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ASP Scan (Weekly) for May 07, 2021

ASP Scan (Weekly) for May 07, 2021

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

US hospital data show link between antibiotic use, C difficile rates

Data from a cohort of US acute care hospitals (ACHs) reveal an association between total and broad-spectrum antibiotic use and hospital-onset Clostridioides difficile infection (HO-CDI) rates, researchers from the Centers for Disease Control and Prevention (CDC) reported today in Infection Control & Hospital Epidemiology.

For the analysis, researchers examined data on antibiotic use, CDI tests, and CDI treatment at ACHs that reported data to the Premier Healthcare Database from 2012 through 2018. Hospital antibiotic use was measured in days of therapy (DOT) per 1,000 patient-days (PD) and examined through monthly rates of total antibiotic use and use of seven antibiotic classes. Facility-level HO-CDI rates were calculated per 10,000 PD.

Over the study period, among 921 participating hospitals, the median hospital-level HO-CDI rate was 6.7 per 10,000 PD. In a cross-sectional multivariable analysis, overall antibiotic use was significantly associated with the facility-level HO-CDI rate. For every 50 DOT per 1,000 PD increase in antibiotic use, there was a 2.8% increase in the HO-CDI rate. In an antibiotic class-specific model, 10 DOT per 1,000 PD increases in the use of carbapenems, cephalosporins, and piperacillin-tazobactam were each independently associated with 1.3%, 0.6%, and 1.1% increases in the HO-CDI rate, respectively.

Notably, four hospitals that reduced total antibiotic use by 30% or more saw a 40% decrease in HO-CDI rates. At 45 hospitals that saw reductions in their combined use of carbapenems, fluoroquinolones, and cephalosporins, annual decreases in the HO-CDI rate ranged from 4% to 16%.

“Although specific reasons for and factors driving the changes in antibiotic use in our hospital cohort were beyond the scope of this investigation, we found that decreased antibiotic use consistently corresponded with decreases in the HO-CDI rate,” the study authors wrote. “These findings should encourage ACHs to invest efforts into monitoring antibiotic use and targeting unnecessary and inappropriate use across all classes of antibiotics.”
May 7 Infect Control Hosp Epidemiol study


Study finds high rate of antibiotics for respiratory infections in rural China

A study conducted in rural China found a high rate of antibiotic prescribing, and frequent use of broad-spectrum antibiotics, for common respiratory tract infections, Chinese and British researchers reported yesterday in BMC Family Practice.

The study, conducted in one village clinic and one township health center in each of four residential areas in Anhui Province, involved non-participative observations, exit surveys, and a microbiologic study. A trained observer was sent to each clinic to record clinical diagnosis and antibiotic prescriptions and conduct semi-structured face-to-face interviews with patients to collect demographic data, disease history, and symptoms, and doctors collected sputum and throat swabs for bacterial culture and antibiotic susceptibility testing.

A total of 1,068 patients provided specimens and completed the surveys, with 638 providing sputum and 385 throat swabs. Overall, 30.5% received a diagnosis of respiratory tract infection, 23.3% were diagnosed as having bronchitis/tracheitis, 11.1% with pharyngitis, and 8% with “common cold.” Also, 88% were prescribed antibiotics; 36% of these prescriptions contained two or more types of antibiotics. The most commonly used antibiotics were penicillins, cephalosporins, and quinolones.

Of all the specimens tested, 30.8% were isolated with pathogenic bacteria. The most frequently isolated bacteria were Klebsiella pneumoniae (24%), Haemophilus influenzae (16%), Haemophilus parainfluenzae (15%), Pseudomonas aeruginosa (6%), and Staphylococus aureus (3%). High rates of resistance were found for K pneumoniae to ampicillin (97.4%), S aureus to penicillin (92.3%), and H influenzae to sulfamethoxazole (62.3%).

The study authors say the findings contradict a common belief among Chinese policymakers that the country’s antibiotic stewardship initiatives, which focus on antibiotic use at secondary and tertiary hospitals, are bringing excessive antibiotic use under control.

“Given that about 57% of China’s vast population lives in rural and township areas and over 70% of antibiotics prescriptions occur at settings in these areas, there is a clear need for added attention on excessive antibiotics use at these settings and communities,” they wrote.
May 6 BMC Fam Pract study


WHO highlights importance of good hand hygiene

Originally published by CIDRAP News May 5

To mark World Hand Hygiene Day, the World Health Organization (WHO) today called for countries to reduce inequalities in the availability of good hand hygiene and other infection prevention and control (IPC) measures.

While good hand hygiene is considered vital in preventing healthcare-associated infections and the spread of antibiotic-resistant pathogens, research has shown that in some low-income countries, only 1 in 10 healthcare workers practices proper hand hygiene, and that’s often because they lack the resources to do so. A 2020 WHO report found that globally, 1 in 4 healthcare facilities lacks basic water services, and 1 in 3 lacks hand hygiene supplies at the point of care.

Another WHO analysis found that, in 2018, only 45% of low-income countries had a functional national IPC program, compared with 70% of high-income countries. Overall, only 22% of countries monitored implementation roll-out and impact of IPC programs.

The lack of resources for good hand hygiene and IPC measures in poorer nations is reflected in healthcare-associated infection rates. The WHO notes that patients in low- and middle-income countries are more than twice as likely to acquire an infection during healthcare delivery as patients in high-income countries (15% vs 7%), and that the risk of infection in intensive care units (ICUs), especially among newborns, is two to 20 times higher.

The WHO also announced a new online monitoring IPC portal to help countries identify and address IPC gaps.

“Health care workers’ compliance with hand hygiene practices is one of the key performance indicators for IPC, patient safety and quality of health services worldwide,” the WHO said in a press release. “The new monitoring portal can play an important part in improving this.”
May 5 WHO press release


Study describes bacterial, fungal coinfections in COVID-19 patients

Originally published by CIDRAP News May 5

A study of hospitalized COVID-19 patients in New York during the first wave of the pandemic found that 17% had bacterial or fungal coinfections, and that antibiotic-resistant bacteria were increasingly isolated from patients with prolonged hospital stays, researchers reported today in Open Forum Infectious Diseases.

In the study, researchers from New York-Presbyterian Hospital/Columbia University Irving Medical Center examined data on COVID-19 patients who were hospitalized for more than 24 hours from Mar 2, 2020, through May 21, 2020, including culture and susceptibility results from all body sources. Microbiologically confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and healthcare-associated infections and describe temporal changes in predominant organisms and antibiotic resistance.

Of the 3,028 COVID-19 patients admitted during the study period, 516 (17%) had positive cultures. Community-associated infections (identified within 72 hours of admission) were identified in 183 patients (6%), and healthcare-associated infections were identified in 350 patients (12%), with the median onset of hospital infection on day 16.

Among the isolates identified as healthcare-associated, 57% were gram-negative bacteria, 25% were gram-positive bacteria, and 19% were fungi. ICU stay, mechanical ventilation, and steroid use were all independently associated with healthcare-associated infections.

Drug susceptibilities differed by source of infection and duration of hospitalization, with the proportion of vancomycin-resistant Enterococci, cephalosporin-resistant (Ceph-R) Enterobacterales, and carbapenem-resistant Enterobacterales infections increasing with the duration of hospitalization. Ceph-R Enterobacterales, identified in 159 isolates, was the most common organism group with multidrug resistance.

The analysis also found that among all 3,028 patients, 2,015 (67%) had exposure to at least one dose of an antibiotic, including 60% of the patients with no confirmed co-infection.

“High rates of antimicrobial use in conjunction with other risk factors, such as prolonged hospital and ICU stays, invasive devices, and the need for patient cohorting, may have contributed to the increasing incidence of multidrug-resistant infections over the course of hospitalizations,” the study authors wrote.

The authors say the findings highlight the importance of antibiotic stewardship principles in hospitalization of COVID-19 patients.
May 5 Open Forum Infect Dis abstract


Bipartisan group of lawmakers urges more funding for AMR response

Originally published by CIDRAP News May 4

A bipartisan group of congressional representatives called on House appropriators last week to increase funding for the federal response to antimicrobial resistance (AMR).

In a letter signed by more than 60 lawmakers from both parties, Rep. Chellie Pingree, D-Maine, and Rep. Buddy Carter, R-Ga., said Congress must fully support the funding necessary to significantly reduce the burden of AMR. Among the requests was $672 million in Fiscal Year 2022 for the CDC’s Antibiotic Resistance Solutions Initiative, $100 million to expand AMR data collection through the CDC’s National Healthcare Safety Network, and $600 million to improve AMR research capacity at the National Institute of Allergy and Infectious Diseases.

“Drug-resistant infections sicken at least 2.8 million and kill at least 35,000 people annually in the U.S.,” the lawmakers wrote to the House Appropriations Committee. “Globally, over 700,000 people die each year accounting for a cost as high as $1.2 trillion. If we do not act now, by 2050 antibiotic resistant infections will be the leading cause of death—surpassing cancer—and could cost the world $100 trillion.”

Citing the need for new antibiotics and the financial challenges of antibiotic development, the letter also requested $300 million for the Biomedical Advanced Research and Development Authority and CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) to boost development of innovative antibacterial products, and $200 million for the Project BioShield Special Reserve Fund for broad-spectrum antimicrobials.

“The pipeline of new antibiotics in development is insufficient to meet patient needs,” Pingree and Carter wrote. “The imminent collapse of the antibiotic market is exacerbating this threat, and small companies that are responsible for nearly all current antibiotic innovation are facing bankruptcy because factors unique to antibiotics, including the need for judicious use, make it challenging for companies to earn a return on investments in antibiotic research and development.” 
Apr 28 Congressional letter

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