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Stewardship / Resistance Scan for May 21, 2021

Stewardship / Resistance Scan for May 21, 2021

High level of antibiotic use found in dying organ donors

In a first-of-its-kind study, a team of US researchers reported this week in Clinical Infectious Diseases that nearly all of more than 400 deceased organ donors received at least one antibiotic dose during their terminal hospitalization, a finding that study authors say highlights the need for antibiotic stewardship in this population.

While there is concern about the use of donated organs that are infected or colonized with multidrug-resistant organisms (MDROs) and the potential for donor-derived infection (DDI), to date there have been no studies on antibiotic use among deceased organ donors, which is considered an important risk for MDRO colonization or infection. To investigate the level of antibiotic use in this group, a team led by researchers with the University of Pennsylvania Perelman School of Medicine examined data on 440 organ donors at four transplant centers in the Philadelphia region. Details on all antibiotics administered during terminal hospitalization, including those given leading up to and during organ procurement, were included.

Of the 440 organ donors, 427 (97%) received at least one course of antibiotics during terminal hospitalization, and 400 (91%) received at least one dose outside of the peri-procurement period. A total of 312 donors (71%) received a broad-spectrum antibiotic, with 299 (68%) receiving a broad gram-negative agent and 103 (23%) receiving a broad gram-positive agent. Sixty-three donors (14%) received potentially redundant antibiotics. The most frequently used antibiotics were first-generation cephalosporins (337 donors, 77%), and the median number of total antibiotic days of therapy was 4.

“In conclusion, our study identified widespread use of broad-spectrum antibiotics and many instances of potentially redundant antibiotic prescription among deceased organ donors,” the study authors wrote. “Since brief antibiotic exposures may increase the risk for donor MDRO colonization and subsequent MDRO DDIs in the recipient, the organ donor population is an important future target of antibiotic stewardship interventions.”
May 20 Clin Infect Dis abstract

Stewardship helped limit antibiotics early in pandemic, hospital study finds

Strategies implemented by the antimicrobial stewardship team (AMST) at a hospital in Spain to minimize antibiotic use during the first wave of the COVID-19 pandemic contributed to an overall reduction in antibiotic use in 2020, researchers reported today in Infection Control & Hospital Epidemiology.

In a letter to the editor, clinicians and pharmacists at Moises Broggi Hospital in Barcelona report that antibiotic consumption at the hospital in 2020 was lower than in 2019, except for March, when the onset of the pandemic caused in increase in the use of azithromycin and ceftriaxone. Measured in defined daily doses (DDD) per 100 bed-days, the mean global consumption of antibiotics during hospitalization was 57.8 DDD/100 bed-days in 2020, compared with 64.7 DDD/100 bed-days in 2019.

The study authors say that while the AMST was unable to carry out its work from March through May 2020, protocols established for the management of COVID-19 patients, including recommended antibiotic regimens (azithromycin and ceftriaxone) and recommended durations (5 and 3 days, respectively) and review of antibiotic treatment by the AMST pharmacist, made it possible to control antibiotic consumption during the first wave.

“After the first wave, hospital activity began to normalize and allowed for the usual individualized AMST intervention,” the study authors wrote. “This made it possible to maintain the levels of antibiotic consumption below those observed in the previous year.”
May 21 Infect Control Hosp Epidemiol abstract

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