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Stewardship / Resistance Scan for Aug 27, 2021

Stewardship / Resistance Scan for Aug 27, 2021

Study indicates stewardship helped reduce pediatric vancomycin use

A quality improvement (QI) program combining clinician education, clear and concise recommendations, and decision support was associated with a safe reduction in vancomycin use in a pediatric intensive care unit (PICU), researchers reported today in Pediatrics.

To reduce unnecessary vancomycin use in PICU patients with suspected community-acquired infections (CAIs), a multidisciplinary team at Nationwide Children’s Hospital in Columbus, Ohio, developed consensus indications for empirical vancomycin use based on epidemiologic risk factors for methicillin-resistant Staphylococcus aureus (MRSA). While vancomycin is the antibiotic of choice for MRSA infections, not all patients have the same risk factors, and exposure to vancomycin can increase the risk for developing resistant bacteria.

Starting in May 2018, the indications were posted on PICU workstations, education on empiric vancomycin use was provided for medical residents, and antibiotic order sets were modified. To determine the impact of the intervention, the researchers measured the percentage of patients with suspected CAIs who received empiric vancomycin within 48 hours of admission to the PICU from May 2017 to July 2019.

A total of 1,620 PICU patients with suspected CAIs were identified during the study period. The percentage of patients who received empirical vancomycin fell from 73% during the baseline (May 2017 to April 2018) to 45% post-intervention, a 38% relative reduction. During the same period, overall vancomycin use in the PICU fell from an average of 343 to 218 days of therapy per 1,000 patient-days, or a 36% reduction. No patient not prescribed empiric vancomycin later required the addition of vancomycin or other MRSA-targeted antibiotics.

The study authors say that while they can’t prove causality, the QI program was the only new intervention targeting vancomycin use in the PICU during the study period.

“A multidisciplinary QI approach with consensus empirical vancomycin indications successfully and safely reduced vancomycin use in our large academic center PICU,” they write. “Validating the consensus indications in our own, local population and obtaining buy-in from front-line, critical care providers were essential to successful implementation of the indications and subsequent decreased vancomycin use.”
Aug 27 Pediatrics abstract

UK survey looks at awareness of, and attitudes toward, drug resistance

A new survey conducted in the United Kingdom suggests some public confusion over the terms “antibiotic resistance” and “antimicrobial resistance.”

The survey, by the UK Food Standards Agency (FSA) and including 2,555 residents aged 16 to 75, found that only about a fourth of respondents (26%) had heard of “antimicrobial resistance,” while only 11% had heard of the “AMR” acronym. But much higher proportions were familiar with antibiotic resistance and “superbugs,” with more than two thirds of respondents (69% and 70%, respectively) having heard those terms. More than half of respondents (57%) did not understand the difference between antibiotic resistance and antimicrobial resistance, while 14% said they had not heard of any of the terms.

The survey also found that public concern about antimicrobial resistance from people overusing antibiotics has declined slightly, falling from 71% in a 2019 survey to 65%. Almost two fifths of respondents (39%) said overuse of antibiotics by doctors and patients was the biggest contributor to the increase in infections caused by antibiotic-resistant bacteria, while 15% cited antibiotic use in farming as the biggest contributor, and 7% cited poor personal hygiene.

Concern about antimicrobial resistance in the food chain was lower, at 58%, but up from 55% in 2019. Respondents were less concerned about the risk of antimicrobial resistance from food imported from the European Union (51%) or produced in the United Kingdom (48%) than they were about food imported from countries outside the European Union (58%).

The authors of the survey note that international research has found similar low levels of familiarity surrounding antimicrobial resistance.
Aug 26 FSA survey

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