Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/04/stewardship-resistance-scan-apr-26-2019
Stewardship / Resistance Scan for Apr 26, 2019
Outpatient antibiotic decline in Denmark; Inappropriate empiric therapy in Spain
Filed Under:
Antimicrobial Stewardship
[h=3]Study shows decline in outpatient antibiotic use in Denmark[/h] Outpatient antibiotic use in central Denmark fell by nearly 20% from 2011 through 2015, Danish researchers report in a new study in BMC Infectious Diseases.
Using data from the Danish National Health Service Prescription Database, the researchers examined recent time trends in the utilization of narrow- and broad-spectrum antibiotics in central Denmark and the variation in antibiotic use by sex, age, and municipality of residence from 2006 through 2015. They found that, after a slight increase from 2006 through 2011, the overall rate of redeemed prescriptions for antibiotics fell from 290 per 1,000 person-years in 2011 to 236/1,000 person-years in 2015?a decline of 17%. The decreasing trend in antibiotic use over time was observed in all municipalities, mainly due a decrease in narrow-spectrum antibiotics. Among people aged 65 and over, the decline in use began in 2013 and was less pronounced.
The analysis also found that antibiotic use in 2015 remained higher among women (289/1,000 person-years) than men (182/1,000 person-years) and among the very old (520/1,000 person-years in people over 85) versus those in middle-age (204/1,000 person-years in people ages 45 to 65). In addition, there was a 1.6-fold geographical variation in antibiotic use in 2015 that was not explained by age and sex differences, and a continuous increasing trend in broad-spectrum antibiotic use was observed in women over 65 and men over 85, primarily related to increasing use of combinations of penicillins with beta-lactamase inhibitors. Notably, 2015 marked the first time that prescribing of broad-spectrum antibiotics surpassed prescribing of narrow-spectrum antibiotics.
The authors of the study say the data show there is room for improvement in antibiotic prescribing, and that a greater focus on avoiding unnecessary broad-spectrum antibiotic use is needed.
Apr 24 BMC Infect Dis study
[h=3]Spanish hospital study highlights inappropriate empiric antibiotic therapy[/h] An observational study conducted in two Spanish hospitals has found that inappropriate empiric antibiotic therapy (IEAT) is frequent in patients with febrile neutropenia (FN) and bloodstream infections, especially those caused by multidrug-resistant gram-negative pathogens, Spanish researchers reported yesterday in Clinical Infectious Diseases.
The researchers wanted to investigate IEAT in patients with FN?a common complication of chemotherapy?because the epidemiology of bloodstream infections in these patients has been changing in recent decades, with an increase in gram-negative bacilli (GNB) and multidrug-resistant strains. At the same time, Infectious Diseases Society of America (IDSA) guidelines for empiric antibiotic therapy in FN have not been updated to reflect this change, making appropriate empiric therapy more of a challenge.
In the observational study, 1,615 episodes of bloodstream infection in 1,309 patients with high-risk FN were documented. Gram-negative microorganisms accounted for 56% of bloodstream infections and gram-positives 43%, with Escherichia coli (24%), coagulase-negative Staphylococci (21%), and Pseudomonas aeruginosa (18%) the most frequently isolated organisms. Multidrug-resistant gram-negative bacilli (MDR-GNB) accounted for 24% of all cases. Even though IDSA recommendations were followed 87% of the time, 24% of patients received IEAT, and patients with infections caused by MDR-GNB were more likely to receive IEAT than patients without MDR strains (39% vs. 7%).
Analysis of outcomes showed that patients who received IEAT had significantly higher mortality than those who received appropriate therapy (36% vs. 24%). When considering individual organisms, only patients with infection caused by P aeruginosa had significantly higher mortality when receiving IEAT (48% vs. 31%). Multivariate analysis identified IEAT (odds ratio [OR], 2.41; 95% confidence interval, 1.19 to 4.91), septic shock at onset (OR, 4.62; 95% CI, 2.49 to 8.56), and pneumonia (OR, 3.01; 95% CI, 1.55 to 5.83) as independent risk factors for mortality in patients with P aeruginosa bloodstream infections.
"These results should encourage a reassessment of the current FN guidelines and the use of new approaches to predict MDR infections," the authors of the study conclude.
Apr 25 Clin Infect Dis abstract
Stewardship / Resistance Scan for Apr 26, 2019
Outpatient antibiotic decline in Denmark; Inappropriate empiric therapy in Spain
Filed Under:
Antimicrobial Stewardship
[h=3]Study shows decline in outpatient antibiotic use in Denmark[/h] Outpatient antibiotic use in central Denmark fell by nearly 20% from 2011 through 2015, Danish researchers report in a new study in BMC Infectious Diseases.
Using data from the Danish National Health Service Prescription Database, the researchers examined recent time trends in the utilization of narrow- and broad-spectrum antibiotics in central Denmark and the variation in antibiotic use by sex, age, and municipality of residence from 2006 through 2015. They found that, after a slight increase from 2006 through 2011, the overall rate of redeemed prescriptions for antibiotics fell from 290 per 1,000 person-years in 2011 to 236/1,000 person-years in 2015?a decline of 17%. The decreasing trend in antibiotic use over time was observed in all municipalities, mainly due a decrease in narrow-spectrum antibiotics. Among people aged 65 and over, the decline in use began in 2013 and was less pronounced.
The analysis also found that antibiotic use in 2015 remained higher among women (289/1,000 person-years) than men (182/1,000 person-years) and among the very old (520/1,000 person-years in people over 85) versus those in middle-age (204/1,000 person-years in people ages 45 to 65). In addition, there was a 1.6-fold geographical variation in antibiotic use in 2015 that was not explained by age and sex differences, and a continuous increasing trend in broad-spectrum antibiotic use was observed in women over 65 and men over 85, primarily related to increasing use of combinations of penicillins with beta-lactamase inhibitors. Notably, 2015 marked the first time that prescribing of broad-spectrum antibiotics surpassed prescribing of narrow-spectrum antibiotics.
The authors of the study say the data show there is room for improvement in antibiotic prescribing, and that a greater focus on avoiding unnecessary broad-spectrum antibiotic use is needed.
Apr 24 BMC Infect Dis study
[h=3]Spanish hospital study highlights inappropriate empiric antibiotic therapy[/h] An observational study conducted in two Spanish hospitals has found that inappropriate empiric antibiotic therapy (IEAT) is frequent in patients with febrile neutropenia (FN) and bloodstream infections, especially those caused by multidrug-resistant gram-negative pathogens, Spanish researchers reported yesterday in Clinical Infectious Diseases.
The researchers wanted to investigate IEAT in patients with FN?a common complication of chemotherapy?because the epidemiology of bloodstream infections in these patients has been changing in recent decades, with an increase in gram-negative bacilli (GNB) and multidrug-resistant strains. At the same time, Infectious Diseases Society of America (IDSA) guidelines for empiric antibiotic therapy in FN have not been updated to reflect this change, making appropriate empiric therapy more of a challenge.
In the observational study, 1,615 episodes of bloodstream infection in 1,309 patients with high-risk FN were documented. Gram-negative microorganisms accounted for 56% of bloodstream infections and gram-positives 43%, with Escherichia coli (24%), coagulase-negative Staphylococci (21%), and Pseudomonas aeruginosa (18%) the most frequently isolated organisms. Multidrug-resistant gram-negative bacilli (MDR-GNB) accounted for 24% of all cases. Even though IDSA recommendations were followed 87% of the time, 24% of patients received IEAT, and patients with infections caused by MDR-GNB were more likely to receive IEAT than patients without MDR strains (39% vs. 7%).
Analysis of outcomes showed that patients who received IEAT had significantly higher mortality than those who received appropriate therapy (36% vs. 24%). When considering individual organisms, only patients with infection caused by P aeruginosa had significantly higher mortality when receiving IEAT (48% vs. 31%). Multivariate analysis identified IEAT (odds ratio [OR], 2.41; 95% confidence interval, 1.19 to 4.91), septic shock at onset (OR, 4.62; 95% CI, 2.49 to 8.56), and pneumonia (OR, 3.01; 95% CI, 1.55 to 5.83) as independent risk factors for mortality in patients with P aeruginosa bloodstream infections.
"These results should encourage a reassessment of the current FN guidelines and the use of new approaches to predict MDR infections," the authors of the study conclude.
Apr 25 Clin Infect Dis abstract