Stewardship / Resistance Scan for May 16, 2022

News brief

Study finds MRSA and VRE can linger in nursing homes

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

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

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 patient-days (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

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News Scan for May 16, 2022

News brief

Trial suggests awake prone position doesn't cut need for intubation in COVID

A randomized, controlled trial of 400 adults hospitalized for COVID-19–related respiratory failure suggests that awake prone positioning doesn't significantly reduce the need for endotracheal intubation at 30 days, but the authors caution that the effect size was imprecise and a therapeutic benefit cannot be ruled out.

Published yesterday in JAMA, the study was led by McMaster University researchers and enrolled nonintubated respiratory failure patients who needed supplemental oxygen at 21 hospitals in Canada, Kuwait, Saudi Arabia, and the United States from May 19, 2020, to May 18, 2021. Patients were, on average, 57.6 years old, 29.3% were women, 205 were assigned to receive prone positioning, and 195 served as controls.

In the first 4 days, intervention patients were placed in the prone position for 4.8 hours per day. By 30 days, 70 of 205 (34.1%) intervention patients advanced to needing endotracheal intubation, compared with 79 of 195 (40.5%) of controls. The hazard ratio [HR] was 0.81, but the result was not statistically significant.

By 60 days, prone positioning hadn't significantly reduced the death rate (HR, 0.93; absolute difference, −1.15%) or increased days free from invasive or noninvasive mechanical ventilation or intensive care unit stay, or shortened hospital stay.

In the intervention group, 21 patients (10%) had adverse events, the most common of which was musculoskeletal pain from prone positioning (13 [6.34%]) and oxygen desaturation (2 [0.98%]). No serious adverse events were reported.

The researchers noted that prone positioning has been used to treat patients undergoing invasive mechanical ventilation for acute respiratory distress syndrome (ARDS) since the 1970s. Previous trials have produced mixed results in COVID-19 patients, and the most current practice guideline on treating sepsis in COVID-19 said that evidence to support a recommendation on it is lacking.

Awake prone positioning may not benefit patients with more severe infections, the authors said. "However, the false discovery rate did not reach statistical significance for any of the preplanned subgroups; therefore, these findings should be interpreted with great caution and considered hypothesis generating," they wrote.
May 15 JAMA study


Avian flu outbreaks strike more poultry in 4 states

Four states reported more highly pathogenic avian flu outbreaks, with two of the events involving commercial farms in Pennsylvania and Wisconsin, according to the latest updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

In Pennsylvania, the virus struck a layer poultry breeding farm in Berks County in the southeast housing 83,700 birds. So far, all 10 of the state's avian flu outbreaks have occurred at commercial farms, 6 of them at layer facilities. Pennsylvania is the nation's fourth-largest table egg producer.

Meanwhile, Wisconsin reported an outbreak at a commercial turkey farm housing 10,500 birds in Barron County in the northwest.

Two western states—Idaho and Wyoming—reported more outbreaks in backyard birds. Idaho reported two, one in Ada County and the other in neighboring Canyon County, both in the southwestern part of the state. Wyoming also reported a pair of outbreaks, one in Lincoln County in the southwest and the other in Sheridan County in the north central part of the state.

The latest outbreaks are part of ongoing Eurasian H5N1 activity affecting US poultry flocks and wild birds. The virus has affected poultry flocks in 34 states and has so far led to the loss of 37.72 million birds.
USDA APHIS avian flu update


Two new monkeypox cases identified in UK

Two new monkeypox cases have been identified in London residents, according to the UK Health Security Agency (UKHSA).

The case-patients live together in a household and have no connection to a monkeypox case reported earlier this month by the UKHSA. One person is currently hospitalized for the virus, while the other is isolated and recovering at home.

"While investigations remain ongoing to determine the source of infection, it is important to emphasise it does not spread easily between people and requires close personal contact with an infected symptomatic person. The overall risk to the general public remains very low," said Colin Brown, MBChB, the director of clinical and emerging infections at UKHSA.

Most cases of monkeypox are mild, but the virus can be severe and even deadly. UK health authorities emphasize that the virus is not highly contagious.

Earlier this month UK authorities confirmed monkeypox in a person who had recently traveled to Nigeria. According to a World Health Organization (WHO) update today, contact tracing has revealed no additional cases.

The WHO said, "Based on the travel history and rash illness, monkeypox was suspected at an early stage and the case was isolated immediately. Appropriate use of personal protective equipment was ensured during hospitalization."
May 14 UKHSA
press statement
May 16 WHO
update on previous case

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