Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2018/08/stewardship-resistance-scan-aug-02-2018
Stewardship / Resistance Scan for Aug 02, 2018
Carbapenemase-producing Klebsiella in Greece; Pneumonia treatment in Spain
Filed Under:
Antimicrobial Stewardship
[h=3]Carbapenemase-producing K pneumoniae in Greece now more resistant[/h] An analysis of carbapenem-nonsusceptible Klebsiella pneumoniae isolates in Greece has found increasing resistance to last-line antibiotics.
In an article today in Eurosurveillance, Greek researchers report that, of 394 carbapenem-nonsusceptible K pneumoniae isolates collected at 15 hospitals from November 2014 through April 2016, 389 (98.7%) were carbapenemase producers. KPC enzymes were the most frequent carbapenemase, detected in 66.5% of isolates, followed by NDM enzymes (13.7%) and VIM enzymes (8.6%). OXA-48 and double carbapenemase producers remained uncommon (3.6% and 6.3%, respectively).
Antibiotic susceptibility testing revealed high resistance to last-line antibiotics. Gentamicin and colistin were the most active antibiotics in vitro, inhibiting 61.9% and 59.6% of isolates, followed by fosfomycin (58.4% susceptible) and tigecycline (51.5% susceptible). The authors of the study note that the colistin non-susceptibility rate of 40.4% is significantly higher than the 28.3% observed in a study of 36 European countries. They suggest this could be due to increased consumption of colistin in Greece.
The authors conclude, "The steeply increasing resistance to last-line antimicrobials such as colistin in Greece mandates the necessity of continuous surveillance as well as the application of strict contact precautions along with antimicrobial stewardship."
Aug 2 Eurosurveill research article
[h=3]Study finds only half of Spanish seniors get proper pneumonia treatment[/h] A study today in Epidemiology and Infection reports that empirical antibiotic treatment for community-acquired pneumonia (CAP) in elderly patients in Spain conforms to national guidelines roughly half the time.
The multicenter study, which included 1,857 patients age 65 and over who were hospitalized for CAP in the 2013-14 and 2014-15 influenza seasons, found that treatment was conforming with guidelines from the Spanish Society of Pulmonology and Thoracic Surgery in 51.4% of patients without intensive care unit (ICU) admission and was associated with the absence of renal failure without hemodialysis (odds ratio [OR], 1.49) and no cognitive dysfunction (OR, 1.71) when the effect of Spain's autonomous communities was controlled for. There was also a trend toward association with COPD (OR, 1.23).
In patients admitted to the ICU, treatment was conforming in 45.1% of patients and was associated with fewer than three hospital visits in the last year (OR, 2.70). There was also some evidence that conforming treatment was more associated with the 2013-14 flu season than the 2014-15 season.
Although the conforming of treatment to national guidelines in Spain was found to be higher than that found in Europe-wide studies (38.8%), the authors note that the wide variability among autonomous communities in adhering to correct CAP treatment is concerning, given that the guidelines are national. They suggest the reasons for this variability should be studied, they add.
Aug 2 Epidemiol Infect abstract
Stewardship / Resistance Scan for Aug 02, 2018
Carbapenemase-producing Klebsiella in Greece; Pneumonia treatment in Spain
Filed Under:
Antimicrobial Stewardship
[h=3]Carbapenemase-producing K pneumoniae in Greece now more resistant[/h] An analysis of carbapenem-nonsusceptible Klebsiella pneumoniae isolates in Greece has found increasing resistance to last-line antibiotics.
In an article today in Eurosurveillance, Greek researchers report that, of 394 carbapenem-nonsusceptible K pneumoniae isolates collected at 15 hospitals from November 2014 through April 2016, 389 (98.7%) were carbapenemase producers. KPC enzymes were the most frequent carbapenemase, detected in 66.5% of isolates, followed by NDM enzymes (13.7%) and VIM enzymes (8.6%). OXA-48 and double carbapenemase producers remained uncommon (3.6% and 6.3%, respectively).
Antibiotic susceptibility testing revealed high resistance to last-line antibiotics. Gentamicin and colistin were the most active antibiotics in vitro, inhibiting 61.9% and 59.6% of isolates, followed by fosfomycin (58.4% susceptible) and tigecycline (51.5% susceptible). The authors of the study note that the colistin non-susceptibility rate of 40.4% is significantly higher than the 28.3% observed in a study of 36 European countries. They suggest this could be due to increased consumption of colistin in Greece.
The authors conclude, "The steeply increasing resistance to last-line antimicrobials such as colistin in Greece mandates the necessity of continuous surveillance as well as the application of strict contact precautions along with antimicrobial stewardship."
Aug 2 Eurosurveill research article
[h=3]Study finds only half of Spanish seniors get proper pneumonia treatment[/h] A study today in Epidemiology and Infection reports that empirical antibiotic treatment for community-acquired pneumonia (CAP) in elderly patients in Spain conforms to national guidelines roughly half the time.
The multicenter study, which included 1,857 patients age 65 and over who were hospitalized for CAP in the 2013-14 and 2014-15 influenza seasons, found that treatment was conforming with guidelines from the Spanish Society of Pulmonology and Thoracic Surgery in 51.4% of patients without intensive care unit (ICU) admission and was associated with the absence of renal failure without hemodialysis (odds ratio [OR], 1.49) and no cognitive dysfunction (OR, 1.71) when the effect of Spain's autonomous communities was controlled for. There was also a trend toward association with COPD (OR, 1.23).
In patients admitted to the ICU, treatment was conforming in 45.1% of patients and was associated with fewer than three hospital visits in the last year (OR, 2.70). There was also some evidence that conforming treatment was more associated with the 2013-14 flu season than the 2014-15 season.
Although the conforming of treatment to national guidelines in Spain was found to be higher than that found in Europe-wide studies (38.8%), the authors note that the wide variability among autonomous communities in adhering to correct CAP treatment is concerning, given that the guidelines are national. They suggest the reasons for this variability should be studied, they add.
Aug 2 Epidemiol Infect abstract