Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2021/09/stewardship-resistance-scan-sep-30-2021
Stewardship / Resistance Scan for Sep 30, 2021
Hospital antibiotic use, stewardship; Short-course antibiotics for Pseudomonas
Filed Under:
Antimicrobial Stewardship
Global point-prevalence survey helps hospital stewardship, survey finds
Results from a worldwide survey of hospitals suggests that the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) has helped inform stewardship activities, Belgian researchers reported this week in Antimicrobial Resistance and Infection Control.
Launched in 2015, Global-PPS provides hospitals with a standardized method of collecting and assessing antimicrobial prescribing data and has been used by more than 700 hospitals around the world. But little is known about how hospitals are using it to inform antimicrobial stewardship (AMS) activities. To assess its role in AMS efforts and identify barriers to implementing AMS in different resource settings, researchers from the University of Antwerp sent a cross-sectional survey to hospitals within the Global-PPS network.
A total of 248 hospitals from 74 countries participated in the survey; of these, 192 (77.4%) had conducted the PPS at least once. In 96.9% of these 192 hospitals, Global-PPS participation had led to the identification of problems with antimicrobial prescribing. The most common prescription-related problems were a high relative use of certain classes of antibiotics (62%), prolonged surgical antibiotic prophylaxis (60.9%), and a high antimicrobial use prevalence (60.4%). In 69.3% of hospitals, at least one AMS component was related to findings from the Global-PPS. The Global-PPS was mostly used to inform education and communication and the development and review of guidelines.
The level of AMS implementation in hospitals varied by region. Up to 43.1% of all hospitals had a formal AMS strategy, ranging from 10.8% of hospitals in Africa to 60.9% of hospitals in North America. Another 29.7% reported that they were planning to develop a formal AMS strategy. The main barriers to implementing AMS programs were a lack of time (52.7%), knowledge on good prescribing practices (42.0%), and dedicated funding (39.9%). Hospitals in low- and middle-income countries more often reported a lack of prescribing guidelines, insufficient laboratory capacity, and suboptimal use of available lab services.
Despite the substantial variation in hospital AMS programs and the barriers to implementation, the authors say the results show how Global-PPS can contribute to AMS activities.
"Providing all participating hospitals with a personalised feedback report, the Global-PPS allows local teams to identify targets for antimicrobial stewardship without the need to invest time and resources in complex data analyses," they wrote.
Sep 28 Antimicrob Resist Infect Control study
Short-course antibiotics shown effective for Pseudomonas bloodstream infections
A retrospective study of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) found that short-course antibiotic therapy may be as effective long-course therapy, South Korean researchers reported today in the Journal of Antimicrobial Chemotherapy.
The researchers looked at data on all patients admitted to a tertiary care hospital with uncomplicated P aeruginosa BSIs from April 2010 through April 2020. They compared the primary outcome (a composite rate of recurrent P aeruginosa infection and mortality 30 days after discontinuing antibiotics) among patients who received short-course (7 to 11 days) and prolonged (12 to 21 days) antibiotic therapy. The secondary outcome was a recurrence of P aeruginosa infection at any site within 180 days.
A total of 290 patients met the eligibility criteria. Among them, 97 received short-course therapy (median of 9 days) and 193 underwent prolonged therapy (median of 15 days). Eleven patients in the short-course group (11%) and 30 patients in the long-course group (16%) had recurrent P aeruginosa infection or died within 30 days of completing therapy. Propensity scoring analysis using the inverse probability of treatment weighting (IPTW) method showed that prolonged therapy did not significantly reduce the risk of recurrent infection or death compared with short-course therapy (IPTW-adjusted hazard ratio
, 0.68; 95% confidence interval [CI], 0.34 to 1.36).
Recurrent P aeruginosa infection at any site within 180 days of completing therapy occurred in 12 patients in the short-course group (12%) and 37 patients in the prolonged-course group (19%). Prolonged-course therapy did not significantly reduce the risk of this outcome (IPTW-adjusted HR, 0.57; 95% CI, 0.29 to 1.10).
The study authors acknowledge several limitations, including the single-center nature of the study, residual bias, rigorous exclusionary criteria, and wide confidence intervals, and say the study needs to be repeated as a randomized trial with a larger sample size. But they believe the findings could be applied to select patients with uncomplicated P aeruginosa BSIs.
"Our findings reinforce the current tendency to lean toward shorter duration of antimicrobial therapy," they write.
Sep 30 J Antimicrob Chemother abstract
Stewardship / Resistance Scan for Sep 30, 2021
Hospital antibiotic use, stewardship; Short-course antibiotics for Pseudomonas
Filed Under:
Antimicrobial Stewardship
Global point-prevalence survey helps hospital stewardship, survey finds
Results from a worldwide survey of hospitals suggests that the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) has helped inform stewardship activities, Belgian researchers reported this week in Antimicrobial Resistance and Infection Control.
Launched in 2015, Global-PPS provides hospitals with a standardized method of collecting and assessing antimicrobial prescribing data and has been used by more than 700 hospitals around the world. But little is known about how hospitals are using it to inform antimicrobial stewardship (AMS) activities. To assess its role in AMS efforts and identify barriers to implementing AMS in different resource settings, researchers from the University of Antwerp sent a cross-sectional survey to hospitals within the Global-PPS network.
A total of 248 hospitals from 74 countries participated in the survey; of these, 192 (77.4%) had conducted the PPS at least once. In 96.9% of these 192 hospitals, Global-PPS participation had led to the identification of problems with antimicrobial prescribing. The most common prescription-related problems were a high relative use of certain classes of antibiotics (62%), prolonged surgical antibiotic prophylaxis (60.9%), and a high antimicrobial use prevalence (60.4%). In 69.3% of hospitals, at least one AMS component was related to findings from the Global-PPS. The Global-PPS was mostly used to inform education and communication and the development and review of guidelines.
The level of AMS implementation in hospitals varied by region. Up to 43.1% of all hospitals had a formal AMS strategy, ranging from 10.8% of hospitals in Africa to 60.9% of hospitals in North America. Another 29.7% reported that they were planning to develop a formal AMS strategy. The main barriers to implementing AMS programs were a lack of time (52.7%), knowledge on good prescribing practices (42.0%), and dedicated funding (39.9%). Hospitals in low- and middle-income countries more often reported a lack of prescribing guidelines, insufficient laboratory capacity, and suboptimal use of available lab services.
Despite the substantial variation in hospital AMS programs and the barriers to implementation, the authors say the results show how Global-PPS can contribute to AMS activities.
"Providing all participating hospitals with a personalised feedback report, the Global-PPS allows local teams to identify targets for antimicrobial stewardship without the need to invest time and resources in complex data analyses," they wrote.
Sep 28 Antimicrob Resist Infect Control study
Short-course antibiotics shown effective for Pseudomonas bloodstream infections
A retrospective study of patients with Pseudomonas aeruginosa bloodstream infections (BSIs) found that short-course antibiotic therapy may be as effective long-course therapy, South Korean researchers reported today in the Journal of Antimicrobial Chemotherapy.
The researchers looked at data on all patients admitted to a tertiary care hospital with uncomplicated P aeruginosa BSIs from April 2010 through April 2020. They compared the primary outcome (a composite rate of recurrent P aeruginosa infection and mortality 30 days after discontinuing antibiotics) among patients who received short-course (7 to 11 days) and prolonged (12 to 21 days) antibiotic therapy. The secondary outcome was a recurrence of P aeruginosa infection at any site within 180 days.
A total of 290 patients met the eligibility criteria. Among them, 97 received short-course therapy (median of 9 days) and 193 underwent prolonged therapy (median of 15 days). Eleven patients in the short-course group (11%) and 30 patients in the long-course group (16%) had recurrent P aeruginosa infection or died within 30 days of completing therapy. Propensity scoring analysis using the inverse probability of treatment weighting (IPTW) method showed that prolonged therapy did not significantly reduce the risk of recurrent infection or death compared with short-course therapy (IPTW-adjusted hazard ratio
, 0.68; 95% confidence interval [CI], 0.34 to 1.36).
Recurrent P aeruginosa infection at any site within 180 days of completing therapy occurred in 12 patients in the short-course group (12%) and 37 patients in the prolonged-course group (19%). Prolonged-course therapy did not significantly reduce the risk of this outcome (IPTW-adjusted HR, 0.57; 95% CI, 0.29 to 1.10).
The study authors acknowledge several limitations, including the single-center nature of the study, residual bias, rigorous exclusionary criteria, and wide confidence intervals, and say the study needs to be repeated as a randomized trial with a larger sample size. But they believe the findings could be applied to select patients with uncomplicated P aeruginosa BSIs.
"Our findings reinforce the current tendency to lean toward shorter duration of antimicrobial therapy," they write.
Sep 30 J Antimicrob Chemother abstract