Spanish study shows long-term impact of prescribing intervention
Six years after it was first implemented, a multifaceted, practice-based intervention among Spanish primary care physicians continued to keep antibiotic prescribing levels down for respiratory tract infections (RTIs), researchers report in the Journal of Antimicrobial Chemotherapy.
In 2008 and 2009 The HAPPY AUDIT project, a study aimed at strengthening the surveillance of RTIs and developing interventions to reduce prescribing, demonstrated a 50% reduction in antibiotic prescriptions by participating physicians 1 to 3 months after the intervention was implemented. The intervention involved individual prescriber feedback and discussion of the first registration of results in 2008, a training course on the appropriate use of antibiotics for RTIs, clinical guidelines for diagnosis and treatment of RTIs, brochures and handouts to patients about prudent use of antibiotics, and access to rapid point-of-care tests (POCTs).
A follow-up study in 2015 aimed to see if the intervention continued to have an impact. A total of 121 of the 210 physicians who registered in the initial study agreed to participate in the follow-up study, and their prescribing habits were compared with 117 physicians who had not been exposed to interventions on antibiotic prescribing.
The 238 physicians combined treated 22,247 patients with RTIs and prescribed antibiotics to 5,325 of them (23.9%). After adjustment for covariables, compared with the antibiotic prescribing observed just after the intervention was initially implemented in 2008, the 121 physicians in the intervention group prescribed slightly more antibiotics in 2015, although the difference was not statistically significant (odds ratio [OR], 1.08). But the physicians in the control group prescribed significantly more antibiotics (OR, 2.74).
The authors of the study conclude, "Changing clinicians' prescribing behaviour is a complex matter. Several strategies such as the provision of guidelines, poster display in the waiting rooms and even leaflets have limited effect. When active strategies are added to these passive educational sessions, such as the feedback and discussion of previous results, training in enhancing communication skills in the consultation and the provision of POCTs, the effect is much greater."
Apr 27 J Antimicrob Chemother study
Researchers identify variant MCR-3 colistin resistance gene in Brazil
Researchers analyzing Escherichia coli isolates from Brazilian pigs have identified a new variant MCR-3 colistin resistance gene, according to a study today in Antimicrobial Agents and Chemotherapy.
Scientists from Switzerland, Brazil, and France screened samples from 126 Brazilian pigs for colistin resistance. They identified eight colistin-resistant E coli isolates, including one from a pig in Minas Gerais state that contained an MCR-3 variant that they named MCR-3.12. It was carried by an IncA/C2 plasmid and had a similar function as MCR-1 and MCR-2.
Since the colistin resistance gene MCR-1 was first identified in Escherichia coli samples from pigs, pork products, and humans in China in 2015, it has been detected in more 30 countries, and MCR-2 through MCR-7 genes have been identified. Colistin is considered a last-resort antibiotic for treating infections caused by multidrug-resistant bacteria, and the plasmids containing MCR genes can transfer among different bacterial species, another cause for concern.
Apr 30 Antimicrob Agent Chemother abstract
Apr 18 CIDRAP News scan "New colistin resistance gene identified in Chinese poultry"
Africa analysis finds high levels of antibiotic-resistant H pylori
A study designed to provide a clearer picture of the burden of Helicobacter pylori antibiotic resistance, which is increasing worldwide, found that levels in Africa are high, an international team of researchers reported in a recent edition of BMC Infectious Diseases.
They noted that the prevalence of H pylori infection, which can cause peptic ulcers and gastric cancer, varies by geographic region and quantity of antibiotics used, with seropositive levels much higher in developing countries than in their developed counterparts.
In their meta-analysis, the team looked at 26 studies on H pylori resistance from 14 African countries that were published from 1986 to 2017. Their goal was to estimate the extent of resistance to macrolides, quinolones, amoxicillin, tetracycline, and metronidazole. In total, 2,085 isolates were tested for metronidazole, 1,530 for amoxicillin, 1,277 for tetracycline, 1,752 for clarithromycin, and 823 for quinolones.
Pooled proportion of H pylori resistance was 17.4% for quinolones, 29.2% for clarithromycin, 48.7% for tetracycline, 75.8% for metronidazole, and 72.6% for amoxicillin.
The authors wrote that treatment guidelines for managing H pylori infections in developing countries have recommended first, second, and rescue therapy based on local susceptibility patterns, but poor resources make following them a challenge, and eradication rates have been found to be lower than 80%. They noted that the metronidazole resistance they found in Africa was significantly higher than in Europe and America, and the use of the drug for treating endemic diarrheal and protozoal diseases might explain the high resistance rate seen in Africa.
The investigators said the level of clarithromycin resistance in Africa, which was similar to some other regions of the world, could be related to high used of macrolides for communicable diseases. The overall resistance they saw for amoxicillin was much higher than in other regions, which the team said might be related to ampicillin's role as one of the most abused antibiotics in rural and urban African areas, because oral formulations are cheap and available.
They added that there's a need to conduct standard surveillance of H pylori susceptibility patterns in Africa to yield data that can help establish effective empirical treatment.
Apr 24 BMC Infect Dis abstract