16
Environmental screening of single-occupancy rooms in a nursing home found high levels of circulation and persistence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), according to a study published today in Antimicrobial Stewardship & Healthcare Epidemiology.
In the prospective cohort study, researchers screened five high-touch surfaces in a cluster of nine single-occupancy rooms at a nursing home three times a week for 34 weeks. They also screened patients if they agreed to participate. Overall, there were 146 distinct occupancy events captured during the study, with 387 study visits and 4,670 swabs collected.
Screening revealed that all rooms were contaminated with VRE, and eight of nine were also contaminated with MRSA. New contamination of a room with MRSA or VRE was observed in 43 (23%) of 185 opportunities, with potential persistence occurring in 25 (32.9%) of 76 opportunities.
Whole-genome sequencing of 67 non-redundant isolates identified at least 6 enterococcal clades and 10 MRSA clades, indicating a high degree of diversity and likely multiple introductions in the facility during the study period, including one case of a MRSA strain persisting in a clean room before admission of the next patient.
The researchers, who presented the study at the Society for Healthcare Epidemiology (SHEA) spring conference last month, say the findings indicate that active surveillance screening and recurring evaluation of terminal cleaning procedures should be considered in the nursing home setting.
May 16 Antimicrob Steward Healthc Epidemiol abstract
Multiple factors influence antimicrobial use in cats and dogs, data show
Originally published by CIDRAP News May 16
In another study presented at the SHEA spring conference and published in Antimicrobial Stewardship & Healthcare Epidemiology today, researchers identified multiple factors associated with antimicrobial prescriptions in dogs and cats.
Using demographic, clinical, and prescription data from the electronic medical record system at a small-animal teaching hospital from 2018 to 2020, the researchers assessed the association between demographic and clinical factors of systemic antimicrobial drug prescriptions in dogs and cats. Across 11,685 dogs with 14,328 admissions (mean age 7.4 years; 47% female), they found that female sex, longer admission, a history of chemotherapy within 30 days of admission, surgery upon admission or within the last 30 days, intensive care unit (ICU) admission, and oxygen support were associated with increased odds of any antimicrobial prescription.
In 3,371 cats with 4,088 admissions (mean age, 8.6 years; 39% female), the researchers found that female sex, longer admission, increased age (older than 8 years), ICU admission, surgery upon admission, and no requirement for oxygen support or urinary catheterization were associated with increased odds of any antimicrobial prescription.
The researchers say the findings can inform veterinary antimicrobial stewardships efforts and may be useful for benchmarking antimicrobial use on an institutional or multi-institutional scale.
May 16 Antimicrob Steward Healthc Epidemiol abstract
Surveillance system linked to antibacterial decline in NICUs
Originally published by CIDRAP News May 16
Implementation of a mandatory surveillance system in neonatal ICUs (NICUs) in Germany was associated with a reduction in antibacterial consumption in preterm infants, researchers reported late last week in the Journal of Infection.
For the study, a team of German researchers analyzed data on antibacterial use in 231 NICUs in Germany from 2013—when a module for the assessment of antibacterial use in very low birth weight (VLBW) newborns was added to the German national nosocomial infection surveillance system for neonates (NEO-KISS)—to 2019. NEO-KISS assesses the incidence antibacterial use, healthcare-associated infections, and multidrug-resistance organisms in premature infants during inpatient care. The primary outcome assessed was antibacterial consumption during days of treatment (DOT) per 1,000 PD.
In total, 2,090,241 patient-days with 344,929 days of antibacterial use were observed. Over the entire study period, antibacterial consumption was 430.4 DOT/1,000 PD, but consumption declined from 474.3 DOT/1,000 PD in 2013 to 382.1 DOT/1,000 PD in 2019—a 19.5% decrease.
Of all neonates under surveillance, 72.9% received antibacterial therapy. Use of penicillins with extended spectrum, other aminoglycosides, glycopeptide antibacterials, and third-generation cephalosporins decreased, while use of macrolides and combinations of penicillins, including beta-lactamase inhibitors, increased over time.
The analysis also found that severe healthcare-associated infections decreased continually during the study period. Regression analysis identified year of birth as an independent protective factor for the prescription of antibacterials in general.
The study authors say that while the underlying reasons for the reduction cannot be directly identified, they note that implementation of surveillance systems can stimulate activities to improve prescribing on a local and national level, such as establishing benchmarks for antibacterial use.
"Assessment of antibacterial consumption could further help to implement additional targeted antimicrobial stewardship measures potentially further reduce antibacterial consumption and improve antibacterial prescriptions on NICUs beyond VLBW," they wrote.
May 14 J Infect study