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Source: http://www.cidrap.umn.edu/news-persp...an-may-23-2019
Stewardship / Resistance Scan for May 23, 2019
Urgent sepsis antibiotics; Resistant Pseudomonas from Mexico
Filed Under:
Antimicrobial Stewardship
Study links lower triage scores to delayed sepsis antibiotics
Sepsis patients who received a slightly higher emergency department (ED) triage score received antibiotics faster, a crucial step for survival, researchers from Intermountain Medical Center reported yesterday at the American Thoracic Society annual meeting under way in Dallas.
For the study, the team looked at adult sepsis patients who were treated at four Intermountain EDs in Utah from July 2013 to January 2017, according to an Intermountain press release. The EDs use a common five-point acuity score, with one being most in need of immediate care and five the least. They focused on patients with mid-range scores of 2 (emergent) and 3 (urgent) who had abnormally low blood pressures. Of 799 patients, 591 has a score of 2 and 208 had a score of 3. Then they gauged how quickly the patients received antibiotics.
Those who had triage scores of 3 had door-to-antibiotic times that were 32 minutes longer than those assigned a score of 2.
Ithan D. Peltan, MD, MSc, the study's senior author and attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit and Intermountain Healthcare Telecritical Care, said in the statement that federal and international standards encourage starting broad-spectrum antibiotics within 3 hours of a sepsis patient's ED arrival. "Those 32 minutes can make a major difference in a patient's chances for survival."
May 22 Intermountain Medical Center press release
Report on superbugs from Mexico highlights medical tourism dangers
Officials from the Centers for Disease Control and Prevention (CDC) and seven state health departments today provided new details on 12 US patients who contracted Verona integron?encoded metallo-beta-lactamase?producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) tied to medical procedures in Mexico?and how the infections could pose a risk to US hospitals.
Reporting in Morbidity and Mortality Weekly Report (MMWR), the investigators say the CDC received 31 reports of VIM-CRPA through its Antibiotic Resistance Laboratory Network from Sep 18 through Nov 19, 2018. Six of those cases were tied to invasive medical procedures in Mexico. After the CDC alerted healthcare professionals about the risk, six more cases came to light.
The 12 patients were from seven states: Utah, Washington, Arizona, Arkansas, Oregon, Texas, and West Virginia. Specimen collection ranged from November 2015 through December 2018. Eleven of the patients were medical tourists?they had traveled to Mexico specifically for bariatric surgery?and the 12th underwent endoscopic cholangiopancreatography in September 2018 after falling ill while traveling. Six patients were hospitalized in the United States for their VIM-CRPA infections, and one who developed a bloodstream infection died. Previous reports have noted that the infections have been tied to Grand View Hospital in Tijuana.
"This investigation highlights the potential for acquiring infections with highly antibiotic-resistant organisms not commonly found in the United States when receiving health care abroad that, once imported into this country, can spread within U.S. health care facilities," the authors write.
They add, "Any patient with an overnight stay in a health care facility outside the United States in the preceding 6 months should undergo rectal screening for carbapenemases on admission to a U.S. health care facility."
On Mar 5, the World Health Organization said 20 people in nine states were tied to the outbreak.
May 24 MMWR report
Mar 5 CIDRAP News scan
Stewardship / Resistance Scan for May 23, 2019
Urgent sepsis antibiotics; Resistant Pseudomonas from Mexico
Filed Under:
Antimicrobial Stewardship
Study links lower triage scores to delayed sepsis antibiotics
Sepsis patients who received a slightly higher emergency department (ED) triage score received antibiotics faster, a crucial step for survival, researchers from Intermountain Medical Center reported yesterday at the American Thoracic Society annual meeting under way in Dallas.
For the study, the team looked at adult sepsis patients who were treated at four Intermountain EDs in Utah from July 2013 to January 2017, according to an Intermountain press release. The EDs use a common five-point acuity score, with one being most in need of immediate care and five the least. They focused on patients with mid-range scores of 2 (emergent) and 3 (urgent) who had abnormally low blood pressures. Of 799 patients, 591 has a score of 2 and 208 had a score of 3. Then they gauged how quickly the patients received antibiotics.
Those who had triage scores of 3 had door-to-antibiotic times that were 32 minutes longer than those assigned a score of 2.
Ithan D. Peltan, MD, MSc, the study's senior author and attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit and Intermountain Healthcare Telecritical Care, said in the statement that federal and international standards encourage starting broad-spectrum antibiotics within 3 hours of a sepsis patient's ED arrival. "Those 32 minutes can make a major difference in a patient's chances for survival."
May 22 Intermountain Medical Center press release
Report on superbugs from Mexico highlights medical tourism dangers
Officials from the Centers for Disease Control and Prevention (CDC) and seven state health departments today provided new details on 12 US patients who contracted Verona integron?encoded metallo-beta-lactamase?producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) tied to medical procedures in Mexico?and how the infections could pose a risk to US hospitals.
Reporting in Morbidity and Mortality Weekly Report (MMWR), the investigators say the CDC received 31 reports of VIM-CRPA through its Antibiotic Resistance Laboratory Network from Sep 18 through Nov 19, 2018. Six of those cases were tied to invasive medical procedures in Mexico. After the CDC alerted healthcare professionals about the risk, six more cases came to light.
The 12 patients were from seven states: Utah, Washington, Arizona, Arkansas, Oregon, Texas, and West Virginia. Specimen collection ranged from November 2015 through December 2018. Eleven of the patients were medical tourists?they had traveled to Mexico specifically for bariatric surgery?and the 12th underwent endoscopic cholangiopancreatography in September 2018 after falling ill while traveling. Six patients were hospitalized in the United States for their VIM-CRPA infections, and one who developed a bloodstream infection died. Previous reports have noted that the infections have been tied to Grand View Hospital in Tijuana.
"This investigation highlights the potential for acquiring infections with highly antibiotic-resistant organisms not commonly found in the United States when receiving health care abroad that, once imported into this country, can spread within U.S. health care facilities," the authors write.
They add, "Any patient with an overnight stay in a health care facility outside the United States in the preceding 6 months should undergo rectal screening for carbapenemases on admission to a U.S. health care facility."
On Mar 5, the World Health Organization said 20 people in nine states were tied to the outbreak.
May 24 MMWR report
Mar 5 CIDRAP News scan