Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2018/11/stewardship-resistance-scan-nov-27-2018
Stewardship / Resistance Scan for Nov 27, 2018
Fluoroquinolones and aortic rupture risk; Resistance action plan
Filed Under:
Antimicrobial Stewardship
[h=3]Study: Fluoroquinolone use common in patients at risk of aortic rupture[/h] A study yesterday in Antimicrobial Agents and Chemotherapy found that patients at risk for aortic rupture are frequently exposed to fluoroquinolones during hospitalization, despite concerns that fluoroquinolone use may be associated with increased risk of aortic aneurysm and/or dissection (AAD).
In the study, investigators from Baylor College of Medicine analyzed hospital admissions data for the years 2009 through 2015 to explore how often patients with AAD or Marfan syndrome (a genetic disorder linked to increased risk of AAD) are being treated with fluoroquinolones in the acute care setting, given that these patients are already at increased risk of aortic rupture. Fluoroquinolones are among the most commonly prescribed antibiotics worldwide, but post-marketing and clinical surveillance studies have linked them with several adverse effects, and four recent observational clinical studies have suggested they may be associated with an increased risk of AAD.
Using the Advisory Board billing and administrative database, the investigators identified 136,789 admissions for AAD, which involved 99,818 unique patients, and 2,871 unique admissions for Marfan syndrome, involving 1,872 unique patients. Of the 19,818 patients with AAD, 20% were administered a fluoroquinolone during admission. Of the 7,045 patients with dissection, 18% were exposed to fluoroquinolones, and 19% of the patients who underwent aortic repair received fluoroquinolones before the surgery. In addition, 14% of the Marfan syndrome patients were exposed to fluoroquinolones.
Multi-level regression analysis to determine factors associated with fluoroquinolone use revealed that in patients with AAD, having a diagnosis of pneumonia or urinary tract infection (UTI) increased the likelihood of receiving a fluoroquinolone by 46% and 40%, respectively. Pneumonia and UTIs also increased the risk of fluoroquinolone use in Marfan syndrome patients as well.
"If the suspected deleterious effects of FQs [fluoroquinolones] on aortic integrity is substantiated, reducing FQ use in these patients should be a high priority for antibiotic stewardship and patient safety programs," the authors of the study write. "Our results help identify the patients who are most at risk of FQ exposure during hospitalization and, thus, provide a starting place for stewardship interventions."
Nov 26 Antimicrob Agents Chemother abstract
[h=3]Advisory group seeks input on priorities for resistance action plan[/h] The US Presidential Advisory Committee on Combating Antibiotic Resistant Bacteria (PACCARB) is seeking the public's input for an update on the US government's efforts to fight antibiotic resistance.
On Nov 23 PACCARB posted a Request for Information (RFI) in the Federal Register that will allow a wide range of stakeholders to suggest new priority areas within each of the five goals that were established in the first National Action Plan (NAP) for Combating Antibiotic-Resistant Bacteria, which covers the years 2015 to 2020. PACCARB posted the RFI in response to a request from Department of Health and Human Services (HHS) Secretary Alex Azar to identify significant areas that have emerged since the first NAP was published in 2015.
The goals of the initial NAP included slowing the emergence of resistant bacteria and preventing the spread of resistant infections; strengthening national One Health surveillance efforts; advancing development and use of rapid and innovative diagnostic tests; accelerating research and development for new antibiotics and other therapeutics; and improving international collaboration. Azar asked PACCARB to identify three to five areas within each of these goals that should be considered for the second iteration of the NAP, which will guide action against antibiotic resistance for the period 2020-2025.
The deadline for submitting comments in Jan 7, 2019. Priority areas will be explored at the next PACCARB public meeting, scheduled for Jan 30-31, 2019.
Nov 23 Federal Register notice
HHS online comment form
Stewardship / Resistance Scan for Nov 27, 2018
Fluoroquinolones and aortic rupture risk; Resistance action plan
Filed Under:
Antimicrobial Stewardship
[h=3]Study: Fluoroquinolone use common in patients at risk of aortic rupture[/h] A study yesterday in Antimicrobial Agents and Chemotherapy found that patients at risk for aortic rupture are frequently exposed to fluoroquinolones during hospitalization, despite concerns that fluoroquinolone use may be associated with increased risk of aortic aneurysm and/or dissection (AAD).
In the study, investigators from Baylor College of Medicine analyzed hospital admissions data for the years 2009 through 2015 to explore how often patients with AAD or Marfan syndrome (a genetic disorder linked to increased risk of AAD) are being treated with fluoroquinolones in the acute care setting, given that these patients are already at increased risk of aortic rupture. Fluoroquinolones are among the most commonly prescribed antibiotics worldwide, but post-marketing and clinical surveillance studies have linked them with several adverse effects, and four recent observational clinical studies have suggested they may be associated with an increased risk of AAD.
Using the Advisory Board billing and administrative database, the investigators identified 136,789 admissions for AAD, which involved 99,818 unique patients, and 2,871 unique admissions for Marfan syndrome, involving 1,872 unique patients. Of the 19,818 patients with AAD, 20% were administered a fluoroquinolone during admission. Of the 7,045 patients with dissection, 18% were exposed to fluoroquinolones, and 19% of the patients who underwent aortic repair received fluoroquinolones before the surgery. In addition, 14% of the Marfan syndrome patients were exposed to fluoroquinolones.
Multi-level regression analysis to determine factors associated with fluoroquinolone use revealed that in patients with AAD, having a diagnosis of pneumonia or urinary tract infection (UTI) increased the likelihood of receiving a fluoroquinolone by 46% and 40%, respectively. Pneumonia and UTIs also increased the risk of fluoroquinolone use in Marfan syndrome patients as well.
"If the suspected deleterious effects of FQs [fluoroquinolones] on aortic integrity is substantiated, reducing FQ use in these patients should be a high priority for antibiotic stewardship and patient safety programs," the authors of the study write. "Our results help identify the patients who are most at risk of FQ exposure during hospitalization and, thus, provide a starting place for stewardship interventions."
Nov 26 Antimicrob Agents Chemother abstract
[h=3]Advisory group seeks input on priorities for resistance action plan[/h] The US Presidential Advisory Committee on Combating Antibiotic Resistant Bacteria (PACCARB) is seeking the public's input for an update on the US government's efforts to fight antibiotic resistance.
On Nov 23 PACCARB posted a Request for Information (RFI) in the Federal Register that will allow a wide range of stakeholders to suggest new priority areas within each of the five goals that were established in the first National Action Plan (NAP) for Combating Antibiotic-Resistant Bacteria, which covers the years 2015 to 2020. PACCARB posted the RFI in response to a request from Department of Health and Human Services (HHS) Secretary Alex Azar to identify significant areas that have emerged since the first NAP was published in 2015.
The goals of the initial NAP included slowing the emergence of resistant bacteria and preventing the spread of resistant infections; strengthening national One Health surveillance efforts; advancing development and use of rapid and innovative diagnostic tests; accelerating research and development for new antibiotics and other therapeutics; and improving international collaboration. Azar asked PACCARB to identify three to five areas within each of these goals that should be considered for the second iteration of the NAP, which will guide action against antibiotic resistance for the period 2020-2025.
The deadline for submitting comments in Jan 7, 2019. Priority areas will be explored at the next PACCARB public meeting, scheduled for Jan 30-31, 2019.
Nov 23 Federal Register notice
HHS online comment form