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Source: http://www.cidrap.umn.edu/news-persp...an-oct-18-2018
Stewardship / Resistance Scan for Oct 18, 2018
AST barriers; AMR surveillance in South Korea; Biomarkers and sepsis management
Filed Under:
Sepsis; Antimicrobial Stewardship
Paper lays out hurdles for developing rapid antibiotic susceptibility tests
An international group of specialists from hospitals, research institutes, public health agencies, and diagnostics firms yesterday published a paper outlining the challenges to developing novel and rapid antibiotic susceptibility tests (ASTs). The consensus statement was published in Nature Reviews Microbiology.
ASTs are necessary to ensure that patients with bacterial infections get the most appropriate treatment. They also enable healthcare facilities to collect data on local patterns of antibiotic resistance; this data can be used to craft policies guiding empiric antibiotic therapy and to design strategic actions to control the spread of antibiotic-resistant pathogens. But current AST methods are time consuming (between 12 and 48 hours), and even currently available rapid tests take several hours and lack full automation. And when infections are severe, a delay in appropriate treatment can be the difference between life and death.
"Therefore, to facilitate targeted (and personalized) antimicrobial prescribing practices and to help reduce the increasing global burden of antibiotic resistance, there is an urgent need for the development and implementation of novel and truly rapid AST platforms (that is, results being available in 30 min to 1 h)," the authors write.
But the development of widely used rapid AST platforms has been slow over the past decade, the authors explain, for a variety of reasons. These include complex legal and regulatory landscapes; a complicated, multi-step development process that favors large diagnostics companies over small- and medium-sized enterprises; issues with quality and quality control; and difficulties in demonstrating the clinical utility, validity, and cost-effectiveness of new ASTs.
The authors say they hope that laying out these challenges will lead to increased dialogue between AST developers and end users and, ultimately, improve patient care.
"Better communication about the importance of AST should lead to better collaboration between the public, academia, patient groups, policy makers and industry," they write. "Understanding AST platform development and implementation issues will lead to a better understanding of the barriers and solutions required by public and private entities in maximizing the availability and use of (new and rapid) AST platforms."
Oct 17 Nat Rev Microbiol paper
Report shows results from new South Korean AMR surveillance system
Scientists from South Korea today published the first year of results from the government's new antimicrobial resistance (AMR) surveillance system, Kor-GLASS, which is modeled after the World Health Organization's Global AMR Surveillance System. The findings, along with a description of how Kor-GLASS was established, appear in Eurosurveillance.
From May 2016 through April 2017, non-duplicated isolates of major pathogens from blood, urine, feces, and urethral and cervical swabs were collected from six sentinel hospitals and tested at a central laboratory. Among 67,803 blood cultures, 3,523 target pathogens were recovered; Escherichia coli (1,536 isolates), Klebsiella pneumoniae (597), and Staphylococcus aureus (584) were the predominant bacterial species identified. Among 57,477 urine cultures, 6,394 E coli and 1,097 K pneumoniae isolates were recovered. From 12,782 stool cultures, 77 Salmonella spp. were recovered. None of the 3,111 genital cultures were positive for Neisseria gonorrhoeae.
Analysis of AMR prevalence in the major pathogens showed that 54.3% of the S aureus isolates were methicillin-resistant, 34.7% of E coli blood isolates and 27.0% of K pneumoniae blood isolates were resistant to cefotaxime, and 29.0% of Enterococcus faecium isolates were resistant to vancomycin. While resistance rates in E coli urine isolates were similar to those in blood isolates, K pneumonia urine isolates exhibited higher rates of resistance than K pneumoniae blood isolates. In addition, carbapenem and colistin resistance were identified more frequently in K pneumoniae blood and urine isolates than E coli blood and urine isolates. Among Acinetobacter baumannii isolates, 76.1% were multidrug-resistant, and 13.8% were extensively drug-resistant.
Bloodstream infections in inpatients per 10,000 patient-days were highest for cefotaxime-resistant E coli with 2.1, followed by 1.6 for methicillin-resistant S aureus, 1.1 for imipenem-resistant A baumannii, 0.8 for cefotaxime-resistant K pneumoniae, and 0.4 for vancomycin-resistant E faecium. Urinary tract infections in inpatients were 7.7 and 2,1 per 10,000 patient-days for cefotaxime-resistant E coli and K pneumoniae, respectively.
The authors of the report say that the country's previous AMR surveillance system had two notable limitations: AST methods were not well-harmonized across the participating clinical laboratories, and duplicated isolates were not filtered out. This created problems with reliability and potential overestimation of national AMR rates. They believe the results from the first year of Kor-GLASS show that the system is reliable, devoid of collection bias or isolate duplication, and can be expanded to include more sentinel hospitals and cover more pathogens.
"Beyond monitoring AMR, this system is a useful tool for public health authorities to deal with AMR," they write. "Kor-GLASS's successful AMR monitoring system has encouraged the South Korean government to establish a 'one health' approach for AMR in 2017 and to further develop the project by 2019."
Oct 18 Eurosurveill surveillance and outbreak report
Oct 18 Eurosurveill perspective
Study profiles use of procalcitonin and other biomarkers for sepsis
Researchers who looked at the use of biomarkers to guide clinical assessment and treatment in sepsis patients found that use of procalcitonin (PCT) increased sixfold over the 4-year study period, while lactate and C-reactive protein use remained level. They reported their findings yesterday in Public Library of Science (PLOS) One.
In the US retrospective observational study, the team analyzed adult sepsis discharges from 2012 through 2015. Of 933,591 adult sepsis discharges during the study period, 731,392 (78%) had biomarker testing.
Researchers also found that PCT use was linked to decreased odds of in-hospital mortality but increased hospital costs per day. It was also associated with increased antimicrobial use and increased length of stay. They also noted that serial biomarker monitoring may be connected to improved outcomes in the most critically ill patients
Oct 17 PLOS One report
Stewardship / Resistance Scan for Oct 18, 2018
AST barriers; AMR surveillance in South Korea; Biomarkers and sepsis management
Filed Under:
Sepsis; Antimicrobial Stewardship
Paper lays out hurdles for developing rapid antibiotic susceptibility tests
An international group of specialists from hospitals, research institutes, public health agencies, and diagnostics firms yesterday published a paper outlining the challenges to developing novel and rapid antibiotic susceptibility tests (ASTs). The consensus statement was published in Nature Reviews Microbiology.
ASTs are necessary to ensure that patients with bacterial infections get the most appropriate treatment. They also enable healthcare facilities to collect data on local patterns of antibiotic resistance; this data can be used to craft policies guiding empiric antibiotic therapy and to design strategic actions to control the spread of antibiotic-resistant pathogens. But current AST methods are time consuming (between 12 and 48 hours), and even currently available rapid tests take several hours and lack full automation. And when infections are severe, a delay in appropriate treatment can be the difference between life and death.
"Therefore, to facilitate targeted (and personalized) antimicrobial prescribing practices and to help reduce the increasing global burden of antibiotic resistance, there is an urgent need for the development and implementation of novel and truly rapid AST platforms (that is, results being available in 30 min to 1 h)," the authors write.
But the development of widely used rapid AST platforms has been slow over the past decade, the authors explain, for a variety of reasons. These include complex legal and regulatory landscapes; a complicated, multi-step development process that favors large diagnostics companies over small- and medium-sized enterprises; issues with quality and quality control; and difficulties in demonstrating the clinical utility, validity, and cost-effectiveness of new ASTs.
The authors say they hope that laying out these challenges will lead to increased dialogue between AST developers and end users and, ultimately, improve patient care.
"Better communication about the importance of AST should lead to better collaboration between the public, academia, patient groups, policy makers and industry," they write. "Understanding AST platform development and implementation issues will lead to a better understanding of the barriers and solutions required by public and private entities in maximizing the availability and use of (new and rapid) AST platforms."
Oct 17 Nat Rev Microbiol paper
Report shows results from new South Korean AMR surveillance system
Scientists from South Korea today published the first year of results from the government's new antimicrobial resistance (AMR) surveillance system, Kor-GLASS, which is modeled after the World Health Organization's Global AMR Surveillance System. The findings, along with a description of how Kor-GLASS was established, appear in Eurosurveillance.
From May 2016 through April 2017, non-duplicated isolates of major pathogens from blood, urine, feces, and urethral and cervical swabs were collected from six sentinel hospitals and tested at a central laboratory. Among 67,803 blood cultures, 3,523 target pathogens were recovered; Escherichia coli (1,536 isolates), Klebsiella pneumoniae (597), and Staphylococcus aureus (584) were the predominant bacterial species identified. Among 57,477 urine cultures, 6,394 E coli and 1,097 K pneumoniae isolates were recovered. From 12,782 stool cultures, 77 Salmonella spp. were recovered. None of the 3,111 genital cultures were positive for Neisseria gonorrhoeae.
Analysis of AMR prevalence in the major pathogens showed that 54.3% of the S aureus isolates were methicillin-resistant, 34.7% of E coli blood isolates and 27.0% of K pneumoniae blood isolates were resistant to cefotaxime, and 29.0% of Enterococcus faecium isolates were resistant to vancomycin. While resistance rates in E coli urine isolates were similar to those in blood isolates, K pneumonia urine isolates exhibited higher rates of resistance than K pneumoniae blood isolates. In addition, carbapenem and colistin resistance were identified more frequently in K pneumoniae blood and urine isolates than E coli blood and urine isolates. Among Acinetobacter baumannii isolates, 76.1% were multidrug-resistant, and 13.8% were extensively drug-resistant.
Bloodstream infections in inpatients per 10,000 patient-days were highest for cefotaxime-resistant E coli with 2.1, followed by 1.6 for methicillin-resistant S aureus, 1.1 for imipenem-resistant A baumannii, 0.8 for cefotaxime-resistant K pneumoniae, and 0.4 for vancomycin-resistant E faecium. Urinary tract infections in inpatients were 7.7 and 2,1 per 10,000 patient-days for cefotaxime-resistant E coli and K pneumoniae, respectively.
The authors of the report say that the country's previous AMR surveillance system had two notable limitations: AST methods were not well-harmonized across the participating clinical laboratories, and duplicated isolates were not filtered out. This created problems with reliability and potential overestimation of national AMR rates. They believe the results from the first year of Kor-GLASS show that the system is reliable, devoid of collection bias or isolate duplication, and can be expanded to include more sentinel hospitals and cover more pathogens.
"Beyond monitoring AMR, this system is a useful tool for public health authorities to deal with AMR," they write. "Kor-GLASS's successful AMR monitoring system has encouraged the South Korean government to establish a 'one health' approach for AMR in 2017 and to further develop the project by 2019."
Oct 18 Eurosurveill surveillance and outbreak report
Oct 18 Eurosurveill perspective
Study profiles use of procalcitonin and other biomarkers for sepsis
Researchers who looked at the use of biomarkers to guide clinical assessment and treatment in sepsis patients found that use of procalcitonin (PCT) increased sixfold over the 4-year study period, while lactate and C-reactive protein use remained level. They reported their findings yesterday in Public Library of Science (PLOS) One.
In the US retrospective observational study, the team analyzed adult sepsis discharges from 2012 through 2015. Of 933,591 adult sepsis discharges during the study period, 731,392 (78%) had biomarker testing.
Researchers also found that PCT use was linked to decreased odds of in-hospital mortality but increased hospital costs per day. It was also associated with increased antimicrobial use and increased length of stay. They also noted that serial biomarker monitoring may be connected to improved outcomes in the most critically ill patients
Oct 17 PLOS One report