Project aims to help limited-resource countries address AMR
UK-based charitable foundation Wellcome is funding and co-developing a new project aimed at helping countries with limited resources make the best use of antimicrobial resistance (AMR) surveillance data to optimize antibiotic use and help reduce the spread of drug-resistant pathogens.
Working in collaboration with the World Health Organization, an international team of researchers, data-modelers, and policymakers will study relevant existing datasets on clinical management, antibiotic resistance, antibiotic management, and clinical outcomes to develop simple systems that aim to provide low- and middle-income countries (LMICs) with a more comprehensive view of their patterns of antibiotic use.
The hope is that national governments and local policymakers can then use this information to develop locally relevant policies, guidelines, and targets to reduce inappropriate antibiotic use.
Wellcome will fund the ADILA (Antimicrobial Resistance, Prescribing, and Consumption Data to Inform Country Antibiotic Guidance and Local Action) project for 3.5 years.
"The availability of the tools that will emerge from ADILA will be another step towards enabling and empowering decision makers in countries with limited resources to design and implement local policies better adapted to their own local settings," Wellcome science and research manager Chibuzor Uchea, PhD, said in a post on LinkedIn. "This work will allow for the creation and use of more meaningful guidelines and targets and support greater national ownership of and commitment to tackling AMR."
May 24 LinkedIn post
Risk factors for death from multidrug-resistant infections identified
A retrospective study of patients at Veterans Affairs (VA) hospitals with carbapenem-resistant Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPA) infections found that positive blood cultures and more comorbidities were associated with higher odds of mortality, researchers reported yesterday in BMC Infectious Diseases.
In the study, researchers analyzed CRAB and CRPA isolates from patients treated at 142 VA facilities from 2013 through 2018 and used multivariable cluster adjusted regression models to identify factors associated with hospital length of stay (LOS) and 90- and 365-day mortality after positive CRAB and CRPA cultures.
Over the study period, they identified CRAB and CRPA in 1,048 and 8,204 patients, respectively. The number of CRAB and CRPA cultures decline by 20% and 41%, respectively.
Among patients with CRAB, 30.3% died within 90 days, and 46.5% died within 365 days, and the median LOS post-culture was 20 days. Among CRPA patients, 24.5% died within 90 days, and 40.3% died within 365 days, with a median post-culture LOS of 16 days. In the multivariable analysis, positive blood cultures were associated with an increased odds of 90-day mortality compared to urine cultures in patients with CRAB (odds ratio [OR], 6.98; 95% confidence interval [CI], 3.55 to 13.73) and CRPA (OR, 2.82; 95% CI, 2.04 to 3.90).
In patients with CRAB and CRPA blood cultures, higher Charlson Comorbidity Index score was associated with increased odds of 90-day mortality. In CRAB and CRPA, among patients from inpatient care settings, blood cultures were associated with a decreased LOS compared to urine cultures.
The study authors conclude that despite the observed decline in CRAB and CRPA infections in VA patients, the two multidrug-resistant organisms should continue to be considered a serious threat, and that it's important for clinicians to recognize these risk factors in infected patients and appropriately treat them in a timely manner.
May 24 BMC Infect Dis study