Study finds improper empiric therapy not tied to worse UTI outcomes
A University of Toronto study has discovered no connection between adequate empiric antibiotic therapy and cure time for patients with urinary tract infections (UTIs) caused by bacteria, suggesting a potential for sparing antibiotics, according to a study yesterday in Clinical Microbiology and Infection.
For the retrospective cohort study, the investigators enrolled all patients 16 years and older admitted to Sunnybrook Health Sciences Centre from Apr 1, 2000, to Jul 15, 2015 who had a first episode of bacteremic UTI. They then classified them as to whether they had adequate or inadequate antibiotic therapy within 24 hours of culture collection. They defined adequate therapy as receipt of at least one dose of an empiric antibiotic active in vitro against the infecting pathogen, based on lab-reported susceptibility tests.
The researchers noted that 368 (78.5%) of the 469 patients received adequate empiric antibiotic therapy. But they found no statistical difference between those patients and the patients who were prescribed inadequate empiric antibiotics in mortality, time-to-cure, or time-to-normalization.
The authors conclude, "Our findings add to a body of literature challenging the notion that early empiric therapy is necessary for good outcomes in patients with UTI." They add, "It may be appropriate to accept a higher risk threshold when choosing empiric antibiotic regimens, even in centres with high rates of resistant uropathogens."
Mar 4 Clin Microbiol Infect study
Surgery-linked resistant Pseudomonas from Mexico sickens 20 in 9 states
The World Health Organization (WHO) today said 20 adults in nine states have contracted antibiotic-resistant Pseudomonas aeruginosa after invasive procedures performed in Tijuana, Mexico.
Sixteen of the cases have been confirmed, the WHO said, and the rest are suspected. A confirmed case is defined as Verona integron-encoded metallo-beta-lactamase–producing carbapenem-resistant P. aeruginosa (VIM-CRPA) isolated from a patient.
On Jan 9, the US Centers for Disease Control and Prevention (CDC) issued a travel advisory over the cluster of infections but did not cite the number of cases or give many specifics. On Feb 13 the Public Health Agency of Canada followed suit in posting a travel advisory.
The WHO said in today's update that 2 of the 20 case were retrospectively identified and occurred in 2015 and 2017, but the other 18 infections occurred from Sep 5, 2018, to Jan 24, 2019. Fifteen patients reported having surgery, primarily for weight loss, at Grand View Hospital in Tijuana.
"Half of the total cases reported the use of the same medical tourism travel agency based in the United States to coordinate their surgical procedure in Mexico," the WHO said. The travel agency has referred patients to Grand View from the United States, Canada, and elsewhere.
Thirteen patients were hospitalized in the United States for complications associated with VIM-CRPA infections, and most had surgical-site infections. One patient who had a bloodstream infection and several underlying conditions died. Of the 17 patients with available information, 14 (82%) were female, and they ranged in age from 29 to 62 years.
The WHO says it will continue to monitor the situation.
Mar 5 WHO news release
Jan 10 CIDRAP News scan on CDC alert
Interventions fail to lower hospital-acquired infections except in subset
Two infection control practices for bacterial infections—including those caused by methicillin-resistant Staphylococcus aureus (MRSA)—failed to reduce hospital-acquired infections, except in patients being treated with medical devices, according to a very large study today in The Lancet.
The ABATE (Active Bathing to Eliminate) Infection trial, sponsored by the National Institutes of Health (NIH), evaluated whether daily bathing with the antiseptic soap chlorhexidine—and, in patients with MRSA, adding the nasal antibiotic mupirocin—more effectively reduced hospital-acquired bacterial infections than bathing with ordinary soap and water. Researchers enrolled 333,000 patients in 48 hospitals in the HCA Healthcare system for the 21-month study, which amounted to 1.3 million days of care.
Among all patients, the scientists found no statistically significant difference between the study arms. Patients with medical devices, however, such as central venous catheters or lumbar drains, benefitted from the chlorhexidine-mupirocin intervention. Among those patients, investigators recorded a 30% decrease in bloodstream infections and a nearly 40% drop in antibiotic-resistant bacteria, including MRSA and vancomycin-resistant enterococcus.
"The results of the ABATE Infection trial are already being incorporated into infection prevention efforts," Jonathan Perlin, MD, PhD, chief medical officer of HCA Healthcare and a study co-author, said in an NIH news release. "The HCA system is using this decolonization strategy as a best practice for patients with medical devices across our 179 affiliated hospitals."
Mar 5 Lancet study
Mar 5 NIH news release