Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/06/stewardship-resistance-scan-jun-12-2020
Stewardship / Resistance Scan for Jun 12, 2020
Extended beta-lactam infusion; US hospital antibiotic use; Call for more US leadership on AMR
Filed Under:
Antimicrobial Stewardship
Review suggests mortality benefit for extended beta-lactam infusion
A meta-analysis of randomized controlled trials and observational studies found that extended infusion of antipseudomonal beta-lactam antibiotics in critically ill patients who had respiratory infections was associated with reduced mortality but not with clinical success, Japanese and Egyptian researchers reported yesterday in the International Journal of Infectious Diseases.
The researchers analyzed nine studies involving 1,058 patients that compared extended infusion (more than 3 hours) of beta-lactam antibiotics with intermittent infusion in critically ill patients. While several studies have demonstrated that prolonged infusion of beta-lactams results in higher clinical cure rates, lower mortality, and shorter hospital stays than intermittent infusion, a meta-analysis approach has not been used to examine the clinical efficiency of extended infusion in critically ill patients with predominant respiratory infections.
The primary outcome of the meta-analysis was all-cause mortality, and secondary outcomes included clinical success (based on pre-defined criteria specific to the infection in each study), hospital length of stay (LOS), intensive care unit (ICU) LOS, and antibiotic duration.
The results showed that mortality was lower for extended infusion than for intermittent infusion, with 126 deaths among 735 patients in the extended-infusion arm compared with 195 deaths among 773 patients in intermittent-infusion arm (risk difference [RD], – 0.10; 95% confidence interval [CI], ?–0.15 to ?–0.04). But no significant differences were observed for clinical success (RD, 0.11; 95% CI, –0.09 to 0.30), hospital LOS (RD, –1.68; 95% CI, –3.85 to 0.48), ICU LOS (RD, –2.37; 95% CI, –5.17 to 0.42) or antibiotic duration (RD, 0.05; 95% CI, –1.80 to 1.90) between the two groups.
The authors of the study say well-designed randomized controlled trials are needed to confirm the findings.
Jun 11 Int J Infect Dis abstract
Surveys show little change in antibiotic use in US hospitals
A comparison of surveys of antibiotic use in US hospitals shows little change from 2011 through 2015, US researchers reported this week in Clinical Infectious Diseases.
In 2011, the Centers for Disease Control and Prevention's (CDC's) Emerging Infections Program (EIP) hospital prevalence survey of healthcare-associated infections and antimicrobial use found that 50% of hospitalized patients received antibiotics. The 2015 survey was conducted in hospitals from 10 states that participate in the EIP using similar methods, with each hospital selecting a survey date from May to September 2015, and patients randomly selected from the hospital's morning census on the survey date.
Researchers from the EIP Hospital Prevalence Survey Team reviewed patient records to collect data on antibiotics on the survey date or day before, then compared the percentage of patients on antibiotics with the 2011 results.
Of the 12,299 patients from 199 hospitals, 6,084 (49.5%) received antibiotics on the survey date or the day before (95% CI, 48.6% to 50.4%). Comparison of the 148 hospitals in both surveys found similar rates of antibiotic use, with 4,606 of 9,283 patients (49.6%; 95% CI, 48.6% to 50.6%) receiving antibiotics in 2015 and 4,590 of 9,169 patients (50.1%; 95% CI, 49% to 51.1%) receiving antibiotics in 2011. But the percentage of neonatal critical care patients on antibiotics was lower in 2015 than in 2011 (22.8% vs 32%, P = 0.06).
The results also showed that fluoroquinolone use was lower in 2015 than in 2011 (10.1% vs 11.9%, P < 0.001), while third- and fourth-generation cephalosporin use (12.2% vs 10.7%, P = 0.02) and carbapenem use (3.7% vs 2.7%, P < 0.001) was higher. Pneumonia or respiratory infection was the most common reason for antibiotic use in both surveys.
The authors of the study said the lower prevalence of antibiotic use in neonatal critical care units and reduced use of fluoroquinolones in 2015 are encouraging signs that could provide evidence of the impact of antibiotic stewardship, but noted that the higher use of extended-spectrum cephalosporins and carbapenems is concerning.
Jun 10 Clin Infect Dis abstract
Think tank calls for more US leadership on AMR
A new paper from the Center for Strategic and International Studies (CSIS) is calling for the US government to provide more resources and attention to combating antimicrobial resistance (AMR).
Among the actions recommended in the CSIS brief are the inclusion of AMR funding in any coronavirus legislation to support research and enhance Medicare payments for antibiotic treatments, increased US funding for international AMR monitoring and reduction strategies, development of a concrete action plan to create incentives for developing and sustainably marketing new antibiotics, creation of more effective Medicare reimbursement mechanisms that confer appropriate value to antibiotics, and more federal support for antibiotic research and development.
The paper also calls for the US government to exercise significant global leadership around the issue.
"The U.S. government, in addition to improving infection control and antibiotic stewardship at home, should play a lead role in developing mechanisms to sustain antibiotic development and spur creation of innovative alternatives," CSIS senior associate Nellie Bristol, MPH, writes. "Further, as a public health leader globally, the United States should actively formulate, support, and advance global efforts to reduce AMR to help protect Americans at home and abroad."
Jun 9 CSIS brief
Stewardship / Resistance Scan for Jun 12, 2020
Extended beta-lactam infusion; US hospital antibiotic use; Call for more US leadership on AMR
Filed Under:
Antimicrobial Stewardship
Review suggests mortality benefit for extended beta-lactam infusion
A meta-analysis of randomized controlled trials and observational studies found that extended infusion of antipseudomonal beta-lactam antibiotics in critically ill patients who had respiratory infections was associated with reduced mortality but not with clinical success, Japanese and Egyptian researchers reported yesterday in the International Journal of Infectious Diseases.
The researchers analyzed nine studies involving 1,058 patients that compared extended infusion (more than 3 hours) of beta-lactam antibiotics with intermittent infusion in critically ill patients. While several studies have demonstrated that prolonged infusion of beta-lactams results in higher clinical cure rates, lower mortality, and shorter hospital stays than intermittent infusion, a meta-analysis approach has not been used to examine the clinical efficiency of extended infusion in critically ill patients with predominant respiratory infections.
The primary outcome of the meta-analysis was all-cause mortality, and secondary outcomes included clinical success (based on pre-defined criteria specific to the infection in each study), hospital length of stay (LOS), intensive care unit (ICU) LOS, and antibiotic duration.
The results showed that mortality was lower for extended infusion than for intermittent infusion, with 126 deaths among 735 patients in the extended-infusion arm compared with 195 deaths among 773 patients in intermittent-infusion arm (risk difference [RD], – 0.10; 95% confidence interval [CI], ?–0.15 to ?–0.04). But no significant differences were observed for clinical success (RD, 0.11; 95% CI, –0.09 to 0.30), hospital LOS (RD, –1.68; 95% CI, –3.85 to 0.48), ICU LOS (RD, –2.37; 95% CI, –5.17 to 0.42) or antibiotic duration (RD, 0.05; 95% CI, –1.80 to 1.90) between the two groups.
The authors of the study say well-designed randomized controlled trials are needed to confirm the findings.
Jun 11 Int J Infect Dis abstract
Surveys show little change in antibiotic use in US hospitals
A comparison of surveys of antibiotic use in US hospitals shows little change from 2011 through 2015, US researchers reported this week in Clinical Infectious Diseases.
In 2011, the Centers for Disease Control and Prevention's (CDC's) Emerging Infections Program (EIP) hospital prevalence survey of healthcare-associated infections and antimicrobial use found that 50% of hospitalized patients received antibiotics. The 2015 survey was conducted in hospitals from 10 states that participate in the EIP using similar methods, with each hospital selecting a survey date from May to September 2015, and patients randomly selected from the hospital's morning census on the survey date.
Researchers from the EIP Hospital Prevalence Survey Team reviewed patient records to collect data on antibiotics on the survey date or day before, then compared the percentage of patients on antibiotics with the 2011 results.
Of the 12,299 patients from 199 hospitals, 6,084 (49.5%) received antibiotics on the survey date or the day before (95% CI, 48.6% to 50.4%). Comparison of the 148 hospitals in both surveys found similar rates of antibiotic use, with 4,606 of 9,283 patients (49.6%; 95% CI, 48.6% to 50.6%) receiving antibiotics in 2015 and 4,590 of 9,169 patients (50.1%; 95% CI, 49% to 51.1%) receiving antibiotics in 2011. But the percentage of neonatal critical care patients on antibiotics was lower in 2015 than in 2011 (22.8% vs 32%, P = 0.06).
The results also showed that fluoroquinolone use was lower in 2015 than in 2011 (10.1% vs 11.9%, P < 0.001), while third- and fourth-generation cephalosporin use (12.2% vs 10.7%, P = 0.02) and carbapenem use (3.7% vs 2.7%, P < 0.001) was higher. Pneumonia or respiratory infection was the most common reason for antibiotic use in both surveys.
The authors of the study said the lower prevalence of antibiotic use in neonatal critical care units and reduced use of fluoroquinolones in 2015 are encouraging signs that could provide evidence of the impact of antibiotic stewardship, but noted that the higher use of extended-spectrum cephalosporins and carbapenems is concerning.
Jun 10 Clin Infect Dis abstract
Think tank calls for more US leadership on AMR
A new paper from the Center for Strategic and International Studies (CSIS) is calling for the US government to provide more resources and attention to combating antimicrobial resistance (AMR).
Among the actions recommended in the CSIS brief are the inclusion of AMR funding in any coronavirus legislation to support research and enhance Medicare payments for antibiotic treatments, increased US funding for international AMR monitoring and reduction strategies, development of a concrete action plan to create incentives for developing and sustainably marketing new antibiotics, creation of more effective Medicare reimbursement mechanisms that confer appropriate value to antibiotics, and more federal support for antibiotic research and development.
The paper also calls for the US government to exercise significant global leadership around the issue.
"The U.S. government, in addition to improving infection control and antibiotic stewardship at home, should play a lead role in developing mechanisms to sustain antibiotic development and spur creation of innovative alternatives," CSIS senior associate Nellie Bristol, MPH, writes. "Further, as a public health leader globally, the United States should actively formulate, support, and advance global efforts to reduce AMR to help protect Americans at home and abroad."
Jun 9 CSIS brief