Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans
Paper calls for greater role for vaccines in AMR fight
Vaccines should play a larger role in the battle against antimicrobial resistance (AMR), according to a new paper from British think tank Chatham House.
The paper comes in the wake of last week's United Nations meeting on AMR, which produced a commitment to a broad range of interventions aimed at preserving the effectiveness of the world's antibiotics. While those interventions included the creation of new vaccines to prevent infections, the authors argue that the role of vaccines in minimizing antimicrobial use—and consequentially the selection pressure that drive resistance—is being underrated. If vaccines can prevent people from getting infections in the first place, then antibiotics won't be needed, the authors state.
"Among the proposed solutions for tackling AMR, vaccines are a major tool that eliminates the need for antimicrobials, and therefore the need for other interventions related to conserving the utility of such drugs," write David Heymann, MD, and Abbas Omaar, MSc, of Chatham House's Centre on Global Health Security.
An example they cite is the pneumococcal conjugate vaccine, one of three vaccines against bacteria that have been developed since 1980. The World Health Organization, which has placed the vaccine on its essential medicines list, estimates it could prevent as many as 1.6 million deaths from pneumonia each year. The additional benefit of the vaccine is that it reduces the need for the antibiotics that have become increasingly ineffective against Streptococcus pneumoniae. Vaccines against meningitis and Haemophilus influenzae, they argue, provide similar benefits.
Of course, Heymann and Omaar acknowledge, creating vaccines for every infectious disease is unrealistic, given that vaccine development is technically difficult and expensive. But then again so is antibiotic development, and new antibiotics will do nothing to solve the resistance problem. They argue that more efforts should be made to analyze the costs and benefits of developing new vaccines for AMR control relative to those for investing in stewardship and antibiotic development.
"This may strengthen understanding of the unique and dynamic role that conferring immunity to disease can play in tackling AMR," they write.
Sep 28 Chatham House paper "New vaccines are essential to fighting antimicrobial resistance"
New partnership will focus on antibiotic use in urgent care
A new partnership is aiming to reduce the inappropriate use of antibiotics in outpatient settings.
The Urgent Care Association of America (UCAOA) and the Antibiotic Resistance Action Center (ARAC) at Milken Institute School of Public Health at George Washington University announced this week that they've entered into a 3-year partnership to improve patient and clinician understanding of appropriate antibiotic use in the urgent care sector, which has become an increasingly convenient and affordable option for patients seeking treatment for minor ailments. An estimated 160 million patients visit urgent care sectors each year.
In many cases, urgent care patients are seeking quick treatment for acute, infectious disease–like symptoms such as cough and cold. And too often, the groups say, they are being improperly treated with antibiotics. Patient expectations, and the desire of doctors to keep patients happy, are contributing factors.
UCAOA and ARAC say they will work together to develop patient education programs, implement training and education programs for clinical and non-clinical staff, collect data on antibiotic prescribing, and promote evidence-based stewardship practices.
"We hope to begin by learning the best ways to communicate with patients that improves their understanding of when antibiotics are needed while also ensuring patients feel satisfied with their visits," ARAC Chief Medical Officer Cindy Liu, MD, MPH, said in a press release.
The groups said they hope their efforts will make the urgent care sector a leader in antibiotic stewardship.
Sep 26 Milken Institute School of Public Health press release
Study: Antibiotic use in small hospitals similar to larger facilities
A new study suggests small hospitals should be a target for efforts to improve antibiotic prescribing.
As reported today in Clinical Infectious Diseases, the study looked at antibiotic use in 15 small community hospitals (defined as having fewer than 200 beds) and 4 large community hospitals (200 beds or more) operated by Intermountain Healthcare, a nonprofit healthcare network in Utah and Idaho. Researchers evaluated antibiotic use at the hospitals from 2011 to 2013, using data from the National Healthcare and Safety Network antimicrobial use surveillance system.
Antibiotics were characterized based on spectrum of coverage, and use rates were expressed as days of therapy (DOT) per 1,000 patient days (PD).
Over the 3-year period, total antibiotic use rates at the small community hospitals varied greatly but were similar to rates at the large community hospitals, despite having a less complex patient population than the larger facilities. The researchers observed a median of 436 DOT/1,000 PD at the small hospitals and 509 DOT/1,000 PD at large hospitals. In addition, the proportion of broad-spectrum antibiotic use was similar. Broad-spectrum antibiotics accounted for 26% of total antibiotic use in the small hospitals and 32% in the large hospitals.
The authors say the study is significant because there's been little research done on antibiotic use at small community hospitals, which account for 72.4% of all US hospitals and therefore will play a major role in antibiotic stewardship efforts. And given the high rates of antibiotic use observed and the similar prescribing patterns compared with larger facilities, they conclude that implementing antibiotic stewardship programs (ASPs) at small hospitals is critical.
"With the majority of US hospitals having <200 beds and many without ASPs or infectious diseases support," they write, "helping small community hospitals improve antibiotic prescribing must become a priority for the infectious diseases community."
Sep 30 Clin Infect Dis abstract
Study: Copper-infused surfaces, linens could cut hospital-related infections
Originally published Sep 29.
A new study suggests that copper-impregnated countertops, bed rails, and linens could play a role in reducing healthcare-associated infections (HAIs).
The study, published yesterday in the American Journal of Infection Control, was conducted at a community hospital in Virginia that had replaced a 1970s-era clinical wing with a new wing in 2013. Patient rooms and select patient care clinical areas in the new wing were outfitted with 16% copper oxide–impregnated composite countertops (including sinks, vanities, and nurse workstations), composite molded surfaces (over-the-bed tray tables and bed rails), and linens (bed sheets, blankets, patient gowns, and towels).
The materials for the new wing were chosen because contaminated environmental surfaces in hospitals have been recognized as a potential source of healthcare-associated pathogens that can be passed to patients by healthcare workers. Previous studies have demonstrated that copper has potent biocidal activity against a broad spectrum of microorganisms.
For the quasi-experimental study, researchers assessed the development and rate of HAIs due to multidrug-resistant organisms (MDROs) or Clostridium difficile in 72 rooms of the new wing and 84 rooms of an older hospital wing that were equipped with standard surfaces and lines. The assessment took place from March to December 2014. They then compared the results with the rate of HAIs observed at the hospital in the year leading up the opening of the new wing (November 2012 through November 2013).
Overall, 23,899 hospitalized patients were evaluated during the study, with 13,928 observed during the baseline period and 9,961 observed during the assessment period (5,527 patients in the old wing, and 4,704 in the new wing). HAI prevention measures were implemented consistently throughout the hospital between the baseline period and the assessment period, and equally in both the new and old wings during the assessment period.
In the final analysis, the researchers found that patients in the new hospital wing had 78% fewer HAIs due to MDROs or C difficile compared with the baseline period, 83% fewer C difficile infections overall, and 68% fewer infections due to MDROs. Patients in the old wing saw no change in HAI rates.
Although the results show only an association, the authors say the findings indicate that antimicrobial surfaces and linens may have substantial influence in reducing HAIs due to problematic MDROs.
Sep 28 Am J Infect Control study
Rapid molecular tests tied to improved outcomes in bloodstream infections
Originally published Sep 29.
A meta-analysis of previously published studies has found that molecular rapid diagnostic testing (mRDT), when used in conjunction with an antibiotic stewardship program, is associated with improved clinical outcomes in bloodstream infections (BSIs).
The study, published this week in Clinical Infectious Diseases, looked at 31 studies involving 5,920 patients. The studies were evaluating the differences in clinical outcomes between mRDT and conventional microbiological methods for detecting organisms or resistance mechanisms, which have been used since the inception of microbiological sampling but are laborious and slow. The mRDT technologies included the following tests: polymerase chain reaction (PCR), matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), and peptide nucleic acid fluorescent in situ hybridization (PNA-FISH).
The purpose of the study was to provide a comprehensive assessment of mRDT on mortality, time to effective therapy, and length of stay compared with conventional methods in patients with BSIs. Rapid diagnostic tests in theory can improve clinical outcomes by identifying bacterial infections quicker than conventional methods and reducing the amount of time to effective antibiotic therapy. That's why they are recommended under the National Action Plan for Combating Antibiotic-Resistant Bacteria. But widespread implementation has been limited because of high costs and limited outcomes data.
Overall, the researchers found that the risk of mortality was significantly lower with mRDT compared with conventional methods, but only in the presence of an antibiotic stewardship program. Significant decreases in mortality risk were observed with both gram-positive and gram-negative organisms, but not with yeast. In addition, mRDT was associated with decreased time to effective therapy and decreased length of stay.
Based on the clinical outcomes observed in the studies, the authors conclude that mRDT should be considered part of standard care for patients with BSIs.
Sep 26 Clin Infect Dis study
'Handshake' antibiotic stewardship proves effective in hospital study
Originally published Sep 26.
A new study indicates that a less formal approach to antibiotic stewardship known as "handshake" stewardship can be an effective strategy for reducing antibiotic use in hospitals.
In the study, which was published today in the Pediatric Infectious Disease Journal, researchers at Children's Hospital Colorado retrospectively measured antimicrobial use at the hospital from October 2010 to September 2014. During this period, the hospital initiated an ASP that incorporated three main features: No restriction or preauthorization of antimicrobials, a review of all antimicrobials administered to patients by a stewardship team (an ASP doctor and a pharmacist), and in-person communication between the stewardship team and providers on the units during clinical rounds.
This strategy, coined handshake stewardship because a handshake provides personal contact and signifies "conveyance of trust," differs from most stewardship programs, which rely on preauthorization and restriction of certain antibiotics. The idea is to capitalize on direct communication between stewardship teams and doctors.
The study evaluated the program over three phases: Pre-implementation, planning, and post-implementation.
Following implementation, overall hospital-wide antimicrobial use decreased 10.9%, with antibacterial use decreasing 10.3%. Significant reductions in the use of vancomycin (25.7%) and meropenem (22.2%) were observed. Antifungal use decreased by 12.1%, and antiviral use dropped by 16.4%. Since most of the decreases occurred during the post-implementation phase, the authors concluded they were largely attributable to the handshake stewardship approach, rather than unrelated temporal trends or other stewardship activities.
October 2016 Pediatr Infect Dis J study
