Stewardship / Resistance Scan for Jul 06, 2017

News brief

National guidelines in France tied to drop in ED antibiotic use

After France implemented national guidelines in 2011, antibiotic prescriptions for acute respiratory infections (ARIs) in children in emergency departments (EDs) dropped 31% over 3 years, representing more than 13,000 avoided antibiotic prescriptions, according to data presented yesterday in Clinical Infectious Diseases.

The multicenter, quasi-experimental, interrupted time series analysis of data from seven French pediatric EDs included all 242,534 patients with ARI from November 2009 to October 2014.

After national guidelines were implemented, antibiotic prescriptions for those cases fell 0.4% per 15-day period on average, for a cumulative drop of 30.9% by the end of the study period. This represented 13,136 antibiotic prescriptions avoided, the study authors said. They also noted that the relative percentage of broad-spectrum antibiotics prescribed dropped 62.7%; they were replaced with amoxicillin.
Jun 5 Clin Infect Dis abstract

UK researchers fine-tune diagnostic tool for serious bacterial infections

In a separate study involving children in the ED, UK researchers found that updating a published diagnostic model helped clinicians discriminate between pneumonia, serious bacterial infections (SBIs), and non-SBIs, representing a possible tool to bolster antibiotic stewardship.

The study, published yesterday in Pediatrics, involved 1,101 children younger than 16 years who had a fever and visited an ED, 264 of whom had an SBI. The investigators validated a published model for diagnosing pneumonia or other SBI in children, then updated it by including measures of procalcitonin and resistin.

In validating the published model, which incorporated various clinical symptoms, the authors reported that it discriminated well between pneumonia and no SBI (concordance statistic [CS], 0.85) and between other SBIs and no SBI (CS, 0.76). Refining the model with procalcitonin and resistin, however, led to even better results. In discrimination of pneumonia, CS increased from 0.88 to 0.90 (P = .03), and for other SBI models it increased from 0.82 to 0.84 (P = .03).

The researchers further reported that at a low-risk threshold for pneumonia, the extended pneumonia model had a sensitivity of 92% and a negative likelihood ratio of 0.12. For other SBIs, sensitivity was 92%, and negative likelihood ratio was 0.21. At a high-risk threshold, specificity was 89% for pneumonia and 86% for other SBIs.

The authors conclude, "Improvements in the classification of nonevents have the potential to reduce unnecessary hospital admissions and improve antibiotic prescribing. The benefits of this improved risk prediction should be further evaluated in robust impact studies."
Jul 5 Pediatrics study

Study finds high rate of MRSA in pediatric Staph infections in Taiwan

Almost two thirds of Staphylococcus aureus isolates from kids in northern Taiwan from 2004 to 2012 were methicillin-resistant S aureus (MRSA), and the MRSA proportion rose significantly, according to a study yesterday in BMC Infectious Diseases.

Scientists analyzed 409 S aureus isolates collected from a university hospital from 2004 to 2012 from patients younger than 19 years old. Of the total, 260 (63.6%) were MRSA. The percentage of MRSA-positive isolates rose from 48.5% in 2004-05 to 63.6% in 2012, a statistically significant increase. The highest rate, 69.3%, was recorded in both 2007 and 2011.

In addition, 181 (70%) of the 260 MRSA isolates were community-associated. Among those 181 patients, 157 (86.8%) had skin or soft-tissue infections, 13 (7.2%) had urinary tract infections, and 6 (3.3%) had pneumonia.
Jul 5 BMC Infect Dis study

News Scan for Jul 06, 2017

News brief

Monitoring winds down for contacts in Riyadh hospital clusters

Monitoring of contacts identified in three recent MERS-CoV hospital clusters in Riyadh, Saudi Arabia, ended on Jun 30, and no other cases have been detected, keeping the total number of people infected in the recent outbreaks to 49, the World Health Organization (WHO) said today in an update on the disease.

The WHO also provided details about three MERS-CoV (Middle East respiratory syndrome coronavirus) cases reported by Saudi Arabia between Jun 24 and Jul 3 and noted two deaths in previously reported patients.

Symptom onsets for the three surviving patients range from Jun 16 to Jun 27, and none of the people are healthcare workers. The patients are a 60-year-old man from Riyadh who has underlying health conditions from Riyadh, a 30-year-old woman from Dammam who had been exposed to camels, and a 70-year-old man from Al Bahah who has a chronic medical condition. The sources of infection aren't known for the two men.

Saudi health officials are monitoring the patients' contacts and investigating the source of the illnesses, the WHO said.

Since the virus was first detected in humans in 2012, the WHO has received reports of 2,040 MERS-CoV cases, at least 712 of them fatal.
Jun 6 WHO update

Saudi Arabia's Ministry of Health (MOH) in an update yesterday said one more MERS-CoV death has been reported in a previously announced patient, a 27-year-old expat in Riyadh who was not a health worker and who had a preexisting medical condition. So far the country has reported 1,674 cases, 682 of them fatal. Eight people are still being treated for their MERS-CoV infections.
Jun 5 Saudi MOH update

France makes recommended childhood vaccines mandatory

France's government announced yesterday that parents will be legally obligated to vaccinate their children, the Independent, an online newspaper based in Britain, reported.

Currently, three childhood vaccines are mandatory in France: diphtheria, tetanus, and polio. Others such as hepatitis and pertussis are recommended.

In announcing the move, Edouard Philippe, France's prime minister, said it was unacceptable that children are still dying of measles in a country where vaccines were pioneered based on the research of Louis Pasteur, according to the report. He added that all 11 vaccines recommended by French health officials will now be compulsory.

France is among the European countries that have reported recent measles outbreaks and recorded 79 cases in the first two months of 2017.

Because of similar concerns about unvaccinated children, Italy's government in May made 12 vaccines mandatory for school-age children.
Jul 5 Independent story

H5N8 avian flu hits backyard birds in northern France

France yesterday reported a new highly pathogenic H5N8 avian influenza outbreak, which struck a location just across the border from a facility in Belgium that reported a recent event, according to a report to the World Organization for Animal Health (OIE).

The French outbreak struck backyard birds near the city of Brillon in far northern France. The virus was found when authorities tested the flock after clinical signs were noted. Investigators said the location is about 9 miles from a recent outbreak in Tournai, Belgium, adding that the outbreak in France is probably related to the purchase of chicks in pigeons in a market in Tournai.

The outbreak began on Jun 26 and was declared resolved on Jun 29. Of 347 susceptible birds at the Brillon farm, the virus killed 150, and the surviving birds were culled to curb the spread of the virus.
Jul 5 OIE report on H5N8 in France