Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/04/stewardship-resistance-scan-apr-05-2019
Stewardship / Resistance Scan for Apr 05, 2019
Animal antibiotics legislation; Panning prophylactic azithromycin; Staphylococcus breakpoints; Antibiotics for flu in young kids; Pediatric C diff risk factors
Filed Under:
Antimicrobial Stewardship; Influenza, General; Clostridium difficile
[h=3]Maryland legislature votes to tighten animal antibiotics law[/h] The Maryland State Senate and House of Delegates yesterday passed bills to strengthen a state law that restricts the routine use of antibiotics in animals that aren't sick.
According to a news release from U.S. PIRG (Public Interest Research Group), the Senate and House versions of the bills (SB471/HB652) aim to strengthen and codify regulations for the Keep Antibiotics Effective Act, which was passed by the Maryland legislature in 2017 without a signature from the governor. Supporters of the legislation argued that regulations enacted by the Maryland Department of Agriculture (MDA) in January 2019 contained significant loopholes and undermined the intent of the law.
The bills add new definitions and clarify definitions of certain terms in the MDA regulations, including "administered in a regular pattern," "control of the spread of disease or infection," "elevated risk," "prophylaxis," and "treat a disease or infection." They also add a requirement for veterinarians to report the use of medically important antibiotics yearly to ensure compliance with the law.
"To keep our miracle drugs working when people and animals need them, we have to stop squandering them on livestock that are not sick," Mae Wu, senior attorney at the Natural Resources Defense Council (NDRC), said in the release. "This bill will help make Maryland a leader in the fight against the growing epidemic of drug-resistant infections."
NRDC was one of more than a dozen public health and environmental advocacy groups supporting the legislation. The bill now goes to Governor Larry Hogan.
Apr 4 U.S. PIRG news release
[h=3]Clinical trial finds no long-term benefit from prophylactic azithromycin[/h] A team of American and Tanzanian researchers reported today in Clinical Infectious Diseases that biannual treatment with azithromycin did not have a beneficial effect on diarrhea, cough, fever, or anemia in young Tanzanian children.
The cluster-randomized, placebo-controlled study was conducted in 30 communities in the Kilosa district of Tanzania from January 2015 to August 2017 to determine whether there was a difference in morbidity in a cohort of children ages 1 to 36 months who were randomized to biannual treatment with azithromycin or placebo. The study was embedded into the larger MORDOR trial, which found a year ago that a single dose of azithromycin every 6 months in children ages 1 to 59 months in Niger, Malawi, and Tanzania was associated with a reduction in mortality compared with placebo.
The researchers wanted to see if the reduction in mortality observed in the MORDOR trial could be linked to azithromycin's clinical versatility against a wide range of infections. Previous studies of mass drug administration with azithromycin have shown a protective effect against diarrhea, malaria parasitemia, and respiratory illnesses, but only within 1 month of treatment. In this study, children were monitored every 6 months for signs and symptoms of diarrheal disease, acute respiratory illness, and anemia.
Among the 700 children in the study (350 in each treatment arm), the researchers found no difference in rates of diarrhea, fever, or anemia by treatment arm at baseline and at all phases of follow-up. The decline over time in reported cough was statistically significant in the children who received azithromycin compared with the placebo group, but when adjusted for clustering and age, the difference in decline between the two treatment arms had a P value of .09, which is generally associated with non-significance.
The authors of the study say further research into the mechanisms for reduced mortality observed in the MORDOR trial is needed.
Apr 5 Clin Infect Dis abstract
Apr 28, 2018, CIDRAP News scan on MORDOR study
[h=3]Treatment of Staph bloodstream infections should start ASAP, study finds[/h] University of Southern California researchers today defined the breakpoint duration of Staphylococcus aureus bacteremia (SAB) that is predictive of poor outcomes in an effort to optimize antibiotic prescribing and noted that management should target bacterial clearance as soon as possible.
In the multicenter, prospective, observational study of 884 adult, hospitalized patients with SAB, 63% had short (1- to 2-day), 28% intermediate (3- to 6-day), and 9% prolonged (7 days or longer) bacteremia, and those in the prolonged group had the highest proportion of methicillin-resistant SAB. The study appears in Clinical Infectious Diseases.
The scientists found that the choice of antibiotic therapy did not significantly affect bacteremia duration, but the time to source control procedure was delayed in the prolonged and intermediate groups compared with the short group. They also noted that metastatic complications (12% vs 23% vs 33%), length of stay (9 vs 12 vs 24 days), and 30-day mortality (5% vs 11% vs 22%) were progressively worse as bacteremia duration increased. They also determined that every added day of bacteremia was associated with relative risk of death of 1.16, with a significant increase in risk starting at 3 days.
The authors conclude, "Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of anti-staphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes."
Apr 5 Clin Infect Dis abstract
[h=3]Global study of flu burden in tots shows 41% antibiotic prescribing rate[/h] A study yesterday in BMC Infectious Disease of children under 3 years old shows not only the heavy burden of flu globally but also the continued misuse of antibiotics for the disease, as 41% of the patients received antibiotics.
French and Dutch investigators analyzed data from 2,210 participants included in the placebo arm of a phase 3 trial who had never been vaccinated for influenza and were observed for one or two flu seasons from 2014 to 2016. Among the group, who were from nine countries in both the Northern and Southern Hemisphere, 255 participants had virologically confirmed flu, for an attack rate of 11.5%. The children ranged in age from 6 to 35 months.
Most cases (57.0%) resulted in outpatient visits, but 1.1% required overnight hospitalization. Among all patients, 24.3% had grade 3 fever, 8.7% lower respiratory infection, 6.1% acute otitis media (AOM, or ear infection), and 1.9% pneumonia.
The vast majority of children (93.2%) received fever-reducing drugs, analgesics, or non-steroidal anti-inflammatory drugs. Fully 41.4%, however, received antibiotics for the disease, which is caused by a virus. The antibiotic prescribing rate was 23.5% in South Africa, 38.9% in European nations, and 45.7% in the Philippines.
The authors write, "A few of these antibiotic prescriptions could have been for influenza-associated AOM or acute lower respiratory infection, which were observed in 15% of influenza cases," but they add, "unnecessary antibiotic use in influenza appears to be a continuing problem and may be contributing to the spread of antibiotic-resistant bacteria."
Apr 4 BMC Infect Dis study
[h=3]Study notes recent antibiotics as C difficile risk factor in young children[/h] A study today in Epidemiology and Infection found that antibiotic exposure within the preceding 12 weeks was a significant risk factor for community-associated Clostridioides difficile infection (CA-CDI) in young children.
The aim of the study, which was led by researchers from the US Centers for Disease Control and Prevention (CDC), was to evaluate potential healthcare- and community-related risk factors for CA-CDI in children aged 1 to 5 years. Although several studies have assessed CA-CDI risk factors in adults, data on children are limited. Participants for the case-control study from eight sites were enrolled in the CDC's Emerging Infections Program from October 2014 through February 2016, and caregivers were interviewed regarding relevant exposures.
Overall, 136 children (68 matched pairs) were enrolled. More case-patients than controls had a comorbidity (33.3% vs 12.1%, P = 0.01), recent high-risk outpatient exposures (34.9% vs 17.7%, P = 0.02), recent antibiotic use (54.4% vs 19.4%, P < 0.0001), or recent exposure to a household member with diarrhea (41.3% vs 21.5%, P = 0.04). In multivariable analysis, only antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% confidence interval, 2.18 to 17.96). The most frequently reported indication for antibiotic use was ear, sinus, or respiratory infection.
"Decreasing unnecessary outpatient antibiotic prescribing, particularly for acute respiratory tract infections, might reduce CA-CDI in this population," the authors of the study write. "Further investigation of other potential risk factors, including outpatient healthcare and household exposures, is needed."
Apr 5 Epidemiol Infect abstract
Stewardship / Resistance Scan for Apr 05, 2019
Animal antibiotics legislation; Panning prophylactic azithromycin; Staphylococcus breakpoints; Antibiotics for flu in young kids; Pediatric C diff risk factors
Filed Under:
Antimicrobial Stewardship; Influenza, General; Clostridium difficile
[h=3]Maryland legislature votes to tighten animal antibiotics law[/h] The Maryland State Senate and House of Delegates yesterday passed bills to strengthen a state law that restricts the routine use of antibiotics in animals that aren't sick.
According to a news release from U.S. PIRG (Public Interest Research Group), the Senate and House versions of the bills (SB471/HB652) aim to strengthen and codify regulations for the Keep Antibiotics Effective Act, which was passed by the Maryland legislature in 2017 without a signature from the governor. Supporters of the legislation argued that regulations enacted by the Maryland Department of Agriculture (MDA) in January 2019 contained significant loopholes and undermined the intent of the law.
The bills add new definitions and clarify definitions of certain terms in the MDA regulations, including "administered in a regular pattern," "control of the spread of disease or infection," "elevated risk," "prophylaxis," and "treat a disease or infection." They also add a requirement for veterinarians to report the use of medically important antibiotics yearly to ensure compliance with the law.
"To keep our miracle drugs working when people and animals need them, we have to stop squandering them on livestock that are not sick," Mae Wu, senior attorney at the Natural Resources Defense Council (NDRC), said in the release. "This bill will help make Maryland a leader in the fight against the growing epidemic of drug-resistant infections."
NRDC was one of more than a dozen public health and environmental advocacy groups supporting the legislation. The bill now goes to Governor Larry Hogan.
Apr 4 U.S. PIRG news release
[h=3]Clinical trial finds no long-term benefit from prophylactic azithromycin[/h] A team of American and Tanzanian researchers reported today in Clinical Infectious Diseases that biannual treatment with azithromycin did not have a beneficial effect on diarrhea, cough, fever, or anemia in young Tanzanian children.
The cluster-randomized, placebo-controlled study was conducted in 30 communities in the Kilosa district of Tanzania from January 2015 to August 2017 to determine whether there was a difference in morbidity in a cohort of children ages 1 to 36 months who were randomized to biannual treatment with azithromycin or placebo. The study was embedded into the larger MORDOR trial, which found a year ago that a single dose of azithromycin every 6 months in children ages 1 to 59 months in Niger, Malawi, and Tanzania was associated with a reduction in mortality compared with placebo.
The researchers wanted to see if the reduction in mortality observed in the MORDOR trial could be linked to azithromycin's clinical versatility against a wide range of infections. Previous studies of mass drug administration with azithromycin have shown a protective effect against diarrhea, malaria parasitemia, and respiratory illnesses, but only within 1 month of treatment. In this study, children were monitored every 6 months for signs and symptoms of diarrheal disease, acute respiratory illness, and anemia.
Among the 700 children in the study (350 in each treatment arm), the researchers found no difference in rates of diarrhea, fever, or anemia by treatment arm at baseline and at all phases of follow-up. The decline over time in reported cough was statistically significant in the children who received azithromycin compared with the placebo group, but when adjusted for clustering and age, the difference in decline between the two treatment arms had a P value of .09, which is generally associated with non-significance.
The authors of the study say further research into the mechanisms for reduced mortality observed in the MORDOR trial is needed.
Apr 5 Clin Infect Dis abstract
Apr 28, 2018, CIDRAP News scan on MORDOR study
[h=3]Treatment of Staph bloodstream infections should start ASAP, study finds[/h] University of Southern California researchers today defined the breakpoint duration of Staphylococcus aureus bacteremia (SAB) that is predictive of poor outcomes in an effort to optimize antibiotic prescribing and noted that management should target bacterial clearance as soon as possible.
In the multicenter, prospective, observational study of 884 adult, hospitalized patients with SAB, 63% had short (1- to 2-day), 28% intermediate (3- to 6-day), and 9% prolonged (7 days or longer) bacteremia, and those in the prolonged group had the highest proportion of methicillin-resistant SAB. The study appears in Clinical Infectious Diseases.
The scientists found that the choice of antibiotic therapy did not significantly affect bacteremia duration, but the time to source control procedure was delayed in the prolonged and intermediate groups compared with the short group. They also noted that metastatic complications (12% vs 23% vs 33%), length of stay (9 vs 12 vs 24 days), and 30-day mortality (5% vs 11% vs 22%) were progressively worse as bacteremia duration increased. They also determined that every added day of bacteremia was associated with relative risk of death of 1.16, with a significant increase in risk starting at 3 days.
The authors conclude, "Optimal management of SAB should target bacterial clearance as soon as possible to minimize incremental risk of mortality with each day of positive blood culture. Delay in source control but not type of anti-staphylococcal therapy was significantly associated with prolonged bacteremia and worse outcomes."
Apr 5 Clin Infect Dis abstract
[h=3]Global study of flu burden in tots shows 41% antibiotic prescribing rate[/h] A study yesterday in BMC Infectious Disease of children under 3 years old shows not only the heavy burden of flu globally but also the continued misuse of antibiotics for the disease, as 41% of the patients received antibiotics.
French and Dutch investigators analyzed data from 2,210 participants included in the placebo arm of a phase 3 trial who had never been vaccinated for influenza and were observed for one or two flu seasons from 2014 to 2016. Among the group, who were from nine countries in both the Northern and Southern Hemisphere, 255 participants had virologically confirmed flu, for an attack rate of 11.5%. The children ranged in age from 6 to 35 months.
Most cases (57.0%) resulted in outpatient visits, but 1.1% required overnight hospitalization. Among all patients, 24.3% had grade 3 fever, 8.7% lower respiratory infection, 6.1% acute otitis media (AOM, or ear infection), and 1.9% pneumonia.
The vast majority of children (93.2%) received fever-reducing drugs, analgesics, or non-steroidal anti-inflammatory drugs. Fully 41.4%, however, received antibiotics for the disease, which is caused by a virus. The antibiotic prescribing rate was 23.5% in South Africa, 38.9% in European nations, and 45.7% in the Philippines.
The authors write, "A few of these antibiotic prescriptions could have been for influenza-associated AOM or acute lower respiratory infection, which were observed in 15% of influenza cases," but they add, "unnecessary antibiotic use in influenza appears to be a continuing problem and may be contributing to the spread of antibiotic-resistant bacteria."
Apr 4 BMC Infect Dis study
[h=3]Study notes recent antibiotics as C difficile risk factor in young children[/h] A study today in Epidemiology and Infection found that antibiotic exposure within the preceding 12 weeks was a significant risk factor for community-associated Clostridioides difficile infection (CA-CDI) in young children.
The aim of the study, which was led by researchers from the US Centers for Disease Control and Prevention (CDC), was to evaluate potential healthcare- and community-related risk factors for CA-CDI in children aged 1 to 5 years. Although several studies have assessed CA-CDI risk factors in adults, data on children are limited. Participants for the case-control study from eight sites were enrolled in the CDC's Emerging Infections Program from October 2014 through February 2016, and caregivers were interviewed regarding relevant exposures.
Overall, 136 children (68 matched pairs) were enrolled. More case-patients than controls had a comorbidity (33.3% vs 12.1%, P = 0.01), recent high-risk outpatient exposures (34.9% vs 17.7%, P = 0.02), recent antibiotic use (54.4% vs 19.4%, P < 0.0001), or recent exposure to a household member with diarrhea (41.3% vs 21.5%, P = 0.04). In multivariable analysis, only antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% confidence interval, 2.18 to 17.96). The most frequently reported indication for antibiotic use was ear, sinus, or respiratory infection.
"Decreasing unnecessary outpatient antibiotic prescribing, particularly for acute respiratory tract infections, might reduce CA-CDI in this population," the authors of the study write. "Further investigation of other potential risk factors, including outpatient healthcare and household exposures, is needed."
Apr 5 Epidemiol Infect abstract