Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2019/05/stewardship-resistance-scan-may-02-2019
Stewardship / Resistance Scan for May 02, 2019
Quinolone ear drop risks; MDR Shigella in Vermont
Filed Under:
Antimicrobial Stewardship
[h=3]Study links quinolone ear drops to increased risk of eardrum perforation[/h] The results of a comparative safety study show that the use of quinolone ear drops to treat acute otitis externa (AOE) in children and adults is associated with a previously unreported increased risk of tympanic membrane perforation (TMP), researchers from the University of Florida report today in Clinical Infectious Diseases.
Using Medicaid clinical encounter and pharmacy billing records from 1999 through 2010, the researchers analyzed treatment outcomes in 94,333 patients treated for AOE, an uncomplicated ear infection that is not known to cause eardrum perforation. Quinolone ear drops and other ototopical antibiotics are frequently used to treat AOE, but because quinolones have been linked to soft-tissue damage, such as tendon rupture, the researchers wanted to see whether quinolone ear drops increase the risk of TMP.
Of the patients included in the study, 43,653 were treated with quinolone ear drops with or without corticosteroids and 50,680 were treated with neomycin-plus-hydrocortisone ear drops. Overall, 38 cases of TMP were diagnosed in patients exposed to quinolone ear drops during follow-up, compared with 25 in neomycin-exposed patients. When adjusted for demographics and other covariates, the risk of TMP associated with quinolone ear drops was more than twice that of neomycin ear drops (adjusted hazard ratio
, 2.26; 95% confidence interval [CI], 1.34 to 3.83).
When comparing individual quinolone preparations against neomycin, the adjusted HRs were 2.53 for ofloxacin (95% CI, 1.27 to 5.05), 2.24 for ciprofloxacin plus hydrocortisone (95% CI, 1.03 to 4.85), and 2.30 for ciprofloxacin plus dexamethasone (95% CI, 1.09 to 4.87). Sensitivity analyses were consistent with the primary analysis.
The authors of the study conclude that, given the findings, the risks and benefits of otic quinolones should be considered prior to treatment of AOE. "Therapy duration, volume dispensed, and refills should be limited to what is necessary to ensure clinical cure," they write. "Patients should be counseled on risk of TMP and monitored for TMPs in follow-up visits."
May 2 Clin Infect Dis abstract
[h=3]Officials detail MDR Shigella outbreak in Vermont retirement community[/h] A report today from the Centers for Disease Control and Prevention (CDC) and the Vermont Department of Health (VDH) describes a foodborne outbreak of diarrhea caused by multidrug-resistant (MDR) Shigella sonnei in a Vermont retirement community.
Writing in the latest Morbidity and Mortality Weekly Report (MMWR), CDC and VDH epidemiologists say the outbreak occurred in from Oct 1, 2018, through Nov 8, 2018, and sickened 75 residents, visitors, and staff members (24 with confirmed infections and 51 with probable infections). The median patient age was 80, and 75% of patients were female. Six of the patients were hospitalized and two died, although shigellosis was not considered to be the primary cause of death.
High-quality single nucleotide polymorphism analysis predicted that initial isolates from the outbreak were MDR and closely related to a concurrent multistate cluster. Antibiotic susceptibility testing found resistance to trimethoprim-sulfamethoxazole, ampicillin, and ceftriaxone and decreased susceptibility to azithromycin.
Interviews and a review of facility records indicate the earliest cases involved a staff member who prepared food while ill from Oct 11 through Oct 14 and six visitors who dined at the facility on Oct 14. A questionnaire was subsequently given to residents and staff members asking about meal exposure and other known shigellosis risk factors.
A case-control study that included 36 patients and 172 residents and staff members who didn't get sick during the outbreak period found that illness was associated with eating several meals at the facility from Oct 11 through 14. The strongest associations were found among those who dined at the facility on Oct 14 (odds ratio [OR], 5.6; 95% CI, 2.4 to 14.10), specifically during brunch (OR, 5.5; 95% CI, 2.3 to 13.3) and breakfast (OR, 5.3; 95% CI, 1.2 to 22.9).
The authors say the outbreak demonstrates that MDR shigellosis, which is rare in retirement communities, can affect a wide range of populations. In addition, they write, the fact that the outbreak likely started with a staff member who was working while ill highlights the need for nonpunitive sick leave policies.
May 3 MMWR Notes from the field
Stewardship / Resistance Scan for May 02, 2019
Quinolone ear drop risks; MDR Shigella in Vermont
Filed Under:
Antimicrobial Stewardship
[h=3]Study links quinolone ear drops to increased risk of eardrum perforation[/h] The results of a comparative safety study show that the use of quinolone ear drops to treat acute otitis externa (AOE) in children and adults is associated with a previously unreported increased risk of tympanic membrane perforation (TMP), researchers from the University of Florida report today in Clinical Infectious Diseases.
Using Medicaid clinical encounter and pharmacy billing records from 1999 through 2010, the researchers analyzed treatment outcomes in 94,333 patients treated for AOE, an uncomplicated ear infection that is not known to cause eardrum perforation. Quinolone ear drops and other ototopical antibiotics are frequently used to treat AOE, but because quinolones have been linked to soft-tissue damage, such as tendon rupture, the researchers wanted to see whether quinolone ear drops increase the risk of TMP.
Of the patients included in the study, 43,653 were treated with quinolone ear drops with or without corticosteroids and 50,680 were treated with neomycin-plus-hydrocortisone ear drops. Overall, 38 cases of TMP were diagnosed in patients exposed to quinolone ear drops during follow-up, compared with 25 in neomycin-exposed patients. When adjusted for demographics and other covariates, the risk of TMP associated with quinolone ear drops was more than twice that of neomycin ear drops (adjusted hazard ratio
, 2.26; 95% confidence interval [CI], 1.34 to 3.83).
When comparing individual quinolone preparations against neomycin, the adjusted HRs were 2.53 for ofloxacin (95% CI, 1.27 to 5.05), 2.24 for ciprofloxacin plus hydrocortisone (95% CI, 1.03 to 4.85), and 2.30 for ciprofloxacin plus dexamethasone (95% CI, 1.09 to 4.87). Sensitivity analyses were consistent with the primary analysis.
The authors of the study conclude that, given the findings, the risks and benefits of otic quinolones should be considered prior to treatment of AOE. "Therapy duration, volume dispensed, and refills should be limited to what is necessary to ensure clinical cure," they write. "Patients should be counseled on risk of TMP and monitored for TMPs in follow-up visits."
May 2 Clin Infect Dis abstract
[h=3]Officials detail MDR Shigella outbreak in Vermont retirement community[/h] A report today from the Centers for Disease Control and Prevention (CDC) and the Vermont Department of Health (VDH) describes a foodborne outbreak of diarrhea caused by multidrug-resistant (MDR) Shigella sonnei in a Vermont retirement community.
Writing in the latest Morbidity and Mortality Weekly Report (MMWR), CDC and VDH epidemiologists say the outbreak occurred in from Oct 1, 2018, through Nov 8, 2018, and sickened 75 residents, visitors, and staff members (24 with confirmed infections and 51 with probable infections). The median patient age was 80, and 75% of patients were female. Six of the patients were hospitalized and two died, although shigellosis was not considered to be the primary cause of death.
High-quality single nucleotide polymorphism analysis predicted that initial isolates from the outbreak were MDR and closely related to a concurrent multistate cluster. Antibiotic susceptibility testing found resistance to trimethoprim-sulfamethoxazole, ampicillin, and ceftriaxone and decreased susceptibility to azithromycin.
Interviews and a review of facility records indicate the earliest cases involved a staff member who prepared food while ill from Oct 11 through Oct 14 and six visitors who dined at the facility on Oct 14. A questionnaire was subsequently given to residents and staff members asking about meal exposure and other known shigellosis risk factors.
A case-control study that included 36 patients and 172 residents and staff members who didn't get sick during the outbreak period found that illness was associated with eating several meals at the facility from Oct 11 through 14. The strongest associations were found among those who dined at the facility on Oct 14 (odds ratio [OR], 5.6; 95% CI, 2.4 to 14.10), specifically during brunch (OR, 5.5; 95% CI, 2.3 to 13.3) and breakfast (OR, 5.3; 95% CI, 1.2 to 22.9).
The authors say the outbreak demonstrates that MDR shigellosis, which is rare in retirement communities, can affect a wide range of populations. In addition, they write, the fact that the outbreak likely started with a staff member who was working while ill highlights the need for nonpunitive sick leave policies.
May 3 MMWR Notes from the field