Antibiotic Therapy for Nearly 1 in 4 Adults with Pneumonia Does Not Work

Approximately 1 in 4 (22.1 percent) adults prescribed an antibiotic in an outpatient setting for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference | Infection Control Today

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Image source: Debbie Marshall – Wellcome Images // CC BY 4.0

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae, the species of bacterium that is the commonest cause of pneumonia.

McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.

The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia.  The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.  The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.  After adjusting for patient characteristics, the failure rates by class of antibiotic were:  beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).

Bathing hospitalized dependent patients with prepackaged disposable washcloths instead of traditional bath basins

Martin, E.T. et al. American Journal of Infection Control | Published online: 11 May 2017

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Highlights: 

  • Basins used for patient bathing may become contaminated with resistant organisms.
  • Disposal washcloths had no effect on prevention of infection in a randomized trial.
  • Skin deterioration was less among patients bathed by disposable washcloth.

Read the full abstract here

Researchers Find Door Handles to Be Significant Source of MRSA in Hospitals

The aim of this study by Saba, et al. (2017) was to determine the prevalence and antibiotic susceptibility of S. aureus and methicillin-resistant S. aureus (MRSA) in the environments of three hospitals in Ghana | Infection Control Today

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A total of 120 swab samples were taken from door handles, stair railings and other points of contact at Tamale Teaching Hospital, Tamale Central Hospital and Tamale West Hospital. The swab samples were directly plated on Mannitol Salt and Baird Parker agar plates and incubated at 37 °C (± 2) for 18 to 24 hours. An antibiotic susceptibility test was performed using the Clinical Laboratory Standard Institute’s guidelines. Isolates resistant to both cefoxitin and oxacillin were considered to be MRSA.

The researchers conclude that the high multi-drug resistance of MRSA in hospital environments in Ghana reinforces the need for the effective and routine cleaning of door handles in hospitals. Further investigation is required to understand whether S. aureus from door handles could be the possible causes of nosocomial diseases in the hospitals.

Read the full overview via Infection Control here

The original research abstract is available here

Reducing antibiotic prescribing for children presenting to primary care with acute respiratory tract infection

Blair, P.S. et al. (2017) BMJ Open. 7:e014506

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Objective: To investigate recruitment and retention, data collection methods and the acceptability of a ‘within-consultation’ complex intervention designed to reduce antibiotic prescribing.

Conclusion: Differential recruitment may explain the paradoxical antibiotic prescribing rates. Future cluster level studies should consider designs which remove the need for individual consent postrandomisation and embed the intervention within electronic primary care records.

Read the full article here

Reducing Catheter Associated Urinary Tract Infections

Reducing Catheter Associated Urinary Tract Infections (CAUTI’s) at a District General Hospital. Can change be sustained? | Commissioning for Quality and Innovation (CQINN) project. 

This shared-learning tool describes how Chesterfield Royal Hospital developed an improvement strategy to reduce catheter-associated urinary tract infections after data revealed rates were double the national average.

Full document: Six Step strategy for reducing cather associated urinary tract_infections

Giving immediate antibiotics reduces deaths from sepsis

Giving immediate antibiotics (defined as within one hour) when people present to emergency departments with suspected sepsis reduces their risk of dying by a third compared with later administration. 

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This meta-analysis of observational data from 23,596 people in emergency department settings confirmed that giving antibiotics within one hour was linked to a lower risk of in-hospital mortality compared with giving antibiotics later.

This adds weight to recommendations from NICE and other organisations that antibiotics should be administered straight away in people with suspected sepsis. However, in practice up to a third of people in the UK do not receive antibiotics within the hour.

NHS England and the UK Sepsis Trust have recently launched a campaign to encourage all healthcare professionals to act quickly when they recognise sepsis.

Full reference: Johnston AN, Park J, Doi SA, et al. Effect of immediate administration of antibiotics in patients with sepsis in tertiary care: a systematic review and meta-analysis. Clinical Therapeutics.  2017;39(1):190-202.e6.

How do hospital respiratory clinicians perceive antimicrobial stewardship?

Broom, J. et al. Journal of Hospital Infection | Published online: 5 May 2017

Background: Suboptimal antibiotic use in respiratory infections is widespread both in hospital medicine and primary care. Antimicrobial stewardship (AMS) teams within hospitals, commonly led by infectious diseases physicians, are frequently charged with optimising respiratory antibiotic use, but there is limited information on what drives antibiotic use in this area of clinical medicine, or on how AMS is perceived.

Aim: This study explores the perceptions of hospital respiratory clinicians on AMS in respiratory medicine.

Conclusions: AMS processes are introduced in hospitals with established social structures and knowledge bases. AMS in respiratory medicine is reported by these clinicians to challenge and conflict with many of these dynamics. If the influence of these dynamics is not considered, AMS processes may not be effective in containing antibiotic use in hospital respiratory medicine.

Read the abstract here