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Source: http://www.cidrap.umn.edu/news-persp...an-feb-17-2017
Stewardship / Resistance Scan for Feb 17, 2017
Daptomycin for kids' MRSA; Antibiotics sans prescription; CRE source in the ICU
Filed Under:
Carbapenem-resistant Enterobacteriaceae; Antimicrobial Stewardship; MRSA
Daptomycin shown to be safe, effective in kids with MRSA skin infections
Daptomycin is well-tolerated and effective in children with invasive methicillin-resistant Staphylococcus aureus (MRSA) skin infections, according to the results of a clinical trial published this week in Pediatrics.
Safe and effective alternative therapies are needed for children with skin infections caused by community-acquired MRSA because of concerns about current treatments. The high doses of vancomycin that are needed to treat MRSA infections can cause kidney damage in children, and clindamycin, while well-tolerated, has resistance rates that exceed 10% to 15%. Linezolid, the other alternative agent, carries concerns about myelosuppression and neurotoxicity.
In the multicenter, evaluator-blinded clinical trial conducted at 23 children's hospitals in the United States and seven in India from July 2008 through October 2013, 389 patients from 1 to 17 years old who had complicated skin and skin structure infections (cSSSIs) were randomized 2:1 to receive intravenous (IV) daptomycin or standard-of-care (SOC) treatment (primarily clindamycin or vancomycin). The intent-to-treat population comprised 257 patients randomized to daptomycin and132 randomized to SOC. Over 40% of the infections with documented gram-positive pathogens were caused by MRSA.
The primary objective was to evaluate daptomycin safety. The secondary objective was to compare the efficacy of the treatments, but the study wasn't designed or powered to confirm non-inferiority.
The trial results showed that the proportion of treatment-related adverse events were similar between the two treatment groups, with 14% of patients experiencing adverse events in the daptomycin-treated group and 17% in the SOC-treated group. The most common adverse events were diarrhea and increased levels of the enzyme creatine phosphokinase (CPK) in the blood. Daptomycin was not associated with an increased risk of neurologic or muscular toxicity.
Clinical success rates were similar between the two groups, with 91% of the daptomycin patients and 87% of the SOC patients seeing complete or partial resolution of cSSSI symptoms 7 to 14 days after the end of treatment.
"Daptomycin should provide a safe and effective alternative to vancomycin, clindamycin or linezolid for IV treatment of invasive MRSA skin infections," first author John Bradley, MD, said in a press release from the University of California-San Diego (UCSD). Bradley is a professor of clinical pediatrics at UCSD School of Medicine.
The Food and Drug Administration is considering whether to approve daptomycin for use in children, according to the press release.
Feb 15 Pediatrics abstract
Feb 16 UCSD press release
No prescription required: Study looks at online pharmacies, antibiotic use
A study today in the Journal of Antimicrobial Chemotherapy reports that nearly half of online pharmacies available to residents of the United Kingdom don't require a prescription for the purchase of antibiotics.
In the small study, researchers from Imperial College London entered the search term "buy antibiotics online" into Google and Yahoo, then selected the first 10 unique Web sites that appeared on each search engine, for a sample size of 20. Though the sample size was small, the researchers say they represent a broad range of relevant sites.
Of the 20 online pharmacy sites reviewed, 5 showed evidence of operating in Great Britain. All 5 of those sites were registered with the General Pharmaceutical Council and the Medicines and Healthcare products Regulatory Agency (MHRA)?two groups that monitor and regulate UK pharmacies?and all 5 required a prescription before an antibiotic would be delivered. Fifteen of the Web sites did not have evidence of appropriate registration, which is required by law.
Overall, nine of the online pharmacies (45%) did not require a prescription for purchase of an antibiotic. In addition, 16 of the online pharmacies (80%) surveyed let the consumers choose the type of antibiotic, the dose, and the duration, although one of the pharmacies required customers to fill out a questionnaire after payment that would be reviewed by a doctor to assess an individual's suitability for an antibiotic. Only six of the online pharmacies required customers to complete a health questionnaire prior to purchase.
The investigators also found that antibiotics were advertised on several of the Web sites, a practice they note "is not congruent with current MHRA regulations."
The authors of the study say the findings raise concerns about the effectiveness of legislation, licensing, and regulation of online pharmacies in the United Kingdom. In addition, they highlight the need for patient education to be included in antibiotic stewardship initiatives.
"If the risks of inappropriate antibiotic use are not conveyed to patients there is concern that, as consumers, they may seek to obtain antibiotics from an alternative source," they write. "Education and public awareness campaigns should encourage prescribers to identify patients' ideas, concerns, and expectations, whilst fully explaining why they do not need an antibiotic."
Feb 17 J Antimicrob Chemother study
Report implicates CRE-contaminated sinks in ICU outbreak
An outbreak of carbapenem-resistant Enterobacteriaceae (CRE) at a Belgian hospital in 2015 was traced to contaminated sinks in an intensive care unit (ICU), according to a report yesterday in Antimicrobial Resistance & Infection Control.
Investigators at the University Hospital of Brussels noted that the incidence of CRE rose from 1 case in 2010 to 35 in 2015. They also reported that 5 of those patients became infected or colonized during their stay in the same ICU room from January to August of that year. Because of the timetable and the fact that the strains belonged to different species and had varied mechanisms of resistance, the team suspected environmental contamination.
Sampling revealed that seven of the eight sinks in the ICU were contaminated with CRE. The most frequently isolated strain from both the sinks and the patients was Citrobacter freundii type OXA-48, and genetic analysis showed a close relationship between the sinks and patients, pointing to source contamination. No positive samples were obtained from any of the other three ICUs in the hospital, each of which also house eight sinks.
After the sinks and plumbing were replaced, the sinks were flushed every morning with a glucoprotamin solution, and sink hygiene practices improved, no further cases were reported.
Feb 17 Antimicrob Resist Infect Control report
Stewardship / Resistance Scan for Feb 17, 2017
Daptomycin for kids' MRSA; Antibiotics sans prescription; CRE source in the ICU
Filed Under:
Carbapenem-resistant Enterobacteriaceae; Antimicrobial Stewardship; MRSA
Daptomycin shown to be safe, effective in kids with MRSA skin infections
Daptomycin is well-tolerated and effective in children with invasive methicillin-resistant Staphylococcus aureus (MRSA) skin infections, according to the results of a clinical trial published this week in Pediatrics.
Safe and effective alternative therapies are needed for children with skin infections caused by community-acquired MRSA because of concerns about current treatments. The high doses of vancomycin that are needed to treat MRSA infections can cause kidney damage in children, and clindamycin, while well-tolerated, has resistance rates that exceed 10% to 15%. Linezolid, the other alternative agent, carries concerns about myelosuppression and neurotoxicity.
In the multicenter, evaluator-blinded clinical trial conducted at 23 children's hospitals in the United States and seven in India from July 2008 through October 2013, 389 patients from 1 to 17 years old who had complicated skin and skin structure infections (cSSSIs) were randomized 2:1 to receive intravenous (IV) daptomycin or standard-of-care (SOC) treatment (primarily clindamycin or vancomycin). The intent-to-treat population comprised 257 patients randomized to daptomycin and132 randomized to SOC. Over 40% of the infections with documented gram-positive pathogens were caused by MRSA.
The primary objective was to evaluate daptomycin safety. The secondary objective was to compare the efficacy of the treatments, but the study wasn't designed or powered to confirm non-inferiority.
The trial results showed that the proportion of treatment-related adverse events were similar between the two treatment groups, with 14% of patients experiencing adverse events in the daptomycin-treated group and 17% in the SOC-treated group. The most common adverse events were diarrhea and increased levels of the enzyme creatine phosphokinase (CPK) in the blood. Daptomycin was not associated with an increased risk of neurologic or muscular toxicity.
Clinical success rates were similar between the two groups, with 91% of the daptomycin patients and 87% of the SOC patients seeing complete or partial resolution of cSSSI symptoms 7 to 14 days after the end of treatment.
"Daptomycin should provide a safe and effective alternative to vancomycin, clindamycin or linezolid for IV treatment of invasive MRSA skin infections," first author John Bradley, MD, said in a press release from the University of California-San Diego (UCSD). Bradley is a professor of clinical pediatrics at UCSD School of Medicine.
The Food and Drug Administration is considering whether to approve daptomycin for use in children, according to the press release.
Feb 15 Pediatrics abstract
Feb 16 UCSD press release
No prescription required: Study looks at online pharmacies, antibiotic use
A study today in the Journal of Antimicrobial Chemotherapy reports that nearly half of online pharmacies available to residents of the United Kingdom don't require a prescription for the purchase of antibiotics.
In the small study, researchers from Imperial College London entered the search term "buy antibiotics online" into Google and Yahoo, then selected the first 10 unique Web sites that appeared on each search engine, for a sample size of 20. Though the sample size was small, the researchers say they represent a broad range of relevant sites.
Of the 20 online pharmacy sites reviewed, 5 showed evidence of operating in Great Britain. All 5 of those sites were registered with the General Pharmaceutical Council and the Medicines and Healthcare products Regulatory Agency (MHRA)?two groups that monitor and regulate UK pharmacies?and all 5 required a prescription before an antibiotic would be delivered. Fifteen of the Web sites did not have evidence of appropriate registration, which is required by law.
Overall, nine of the online pharmacies (45%) did not require a prescription for purchase of an antibiotic. In addition, 16 of the online pharmacies (80%) surveyed let the consumers choose the type of antibiotic, the dose, and the duration, although one of the pharmacies required customers to fill out a questionnaire after payment that would be reviewed by a doctor to assess an individual's suitability for an antibiotic. Only six of the online pharmacies required customers to complete a health questionnaire prior to purchase.
The investigators also found that antibiotics were advertised on several of the Web sites, a practice they note "is not congruent with current MHRA regulations."
The authors of the study say the findings raise concerns about the effectiveness of legislation, licensing, and regulation of online pharmacies in the United Kingdom. In addition, they highlight the need for patient education to be included in antibiotic stewardship initiatives.
"If the risks of inappropriate antibiotic use are not conveyed to patients there is concern that, as consumers, they may seek to obtain antibiotics from an alternative source," they write. "Education and public awareness campaigns should encourage prescribers to identify patients' ideas, concerns, and expectations, whilst fully explaining why they do not need an antibiotic."
Feb 17 J Antimicrob Chemother study
Report implicates CRE-contaminated sinks in ICU outbreak
An outbreak of carbapenem-resistant Enterobacteriaceae (CRE) at a Belgian hospital in 2015 was traced to contaminated sinks in an intensive care unit (ICU), according to a report yesterday in Antimicrobial Resistance & Infection Control.
Investigators at the University Hospital of Brussels noted that the incidence of CRE rose from 1 case in 2010 to 35 in 2015. They also reported that 5 of those patients became infected or colonized during their stay in the same ICU room from January to August of that year. Because of the timetable and the fact that the strains belonged to different species and had varied mechanisms of resistance, the team suspected environmental contamination.
Sampling revealed that seven of the eight sinks in the ICU were contaminated with CRE. The most frequently isolated strain from both the sinks and the patients was Citrobacter freundii type OXA-48, and genetic analysis showed a close relationship between the sinks and patients, pointing to source contamination. No positive samples were obtained from any of the other three ICUs in the hospital, each of which also house eight sinks.
After the sinks and plumbing were replaced, the sinks were flushed every morning with a glucoprotamin solution, and sink hygiene practices improved, no further cases were reported.
Feb 17 Antimicrob Resist Infect Control report