Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/02/stewardship-resistance-scan-feb-05-2019
Stewardship / Resistance Scan for Feb 05, 2019
Candida auris fungemia; Microbiology test use in Norway
Filed Under:
Antimicrobial Stewardship; Fungal Infection
[h=3]Report describes Candida auris fungemia cases in Brooklyn hospital[/h] In a paper published yesterday in Emerging Infectious Diseases, a team of clinicians, infection control specialists, and pharmacists at a community hospital in Brooklyn described the management of patients with Candida auris bloodstream infections (fungemia).
Of the nine cases of C auris fungemia reported at the hospital since 2016, most involved patients in the their 70s who had come from nursing homes and had multiple concurrent conditions. Half of the patients had invasive devices. In addition, each patient had a recent history of broad-spectrum antimicrobial use, and many had concomitant antibiotic-resistant organisms?including Pseudomonas aeruginosa and Klebsiella pneumoniae?isolated during the treatment for C auris.
All patients were given micafungin as first-line therapy for an average duration of 22 days, and two of the patients received liposomal amphotericin B after failing micafungin therapy. Average hospitalization was 65 days. Two of the patients died, and 3 of the 7 discharged patients were sent to palliative care.
Although antifungal susceptibility results were not available at the time of treatment, analysis of test results showed that all isolates were markedly resistant to fluconazole, and 40% were resistant to liposomal amphotericin B. The authors of the paper recommend that physicians treating invasive C auris infections consider combination therapy with micafungin plus liposomal amphotericin B in patients who fail monotherapy with micafungin.
Since its identification in Japan in 2009, C auris has caused outbreaks in healthcare facilities in more than 20 countries. The fungus, which has shown resistance to the three major classes of antifungal drugs, can cause serious invasive infections in patients who have compromised immune systems, with an estimated mortality of between 30% and 60%.
Of the 551 invasive C auris infections reported to the Centers for Disease Control in Prevention since 2016, 280 have been in New York.
Feb 4 Emerg Infect Dis research letter
[h=3]Norwegian hospital study finds suboptimal use of microbiology tests[/h] A multicenter study by Norwegian researchers has found that despite large numbers of microbiology test orders, few tests are used to inform antibiotic prescribing. The results appeared yesterday in Antimicrobial Resistance and Infection Control.
The study, conducted over a 5-month period in 2014 at three hospitals in western Norway, analyzed data on patients who had been prescribed antibiotics for sepsis, urinary tract infections (UTIs), skin and soft tissue infections, lower respiratory tract infections (LRTIs), or acute exacerbations of chronic obstructive pulmonary disease (COPD). The primary outcome measures were the degree of microbiology test ordering, compliance with microbiology testing recommendation in the national antibiotic guideline, and the proportion of test results used to inform antibiotic prescribing.
Of the 1,731 patient admissions analyzed, mean compliance with microbiology testing recommendations in the antibiotic guideline was 89%, ranging from 81% in patients with acute exacerbations of COPD to 95% in patients with sepsis. Substantial additional testing was performed beyond the recommendations, however, with 49% of LRTI patients having urine cultures and 22% of UTI patients having respiratory tests. Microbiology test results from one of the hospitals showed that 18% (120/672) of patient admissions had applicable test results, but only half of them were used for therapy guidance, resulting in 9% (63/672) of patient admissions having test results that informed antibiotic prescribing.
The authors of the study say the findings indicate that current use of microbiology lab services in Norway is suboptimal, with diagnostic uncertainty and clinicians' insufficient knowledge of microbiology contributing to excessive testing, and long turnaround times reducing the usefulness of certain tests.
"There is a need both for tests with better performance characteristics and improved test ordering practices," they write. "Furthermore, use of microbiology test results to inform antibiotic decision-making needs to be optimized in order to ensure adequate patient treatment and more targeted therapy."
Feb 4 Antimicrob Resist Infect Control study
Stewardship / Resistance Scan for Feb 05, 2019
Candida auris fungemia; Microbiology test use in Norway
Filed Under:
Antimicrobial Stewardship; Fungal Infection
[h=3]Report describes Candida auris fungemia cases in Brooklyn hospital[/h] In a paper published yesterday in Emerging Infectious Diseases, a team of clinicians, infection control specialists, and pharmacists at a community hospital in Brooklyn described the management of patients with Candida auris bloodstream infections (fungemia).
Of the nine cases of C auris fungemia reported at the hospital since 2016, most involved patients in the their 70s who had come from nursing homes and had multiple concurrent conditions. Half of the patients had invasive devices. In addition, each patient had a recent history of broad-spectrum antimicrobial use, and many had concomitant antibiotic-resistant organisms?including Pseudomonas aeruginosa and Klebsiella pneumoniae?isolated during the treatment for C auris.
All patients were given micafungin as first-line therapy for an average duration of 22 days, and two of the patients received liposomal amphotericin B after failing micafungin therapy. Average hospitalization was 65 days. Two of the patients died, and 3 of the 7 discharged patients were sent to palliative care.
Although antifungal susceptibility results were not available at the time of treatment, analysis of test results showed that all isolates were markedly resistant to fluconazole, and 40% were resistant to liposomal amphotericin B. The authors of the paper recommend that physicians treating invasive C auris infections consider combination therapy with micafungin plus liposomal amphotericin B in patients who fail monotherapy with micafungin.
Since its identification in Japan in 2009, C auris has caused outbreaks in healthcare facilities in more than 20 countries. The fungus, which has shown resistance to the three major classes of antifungal drugs, can cause serious invasive infections in patients who have compromised immune systems, with an estimated mortality of between 30% and 60%.
Of the 551 invasive C auris infections reported to the Centers for Disease Control in Prevention since 2016, 280 have been in New York.
Feb 4 Emerg Infect Dis research letter
[h=3]Norwegian hospital study finds suboptimal use of microbiology tests[/h] A multicenter study by Norwegian researchers has found that despite large numbers of microbiology test orders, few tests are used to inform antibiotic prescribing. The results appeared yesterday in Antimicrobial Resistance and Infection Control.
The study, conducted over a 5-month period in 2014 at three hospitals in western Norway, analyzed data on patients who had been prescribed antibiotics for sepsis, urinary tract infections (UTIs), skin and soft tissue infections, lower respiratory tract infections (LRTIs), or acute exacerbations of chronic obstructive pulmonary disease (COPD). The primary outcome measures were the degree of microbiology test ordering, compliance with microbiology testing recommendation in the national antibiotic guideline, and the proportion of test results used to inform antibiotic prescribing.
Of the 1,731 patient admissions analyzed, mean compliance with microbiology testing recommendations in the antibiotic guideline was 89%, ranging from 81% in patients with acute exacerbations of COPD to 95% in patients with sepsis. Substantial additional testing was performed beyond the recommendations, however, with 49% of LRTI patients having urine cultures and 22% of UTI patients having respiratory tests. Microbiology test results from one of the hospitals showed that 18% (120/672) of patient admissions had applicable test results, but only half of them were used for therapy guidance, resulting in 9% (63/672) of patient admissions having test results that informed antibiotic prescribing.
The authors of the study say the findings indicate that current use of microbiology lab services in Norway is suboptimal, with diagnostic uncertainty and clinicians' insufficient knowledge of microbiology contributing to excessive testing, and long turnaround times reducing the usefulness of certain tests.
"There is a need both for tests with better performance characteristics and improved test ordering practices," they write. "Furthermore, use of microbiology test results to inform antibiotic decision-making needs to be optimized in order to ensure adequate patient treatment and more targeted therapy."
Feb 4 Antimicrob Resist Infect Control study