Stewardship / Resistance Scan for Jun 17, 2021
MDRO's in COVID patients; Antibiotic use on UK pig farms
Filed Under:
Antimicrobial Stewardship; COVID-19; MRSA

Korean study details risk factors for drug-resistant organisms in COVID patients

Multidrug-resistant organisms (MDROs) were isolated in more than a quarter of South Korean patients with confirmed COVID-19 pneumonia and microbial culture results, with corticosteroid use identified as a significant risk factor, researchers reported yesterday in the American Journal of Infection Control.
The researchers from Soonchunhyang University College of Medicine looked at data on patients hospitalized for COVID-19 pneumonia at 1o hospitals in South Korea from February 2020 through May 2020, analyzing microbial culture results and epidemiology and risk factors for isolation of MDROs. Of the 152 patients identified with COVID-19 pneumonia, 47 had microbial culture results.
MDROs were isolated from 28% of patients with culture data (13 of 47) and 8.6% of all patients with COVID-19 pneumonia (13 of 152). The most common MDRO isolated was Stenotrophomonas maltophilia (five isolates), followed by methicillin-resistant Staphylococcus aureus (four isolates). MDROs were most commonly isolated from sputum samples. In-hospital mortality was significantly higher in patients with MDRO isolation than those without (62% vs. 15%).
All patients with MDROs received previous antibiotics. Multivariable analysis indicated that systemic corticosteroid use after COVID-19 diagnosis (adjusted odds ratio [aOR], 15.07; 95% confidence interval [CI], 2.34 to 97.01) and long-term care facility (LTCF) stay before diagnosis of COVID-19 (aOR, 6.09; 95% CI, 1.02 to 36.49) were independent risk factors for MDRO isolation.
The study authors say that while previous LTCF stay is a well-known risk factor for MDRO colonization, the finding that corticosteroid use may promote MDRO infection has great implications, since corticosteroids have been widely used in hospitalized COVID-19 patients.
"Owing to the risk of MDRO infection, corticosteroid usage should be carefully considered only for patients with indication," they wrote.
Jun 16 Am J Infect Control study

Report finds increased use of critical class of antibiotic on UK pig farms

Previously unpublished data indicate use of certain medically important antibiotics more than doubled on United Kingdom pig farms from 2015 through 2019.
The data, compiled by the Agriculture and Horticulture Development Board (AHDB) and obtained under Freedom of Information laws by the Bureau of Investigative Journalism, Vet Record, and the Guardian, show that use of aminoglycosides in pigs jumped from 2.6 milligrams per kilogram of body weight in 2015 to 5.9 mg in 2019.
The news follows a report from AHDB last week that showed that overall antibiotic use, along with use of highest-priority critically important antibiotics, on UK pig farms has declined significantly since 2015. Aminoglycosides are considered a critically important antibiotic by the World Health Organization.
Industry experts told the Bureau of Investigative Journalism that the increase in aminoglycoside use could be linked to the phasing out of other critically important antibiotics like colistin, and to preparations for a European Union ban on zinc oxide, which is used to treat post-weaning diarrhea in piglets. They also expressed concern that the ban could lead to a rise in antibiotic use on pig farms in the coming years.
"We do have great concern about losing zinc oxide because there's a chance it will increase our antibiotic use," a veterinarian with the Pig Health and Welfare Council told the Bureau.
Jun 17 Bureau of Investigative Journalism story
Jun 10 AHDB report