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CIDRAP Stewardship/Resistance Scan - Staph decolonization cost savings; Delayed valley fever diagnosis; Novel antibiotic candidates

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  • CIDRAP Stewardship/Resistance Scan - Staph decolonization cost savings; Delayed valley fever diagnosis; Novel antibiotic candidates


    Stewardship / Resistance Scan for Jul 12, 2019
    Staph decolonization cost savings; Delayed valley fever diagnosis; Novel antibiotic candidates

    Filed Under:
    Antimicrobial Stewardship; Diagnostics; MRSA

    Staph decolonization before joint replacement could cut costs, infections

    A cost-effectiveness analysis indicates a Staphylococcus aureus decolonization protocol for patients undergoing hip and knee replacement could result in cost savings and fewer surgical-site infections (SSIs), Canadian researchers reported yesterday in Antimicrobial Resistance and Infection Control.
    For the study, researchers from the University of Calgary and the University of Alberta used decision analytic models and a probabilistic sensitivity analysis (PSA) to evaluate the cost-effectiveness of an S aureus decolonization protocol previously studied in US patients undergoing hip and knee arthroplasty. In a 2012 trial, the protocol, in which patients at 16 US hospitals received chlorhexidine gluconate baths and twice-daily 2% intranasal mupirocin 5 days before surgery, was found to cut the rate of complex S aureus SSIs in half.
    Using data from a hypothetical cohort of nearly 25,000 adult patients who underwent hip and knee replacement in Alberta from April 2012 through March 2015, the analysis found that the average cost for those receiving the decolonization protocol was $20,525, compared with $20,678 for those who received standard care, a cost saving of $153 per person, which would translate into savings of $1.26 million per year. The risk of developing a complex S aureus SSI was reduced from 0.4% to 0.2%. The PSA determined the decolonization protocol would be more effective and less expensive 84% of the time.
    "Given our findings, we believe health systems should implement a decolonization protocol prior to hip and knee arthroplasty and continue surveillance of complex SSIs to determine if there is a reduction as anticipated," the authors of the study write.
    Jul 11 Antimicrob Resist Infect Control study

    Delayed valley fever diagnosis linked to excess costs, antibiotics

    A review of patients with coccidioidomycocis (valley fever) has found that nearly 90% had a delay in diagnosis, and such delays were associated with excess costs and extensive antibacterial use, University of Arizona researchers reported yesterday in Emerging Infectious Diseases.
    The retrospective review looked at the medical charts of 815 patients in Tucson, a coccidioidomycosis-endemic area, who sought care from January 2015 through September 2017. After excluding patients who had prior coccidiodomycosis, mistaken coding, and unconfirmed diagnoses, the researchers identified 276 patients with coccidioidomycosis. Of those, 30 (11%) received a diagnosis at presentation and 246 (89%) had a delay of more than a day, with 43% having a delay of more than a month.
    Delayed diagnosis was associated with $589,053 in coccidioidomycosis-related costs, and 1,103 antibacterial medication orders submitted before coccidioidomycosis diagnosis. Vancomycin and daptomycin constituted 22% of antibacterial drugs ordered.
    The authors of the study say the problem is that without specific laboratory confirmation, coccidioidomycosis, which typically manifests as a respiratory syndrome, cannot be distinguished from community-acquired pneumonia. Yet the necessary tests are conducted in less than 13% of patients with community-acquired pneumonia in urban Arizona ambulatory departments, and in only 2.8% of emergency-department patients.
    "Our results suggest earlier diagnosis will lower costs and provide secondary benefits including patient reassurance, decreased antibacterial drug use, and improved antibiotic stewardship," they write. "This study reinforces the ongoing challenge to increase coccidioidomycosis awareness for healthcare providers and the urgent need to improve the ease, rapidity, and reliability of coccidioidomycosis testing."
    Jul 11 Emerg Infect Dis dispatch

    French scientists identify promising novel antibiotic class

    A team of French scientists has developed a novel class of antibiotics based on a natural bacterial toxin, according to a paper this week in PLOS Biology.
    The team of scientists from Université de Rennes and Inserme, a French public research organization, designed and synthesized the compounds, called peptidomimetics, by imitating a section of a toxin produced by S aureus to kill other bacteria (PepA). In tests against a broad range of gram-positive and gram-negative pathogens, two of four peptidomimetics developed by the team (Pep16 and Pep19) demonstrated effectiveness against methicillin-resistant S aureus (MRSA) in mild and severe sepsis mouse models, and against Pseudomonas aeruginosa and MRSA in a mouse skin infection model.
    Testing of the compounds on human erythrocytes and kidney cells, zebrafish embryos, and mice showed no toxicity. In addition, after 2 weeks of serial passage performed against multidrug-resistant clinical isolates in vitro, and 4 or 6 days exposure in mice infected with MRSA, the compounds showed no development of resistance.
    Analysis of the mechanism of action indicates the compounds are able to permeate the cell membranes of gram-positive and gram-negative bacteria, leading to bacterial death.
    The scientists conclude, "We have identified potential therapeutic agents that can provide alternative treatments against antimicrobial resistance. Because the compounds are potential leads for therapeutic development, the next step is to start phase I clinical trials."
    Jul 9 PLOS Biol study