Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2016/11/antimicrobial-resistance-scan-nov-10-2016
Antimicrobial Resistance Scan for Nov 10, 2016
MDR-TB in West Africa; Antibiotics and sepsis
Filed Under:
Microbiome; Antimicrobial Stewardship; Tuberculosis
[h=3]Study finds high prevalence of drug-resistant TB in West Africa[/h] The prevalence of multidrug-resistant tuberculosis (MDR-TB) in West Africa is much higher than previously thought, according to a study published Tuesday in BMC Medicine.
In the study, investigators from the West African Network of Excellence for TB, AIDS, and Malaria (WANETAM) set out to determine the distribution of MDR-TB in eight West African countries. Although populations in the region are highly susceptible to infectious diseases, the lack of adequate laboratories means data on drug-resistant TB is scarce. To estimate the prevalence of MDR-TB, the investigators collected isolates from new and retreatment patients and tested them for susceptibility to first- and second-line drugs.
In total, the investigators found that 39% of the 974 isolates tested were resistant to one or more front-line drugs, while 22% were considered multi-drug resistant. The prevalence of MDR-TB was 6% in new patients and 35% in retreatment patients, much higher than the World Health Organization's (WHO's) previous estimates of 2% and 17%.
The highest prevalence for MDR-TB was found in retreatment patients in Mali (59%) and two Nigerian sites?Ibadan (39%) and Lagos (66%). Although no extensively drug resistant (XDR) TB isolates were identified, 21% of the isolates were identified as pre-XDR, which means they will develop extensive drug resistance if no effective interventions are instituted.
The authors of the study say their findings suggest MDR-TB could become a serious public health problem in West Africa if control measures aren?t taken.
"We recommend that efforts be put in place for containment of a potential West African TB epidemic at the earliest possible stage," lead investigator Martin Antonio, PhD, said in a news release from BioMed Central. "This is especially important as West Africa with its 245 million inhabitants is one of the poorest regions globally, whose fragile health systems can easily be overwhelmed by infectious disease epidemics, as seen in the recent Ebola outbreak."
Antonio and his colleagues also say their findings should prompt the implementation of continuous surveillance of all retreatment patients in participating countries.
Nov 2 BMC Medicine study
Nov 2 BioMed Central news release
[h=3]Increased risk of sepsis linked to antibiotic exposure[/h] A study presented at IDWeek 2016 suggests that an increased risk of sepsis following infection-related hospitalization could be linked to antibiotics that disrupt the microbiome.
The study, conducted by researchers with the Centers for Disease Control and Prevention (CDC), used patient records from a hospital drug database to determine how many patients had been re-admitted for sepsis within 90 days of discharge, and how many of those patients had received antibiotics during their initial stay. In particular, they were looking for antibiotics with a high risk for microbiome disruption, such as third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, and oral vancomycin. Animal studies have shown that giving animals antibiotics that disrupt the balance of good and bad bacteria in the microbiome can have an increased risk of sepsis.
Overall, the data showed that among more than 9 million patients who visited 473 hospitals between 2006 and 2010, 0.6% had sepsis during readmission within 90 days of discharge. When the researchers compared patients who had received antibiotics during the index visit to those who had received no antibiotics, they found that the patients with antibiotic exposure were 50% more likely to be hospitalized with sepsis, and nearly 80% more likely if they had received high-risk antibiotics. Patients who received longer courses of treatment also had a higher risk of sepsis.
"The observed increased risk for subsequent sepsis following receipt of antibiotics that significantly disrupt the microbiome?supports the idea that microbiome disruption confers increased risk for subsequent severe infections, " the study authors concluded.
"It's one more call to really focus our efforts on using antibiotics only when we need them, because the adverse effects are really big," Arjun Srinivasan, MD, told reporters. Srinivasan, who directs CDC programs aimed at preventing healthcare-associated infections, was not involved in the study.
Oct 27 IDWeek abstract
Antimicrobial Resistance Scan for Nov 10, 2016
MDR-TB in West Africa; Antibiotics and sepsis
Filed Under:
Microbiome; Antimicrobial Stewardship; Tuberculosis
[h=3]Study finds high prevalence of drug-resistant TB in West Africa[/h] The prevalence of multidrug-resistant tuberculosis (MDR-TB) in West Africa is much higher than previously thought, according to a study published Tuesday in BMC Medicine.
In the study, investigators from the West African Network of Excellence for TB, AIDS, and Malaria (WANETAM) set out to determine the distribution of MDR-TB in eight West African countries. Although populations in the region are highly susceptible to infectious diseases, the lack of adequate laboratories means data on drug-resistant TB is scarce. To estimate the prevalence of MDR-TB, the investigators collected isolates from new and retreatment patients and tested them for susceptibility to first- and second-line drugs.
In total, the investigators found that 39% of the 974 isolates tested were resistant to one or more front-line drugs, while 22% were considered multi-drug resistant. The prevalence of MDR-TB was 6% in new patients and 35% in retreatment patients, much higher than the World Health Organization's (WHO's) previous estimates of 2% and 17%.
The highest prevalence for MDR-TB was found in retreatment patients in Mali (59%) and two Nigerian sites?Ibadan (39%) and Lagos (66%). Although no extensively drug resistant (XDR) TB isolates were identified, 21% of the isolates were identified as pre-XDR, which means they will develop extensive drug resistance if no effective interventions are instituted.
The authors of the study say their findings suggest MDR-TB could become a serious public health problem in West Africa if control measures aren?t taken.
"We recommend that efforts be put in place for containment of a potential West African TB epidemic at the earliest possible stage," lead investigator Martin Antonio, PhD, said in a news release from BioMed Central. "This is especially important as West Africa with its 245 million inhabitants is one of the poorest regions globally, whose fragile health systems can easily be overwhelmed by infectious disease epidemics, as seen in the recent Ebola outbreak."
Antonio and his colleagues also say their findings should prompt the implementation of continuous surveillance of all retreatment patients in participating countries.
Nov 2 BMC Medicine study
Nov 2 BioMed Central news release
[h=3]Increased risk of sepsis linked to antibiotic exposure[/h] A study presented at IDWeek 2016 suggests that an increased risk of sepsis following infection-related hospitalization could be linked to antibiotics that disrupt the microbiome.
The study, conducted by researchers with the Centers for Disease Control and Prevention (CDC), used patient records from a hospital drug database to determine how many patients had been re-admitted for sepsis within 90 days of discharge, and how many of those patients had received antibiotics during their initial stay. In particular, they were looking for antibiotics with a high risk for microbiome disruption, such as third- and fourth-generation cephalosporins, fluoroquinolones, carbapenems, lincosamides, beta-lactam/beta-lactamase inhibitor combinations, and oral vancomycin. Animal studies have shown that giving animals antibiotics that disrupt the balance of good and bad bacteria in the microbiome can have an increased risk of sepsis.
Overall, the data showed that among more than 9 million patients who visited 473 hospitals between 2006 and 2010, 0.6% had sepsis during readmission within 90 days of discharge. When the researchers compared patients who had received antibiotics during the index visit to those who had received no antibiotics, they found that the patients with antibiotic exposure were 50% more likely to be hospitalized with sepsis, and nearly 80% more likely if they had received high-risk antibiotics. Patients who received longer courses of treatment also had a higher risk of sepsis.
"The observed increased risk for subsequent sepsis following receipt of antibiotics that significantly disrupt the microbiome?supports the idea that microbiome disruption confers increased risk for subsequent severe infections, " the study authors concluded.
"It's one more call to really focus our efforts on using antibiotics only when we need them, because the adverse effects are really big," Arjun Srinivasan, MD, told reporters. Srinivasan, who directs CDC programs aimed at preventing healthcare-associated infections, was not involved in the study.
Oct 27 IDWeek abstract