ASP tied to lower broad-spectrum antibiotic use in pediatric hospital
A German study in Infection found that implementation of an antibiotic stewardship program (ASP) was associated with lower rates of broad-spectrum antibiotic prescribing, better dosage accuracy, shorter therapy, and cost savings in a pediatric hospital.
The study enrolled children from four non-surgical pediatric wards in a 61-bed Munich hospital that admits about 3,800 children a year. The researchers compared 273 patients in the pre-ASP period (Sep-Dec 2014) with 263 in the post-intervention period (Sep-Dec 2015).
The investigators found that use of cephalosporins and fluoroquinolones decreased by 35.5% and 59.9%, respectively, while use of penicillins increased by 15.0%. Overall days of therapy and length of therapy dropped 10.5% and 7.7%, respectively. In addition, dosage accuracy climbed from 78.8% to 97.6%, and guideline adherence for community-acquired pneumonia improved from 39.5% to 93.5%.
In addition, the ASP saved €330,000 ($351,000) per year, the authors said.
They conclude, "Our data demonstrate that implementation of an ASP was associated with a profound improvement of rational antibiotic use and, therefore, patient safety."
Apr 10 Infection study
Study reveals spread of drug-resistant MRSA strains in Ireland
A new study in PLoS One reveals the emergence and extensive spread of multiple strains of a multidrug-resistant, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) clone within and between hospitals, healthcare facilities (HCFs), and communities in Ireland.
In the study, researchers investigated 89 MRSA isolates (of the community-associated ST1-MRSA-IV clone) recovered from multiple hospital, healthcare, and community sources from 2013 to 2016. The vast majority of the isolates (78 of 89, or 88%) were healthcare-associated (HCA) MRSA, with many (46 isolates) recovered from a single hospital outbreak and the rest from 16 separate hospitals and 4 HCFs. Eleven of the isolates were community-associated.
Seventy-five of the isolates (84%) were multidrug resistant, exhibiting phenotypic resistance to three or more clinically relevant antibiotic classes, with 50 of 89 isolates (56%) showing high-level resistance to mupirocin.
Whole-genome sequencing and single-nucleotide variation analysis of the isolates identified the concurrent circulation of two closely related strains of ST1-MRSA-IV and multiple sporadic strains. Further investigation revealed that strain 1 spread within and between five different hospitals, two HCFs, and the community, with healthcare workers as a possible reservoir of the strain. Isolates from strain 2 were recovered from eight hospitals, one nursing home, and the community. The outlier strains were recovered from eight hospitals and the community.
"The extensive spread of this CA-MRSA clone within and between the Irish community and hospitals/HCFs highlights the need for infection prevention and control measures that consider CA-MRSA transmission routes into hospitals," the authors write.
Since current national guidelines in Ireland recommend MRSA screening only for patients at risk of HCA-MRSA, the authors argue that infection prevention and control measures should now consider CA-MRSA risk factors as well. They also suggest screening of healthcare workers, as travel of staff between facilities is common in Ireland.
Apr 11 PLoS One research article
Very high rate of MRSA colonization found in Portuguese swine
Researchers in Portugal have found a high rate of MRSA colonization in swine and swine workers at two Portuguese farms, according to a study yesterday in PLoS One.
The aim of the study was to assess whether healthy pigs are contributing to the reservoir of MRSA in Portugal, which has a nosocomial MRSA prevalence of nearly 50%, one of the highest in Europe. For the investigation, researchers evaluated the prevalence, antimicrobial resistance patterns, and clonal profile of MRSA isolates from two pig farms and looked for possible transmission to workers on the farms and their families.
The researchers screened nasal samples from a total of 101 piglets, 5 farm workers, and 4 household members for MRSA colonization. Overall, 99% of the piglets (49 of 50 on farm A and all 51 on farm B), 80% of the farm workers (4 of 5), and 25% of the household members (1 of 4) were nasally colonized with MRSA. All of the116 isolates recovered belonged to a single sequence type—ST398, the main livestock-associated MRSA lineage—associated with two predominant spa types, t011 and t108.
High rates of the isolates were resistant to tetracycline (100%), clindamycin (97%), erythromycin (96%), chloramphenicol (84%), and gentamycin (69%), with 12% showing resistance to quinupristin-dalfopristin.
The authors suggest the high rate of MRSA colonization among the pigs might be caused by animal-to-animal transmission aided by the crowded conditions on the farms, a theory supported by the spread of only two spa types. In addition, they argue, the fact that two of the farmers carried the same lineage found in the pigs "corroborates the idea that pig farming is a significant risk factor for MRSA carriage in humans."
Apr 11 PLoS One research article