Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/12/stewardship-resistance-scan-dec-06-2019
Stewardship / Resistance Scan for Dec 06, 2019
European priority pathogen surveillance; US hospital stewardship
Filed Under:
Antimicrobial Stewardship; Clostridium difficile
[h=3]Study: Mandatory surveillance of priority pathogens lacking in Europe[/h] A review of national documents shows that fewer than half of European countries have implemented publicly accessible mandatory surveillance of at least one of the World Health Organization's (WHO's) priority pathogens, European researchers reported yesterday in Clinical Microbiology and Infection.
The review found that of 28 European Union and 4 European Free Trade Association member states, 21 (66%) had a national mandate to survey at least one of the WHO's critical- and high-priority antibiotic-resistant pathogens, but only 15 (47%) had publicly accessible information that could be evaluated. The most frequently monitored pathogens were carbapenem-resistant Enterobacteriaceae (12, 38%), methicillin-resistant Staphylococcus aureus (12, 38%), and vancomycin-resistant Enterococci (8, 25%). No countries required reporting of resistance in Salmonella, Campylobacter, Helicobacter pylori, and Neisseria gonorrhea.
The reviewers also found significant differences in the type of data collected and disseminated by the 15 mandatory surveillance systems. Those differences included heterogeneous definition of clinical samples, screening, and type of specimen included. Only half of the systems collected data on clinical outcomes, patient-based risk factors, and resistance mechanism. In addition, only 9 (28%) countries had mandatory reporting of outbreaks caused by WHO priority pathogens, of which 6 provided public access and 1 provided weekly numbers.
The authors of the study say that rising antimicrobial resistance (AMR), and the growing risk of spreading resistant pathogens through travel and transfer of hospital patients among countries, underscores the need to improve mandatory surveillance and standardize data collection and reporting.
"The results of this review should push forward the debate on mandatory surveillance for high priority antibiotic resistant bacteria and restructuring of current surveillance strategies at national level in Europe," the authors write. "Making surveillance protocols and results freely-accessibly is considered a pillar of the European AMR strategy and should be made an immediate priority."
Dec 5 Clin Microbiol Infect study
[h=3]Stewardship, C diff prevention up in US hospitals, but ID expertise lags[/h] A survey of US hospitals has found that while antibiotic stewardship programs and evidence-based Clostridioides difficile infection (CDI) prevention practices are now common, infectious disease (ID) expertise is limited, and fewer than half of hospitals meet accreditation standards for multidisciplinary stewardship teams.
In a paper published today in Infection Control and Hospital Epidemiology, researchers report that of 528 US hospitals that completed a 2017 survey on the presence and composition of antibiotic stewardship programs, current methods of CDI prevention and treatment, and diagnostic stewardship practices, 95% reported having an antibiotic stewardship program—up from 52% in 2013. In addition, the reported use of guideline-recommended CDI prevention practices was over 90%, with CDI prevention seen as "important" or "very important" to hospital leadership in 89% of hospitals.
However, the survey also found that antibiotic stewardship team members with ID training were less common: 52% of programs had an ID-trained pharmacist, 69% had an ID physician, and only 43% had both. Team members with ID training were more likely in larger hospitals. Furthermore, only 41% of hospitals met The Joint Commission's 2017 standards for accreditation, which require hospitals to have multidisciplinary antibiotic stewardship teams that include an ID physician, infection preventionist, pharmacist, and practitioner. And CDI prevention practices varied across hospitals, with less use of novel CDI practices and diagnostic stewardship strategies at smaller hospitals.
"Although nearly all hospitals now have an antibiotic stewardship program, team compositions differ by hospital size, and most hospitals do not meet ideal recommendations for multidisciplinary teams," the authors of the paper write. "Specifically, smaller hospitals appear to have limited ID expertise on their stewardship teams and to struggle with deploying diagnostic stewardship strategies."
The authors suggest that CDI prevention at smaller hospitals could be enhanced by emphasizing the role of generalists (including clinical pharmacists, nurses, and hospitalists) in antibiotic stewardship.
Dec 6 Infect Control Hosp Epidemiol abstract
Stewardship / Resistance Scan for Dec 06, 2019
European priority pathogen surveillance; US hospital stewardship
Filed Under:
Antimicrobial Stewardship; Clostridium difficile
[h=3]Study: Mandatory surveillance of priority pathogens lacking in Europe[/h] A review of national documents shows that fewer than half of European countries have implemented publicly accessible mandatory surveillance of at least one of the World Health Organization's (WHO's) priority pathogens, European researchers reported yesterday in Clinical Microbiology and Infection.
The review found that of 28 European Union and 4 European Free Trade Association member states, 21 (66%) had a national mandate to survey at least one of the WHO's critical- and high-priority antibiotic-resistant pathogens, but only 15 (47%) had publicly accessible information that could be evaluated. The most frequently monitored pathogens were carbapenem-resistant Enterobacteriaceae (12, 38%), methicillin-resistant Staphylococcus aureus (12, 38%), and vancomycin-resistant Enterococci (8, 25%). No countries required reporting of resistance in Salmonella, Campylobacter, Helicobacter pylori, and Neisseria gonorrhea.
The reviewers also found significant differences in the type of data collected and disseminated by the 15 mandatory surveillance systems. Those differences included heterogeneous definition of clinical samples, screening, and type of specimen included. Only half of the systems collected data on clinical outcomes, patient-based risk factors, and resistance mechanism. In addition, only 9 (28%) countries had mandatory reporting of outbreaks caused by WHO priority pathogens, of which 6 provided public access and 1 provided weekly numbers.
The authors of the study say that rising antimicrobial resistance (AMR), and the growing risk of spreading resistant pathogens through travel and transfer of hospital patients among countries, underscores the need to improve mandatory surveillance and standardize data collection and reporting.
"The results of this review should push forward the debate on mandatory surveillance for high priority antibiotic resistant bacteria and restructuring of current surveillance strategies at national level in Europe," the authors write. "Making surveillance protocols and results freely-accessibly is considered a pillar of the European AMR strategy and should be made an immediate priority."
Dec 5 Clin Microbiol Infect study
[h=3]Stewardship, C diff prevention up in US hospitals, but ID expertise lags[/h] A survey of US hospitals has found that while antibiotic stewardship programs and evidence-based Clostridioides difficile infection (CDI) prevention practices are now common, infectious disease (ID) expertise is limited, and fewer than half of hospitals meet accreditation standards for multidisciplinary stewardship teams.
In a paper published today in Infection Control and Hospital Epidemiology, researchers report that of 528 US hospitals that completed a 2017 survey on the presence and composition of antibiotic stewardship programs, current methods of CDI prevention and treatment, and diagnostic stewardship practices, 95% reported having an antibiotic stewardship program—up from 52% in 2013. In addition, the reported use of guideline-recommended CDI prevention practices was over 90%, with CDI prevention seen as "important" or "very important" to hospital leadership in 89% of hospitals.
However, the survey also found that antibiotic stewardship team members with ID training were less common: 52% of programs had an ID-trained pharmacist, 69% had an ID physician, and only 43% had both. Team members with ID training were more likely in larger hospitals. Furthermore, only 41% of hospitals met The Joint Commission's 2017 standards for accreditation, which require hospitals to have multidisciplinary antibiotic stewardship teams that include an ID physician, infection preventionist, pharmacist, and practitioner. And CDI prevention practices varied across hospitals, with less use of novel CDI practices and diagnostic stewardship strategies at smaller hospitals.
"Although nearly all hospitals now have an antibiotic stewardship program, team compositions differ by hospital size, and most hospitals do not meet ideal recommendations for multidisciplinary teams," the authors of the paper write. "Specifically, smaller hospitals appear to have limited ID expertise on their stewardship teams and to struggle with deploying diagnostic stewardship strategies."
The authors suggest that CDI prevention at smaller hospitals could be enhanced by emphasizing the role of generalists (including clinical pharmacists, nurses, and hospitalists) in antibiotic stewardship.
Dec 6 Infect Control Hosp Epidemiol abstract