Stewardship / Resistance Scan for Feb 07, 2018

News brief

Survey finds knowledge and practice gaps among antibiotic prescribers

An online survey of frontline prescribers found mostly positive attitudes toward antimicrobial stewardship programs (ASPs) but also identified several specific deficiencies related to knowledge, prescribing practices, and awareness of available resources, according to a study yesterday in Infection Control and Hospital Epidemiology.

The anonymous online survey of antimicrobial prescribers was administered in 2015 at five acute care hospitals within a hospital network in New York. The 49-item survey included questions to assess the knowledge, attitudes, and practices of prescribers related to different aspects of antimicrobial prescribing. The objective of the survey was to identify opportunities for education and other interventions to optimize prescribing practices.

A total of 402 respondents completed the survey. The vast majority of respondents (89%) agreed that antimicrobial resistance is a problem, and almost all agreed that ASPs can reduce resistance (96%) and improve patient care and safety (94%). Yet 32% felt that their hospital's ASP delayed care.

In addition, several knowledge and practice gaps were identified. Nearly one third (32%) of respondents "usually" or "always" liked to use the most broad-spectrum antibiotics possible, and 29% chose an unnecessarily broad-spectrum antibiotic for treating Escherichia coli urinary tract infection with susceptibilities that were provided in the survey. Some respondents lacked confidence in selecting empiric therapy using hospital antibiograms (30%), interpreting susceptibility results (24%), de-escalating therapy (18%), and determining duration of therapy (31%). Only 55% reported always reviewing antimicrobial appropriateness at 48 to 72 hours.

Nearly half (45%) of respondents believed they had not received adequate training regarding antimicrobial prescribing, and 23% said they were unaware of local web-based empiric treatment guidelines.

"The results of this survey demonstrate that prescriber education is an important role of the ASP team and that there is no 'one size fits all' approach to education," the authors write. "Understanding the facilitators of and barriers to appropriate antimicrobial prescribing within a healthcare facility and among prescribers is critical to the successful implementation of ASPs."
Feb 6 Infect Control Hosp Epidemiol study

Chinese surveillance data show substantial gonorrhea resistance levels

An analysis of gonorrhea isolates from seven provinces across China found substantial resistance to azithromycin and decreased susceptibility to ceftriaxone, the two drugs recommended as first-line treatment for the disease in many countries but not as yet in China.

Chinese scientists conducted antibiotic susceptibility and resistance testing on 3,849 clinical Neisseria gonorrhoeae isolates from patients from 2013 to 2016. Defining resistance to azithromycin as a mean inhibitory concentration (MIC) of 1.0 milligrams per liter (mg/L) or higher and decreased susceptibility to ceftriaxone as an MIC of 0.125 mg/L or higher, they found an 18.6% resistance rate to azithromycin and a 10.8% prevalence of decreased susceptibility to ceftriaxone.

Overall prevalence of both qualities was 2.3% but increased from 1.9% to 3.3% over the study period, as reported yesterday in PLoS Medicine.

The authors conclude, "To our knowledge, this is the first national study on susceptibility of N. gonorrhoeae to azithromycin and ceftriaxone in China. . . . Although dual therapy with azithromycin and ceftriaxone has been recommended by [the World Health Organization] and many countries to treat gonorrhea, reevaluation of this therapy is needed prior to its introduction in China."

Monotherapy with ceftriaxone for uncomplicated gonorrhea is still the recommended regimen in China, the study authors say.
Feb 6 PLoS Med study

Aetna highlights its efforts to fight antimicrobial resistance

Healthcare benefits provider Aetna International has released a new white paper on the antimicrobial resistance crisis that highlights some of the strategies the company is using to address the problem.

One of the initiatives the company has undertaken with US healthcare providers focuses on acute bronchitis in adults. Using claims data, Aetna identified more than 1,000 providers who were overprescribing for the condition, which is generally viral in nature and doesn't benefit from antibiotics. Aetna researchers then sent letters to these providers that detailed their position relative to their peers and included information on antibiotic resistance from the Centers for Disease Control and Prevention.

In India, the company is taking a three-stage approach that emphasizes antimicrobial stewardship in clinical training, auditing of medical consultations and prescribing practices, and counseling patients about appropriate antibiotic use. Aetna says it's also supporting efforts by accrediting bodies to make antimicrobial stewardship a standard in hospitals and outpatient settings alike.

According to the paper, these and other efforts helped reduce antibiotic use across Aetna's membership population from 27% in 2014 to 18% in 2016.

"We at Aetna International are doing our part through proactive education, early intervention, data analysis, and an emphasis on value-based care," the company says in the paper. "We invite our members, customers, providers, and everyone else who is affected by this crisis—in other words, everyone on the planet—to join us."
Feb 1 Aetna International white paper

News Scan for Feb 07, 2018

News brief

WHO issues health advisory ahead of South Korea Olympic Games

In a joint statement today the World Health Organization (WHO) and South Korean health officials issued public health recommendations for people attending the upcoming winter Olympic and Paralympic Games in Pyeongchang.

The main threat is an increased risk of respiratory and gastrointestinal infections, and indoor crowding during the two events could increase the risk of the spread of those diseases. The groups noted that the Korea Centers for Disease Control and Prevention is reporting an increase in seasonal flu, mainly caused by influenza B and H3N2, an influenza A strain.

South Korea has experienced outbreaks of highly pathogenic H5N6 avian flu in wild birds and poultry, but no related human cases have been reported, and the risk of human illnesses is considered very low. The advisory warned of a small risk of imported respiratory diseases that aren't typically seen in South Korea, such as measles, diphtheria, and human avian flu.

Generally, the risk of food- and waterborne outbreaks is higher during large gatherings where crowds eat from food outlets, many of which are temporary, the WHO said.

At the global level, given multiple ongoing outbreaks of vaccine-preventable diseases such as measles, diphtheria, influenza, and mumps, the WHO urged those traveling to South Korea to consult their health providers to make sure they are up to date with recommended routine immunizations.
Feb 7 WHO statement

South Sudan declares end to cholera outbreak

With no new cholera cases reported in the past 7 weeks, South Sudan today declared the end of its longest and largest outbreak of the disease, the WHO Regional Office for Africa said today in a statement. Over the course of the outbreak, more than 20,000 infections, 436 of them fatal, were reported. The last confirmed case-patient was discharged on Dec 18.

The country's government worked with several aid agencies in its battle against cholera, which included receiving 2.2 million doses of oral cholera vaccine from a global stockpile funded by GAVI, the Vaccine Alliance. More than 885,000 people were vaccinated in the campaign's first round, and nearly 500,000 were immunized during the second round. Because of security challenges, however, not everyone received the recommended two doses.

Evans Liyosi, the WHO's acting representative to South Sudan, congratulated the country for tacking cholera, but he warned that the disease is endemic there and many risk factors remain, underscoring the importance of maintaining the capacity to detect and respond to new cases.

South Sudan is grappling with many complex health challenges, the WHO said. They include armed conflict that forced nearly 4 million people to flee their homes and food insecurity affecting more than 40% of the population.
Feb 7 WHO Africa statement