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CIDRAP Stewardship/Resistance Scan - Diagnostics in low-resource nations; Combined stewardship strategies

Shiloh

Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/12/stewardship-resistance-scan-dec-19-2019

Stewardship / Resistance Scan for Dec 19, 2019
Diagnostics in low-resource nations; Combined stewardship strategies

Filed Under:
Antimicrobial Stewardship; Diagnostics


[h=3]BioMerieux tapped to provide diagnostics in LMICs to combat AMR[/h] Yesterday, French diagnostics company bioMerieux announced that that the Fleming Fund has selected it as a supplier in a tender process to tackle antimicrobial resistance (AMR) in 18 low- and middle-income countries.
The Fleming Fund is investing ?265 million ($345 million US) in the process, which will involve equipping one reference clinical lab and one veterinary lab in 18 countries across Africa and the Asia-Pacific with diagnostic, susceptibility, and data processing technology over the next 3 years, according to a bioMerieux news release.
"It is a pleasure to work in partnership with bioMerieux to help strengthen health systems and contribute to tackling the threat of antimicrobial resistance around the world," said Andy Leigh, a Fleming Fund program director.
BioMerieux will be active in 18 out of the 24 countries taking part in the program. The company will equip labs with its Vitek MS and Vitek 2 systems for pathogen identification and antimicrobial susceptibility testing, and with Myla software for data processing.
Dec 18 bioMerieux news release

[h=3]French stewardship study finds benefits from combined strategies[/h] A study in France has found that the combination of simplified therapeutic guidelines (STGs) and accompanied self-antibiotic reassessment (ASAR) was associated with optimal antibiotic therapy and reduced antibiotic use at 15 hospitals, researchers reported yesterday in the Journal of Antimicrobial Chemotherapy.
The STGs resulted from at least two rounds of antibiotic audit and feedback at the 15 hospitals and were based on national and international guidelines, the medical and surgical activities of every institution, and on data regarding resistant bacteria. The STGs were explained to prescribers in ASAR sessions, which typically lasted 45 to 90 minutes and consisted of reviewing four to six patients' files. To measure the impact of these strategies, the researchers reviewed patients receiving antibiotic therapy and rated the quality of the antibiotic treatment before and after implementation. They also measured antibiotic consumption at the hospitals, focusing on amoxicillin/clavulanic acid, third-generation cephalosporins, and fluoroquinolones.
Comparison of prescriptions in five hospitals before and after implementation of STGs and ASAR showed that these tools were associated with optimal therapies (adjusted odds ratio [AOR], 3.28; 95% confidence interval [CI], 1.82 to 5.92), amoxicillin/clavulanic acid prescriptions (AOR, 2.18; 95% CI, 1.38 to 3.44) and fewer prescriptions for urine colonization (AOR, 0.20; 95% CI, 0.06 to 0.61). Comparison of prescriptions from 10 departments of three hospitals with STGs and ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other physicians (71% vs 60%; P = 0.003).
Comparing prescriptions in the 10 hospitals that adopted STGs alone with prescriptions at the 5 hospitals that adopted both tools, the researchers observed fewer unnecessary prescriptions in the latter (AOR, 0.52; 95% CI, 0.34 to 0.80). The variation in critical antibiotic consumption between 2017 and 2018 was -16% for the 5 hospitals that adopted both tools and +20% for the other 10.
"In conclusion, STGs + ASAR is a combination of tools that increase the efficiency of non-specialized prescribers, leading to an increase in optimal antibiotic therapy and a reduction in antibiotic consumption," the authors of the study write. "As these tools do not require financial support, our results would be helpful for low- and middle-income countries."
Dec 18 J Antimicrob Chemother abstract
 
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