Analysis of Stewardship and Resistance for November 16, 2018

Australian data show that one-third of the antibiotics used in emergency rooms are not needed

An observational study conducted in Australia found that a third of antibiotic prescriptions in an emergency department were deemed inappropriate, according to a study conducted yesterday in the state of play . Journal of antimicrobial chemotherapy.

Researchers from Gold Coast University Hospital evaluated 1,019 patient presentations with an antibiotic prescription in the ER during a separate 4-week period in 2016, one in February, May, August, and November.

They determined that 640 prescriptions of antibiotics (62.8%) were appropriate, 333 (32.7%) were inappropriate and 46 (4.5%) were not evaluable. Adults were more likely to receive an inappropriate prescription of antibiotics than children (36.9% vs. 22.9%). Patients likely to have organ failure related to sepsis were also more likely to be prescribed inappropriate antibiotics (56.7% vs. 36.1%).

The researchers found no difference in inappropriate prescription rates in the emergency based on the patient 's gender, hospital admission status, the pattern of the patient. administration of antibiotics (treatment versus prophylaxis) or quarter-hour (day versus night).

The authors conclude: "With more than one antibiotic prescription out of three deemed inappropriate for emergencies, it is urgent to develop initiatives to improve the prescription of antibiotics to prevent harm to patients and to the community by antibiotics. "
November 15th J antimicrobic shirt study

Hospital in China drastically reduces antibiotics after start of its stewardship program

A study conducted in a single center in China reveals that after using an antimicrobial management program, the use of antibiotics was reduced by almost two-thirds and the rates of resistance to methicillin Staphylococcus aureus (MRSA) has dropped dramatically, according to a study published today at Epidemiology and infection.

Scientists have explored the trends and correlations between antibiotic consumption and drug resistance. S. aureus in a tertiary hospital of Jiaotong University in northwestern China from 2010 to 2016. They found that the use of antibiotics had dropped from 951.9 to 346.5 daily doses defined by 1,000 patient days, a reduction of 63.6%. The decrease was statistically significant for several classes of antibiotics, including cephalosporins, monobactams, aminoglycosides, imidazole derivatives, and macrolides.

The incidence of MRSA in S. aureus the number of isolates increased from 73.3% in 2010 to 41.4% in 2017, and this decrease was significantly correlated with lower consumption of several classes of antibiotics. The authors note that since the end of the study, resistance rates S. aureus remained significantly reduced and MRSA rates further decreased.
November 16th Epidemiol Infect study

A study of a decade reveals a high consumption of antibiotics in Poland

A ten-year study on antibiotic consumption in Poland published yesterday in Antimicrobial resistance and infection control have discovered a high consumption of these drugs compared to the rest of Europe and that their consumption has increased by 8% since 2007.

The study investigators used data from the Health Care Infections Surveillance Network of the European Center for Disease Prevention and Control (ECDC), combined with a review of the literature. They measured daily dose consumption per 1,000 population per day (DID).

They found that the use of antibiotics in the country had increased from 22.2 IDDs in 2007 to 23.9 in 2016, an increase of 8.3%, compared to the peak of 26.2 in 2015. This figure compares with a minimum of 10 DIDs in the Netherlands and a maximum of 36 DIDs in Greece, according to data from the ECDC. The figure ranks Poland 19th among the highest consumption rates among 23 European countries.

The report also notes that broad-spectrum antibiotic prescription rates are also high, at 25.8% of total antibiotics, which places Poland in 16 of the 23 countries. The broad-spectrum prescription rate is, however, falling in Poland.

The authors say that although the high rate of antibiotic consumption does not bode well for antibiotic resistance, the increase of 8% is well below the 36% global increase recorded in the world these past ten years.

The authors conclude that "since the limited educational activities of physicians and dentists can play an important role in current antibiotic consumption patterns, integrated actions focus on the appropriate prescription of antibiotics in pre- and post-training courses. – universities should be initiated and followed up in advance. [the] National level."
November 15th Antimicrobial Resistance Infect Control study

Swiss researchers report 7,000 cases of AMR and nearly 300 deaths a year

Swiss researchers estimate that antibiotic-resistant bacteria in the country cause more than 7,000 diseases and nearly 300 deaths a year, according to a letter from The Lancet Infectious Diseases.

In order to duplicate a study using ECDC data in 2015 for European Union countries, researchers applied the same methodology to data from the ECDC and the Swiss Antibiotic Resistance Center. of the same year.

They estimated that 7,156 cases of antibiotic-resistant bacteria occurred in 2015, including 276 deaths and 7,400 disability-adjusted life years (DALYs) lost. This corresponds to 85.0 cases, 3.3 deaths and 87.8 DALY per 100,000 inhabitants. The highest proportion of infections was caused by third-generation cephalosporin-resistant patients. Escherichia coli and Klebsiella pneumoniae.
November 15th Lancet Infect Dis letter