Antimicrobial stewardship program and Clostridium difficile

Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown | American Journal of Infection Control

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

Image shows a colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Highlights: 

  • More hospitals with non-better Clostridium difficile rank used prospective audit and feedback.
  • More better C difficile rank hospitals used a preauthorization strategy.
  • More better C difficile rank hospitals restricted more high-risk antibiotics.

Full reference: Barlow, G. et al. (2017) Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance. American Journal of Infection Control. Published online: 27 July 2017.

The association between infection control interventions and CRE incidence

The aim of this study was to assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and (CRE) incidence | Journal of Hospital Infection

https://www.flickr.com/photos/niaid/13743456084

Image source: NIAID – FLickr // CC BY 2.0

Image shows a human neutrophil interacting with Klebsiella pneumoniae (pink).

Background: Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceaee (CRE) starting in 2006.

Methods: Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospitals days (HD), was plotted quarterly between 2005 to 2016. IC interventions were applied at different time-points throughout this period. We collected data on IC staffing, number of rectal surveillance cultures and carbapenem consumption. We used auto-correlated segmented linear regression analysis to assess the time-points where a significant change in the CRE incidence trend occurred and assessed the relationship between the timing of IC intervention implementation and observed CRE trends. Trends between time-points are expressed as quarterly percent change (QPC) with 95% confidence intervals.

Findings: Between 2005-2008, CRE incidence increased significantly, QPC 19.7% (11.5-28.4%), reaching a peak of 186.6 new acquisitions/100,000 HD. From mid-2011 until the end of follow-up, there was a significant decreasing incidence trend, QPC -4.5 (-6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments and carbapenem restriction were required. Decreasing CRE incidence was observed with an ID/IC staffing of 1.2-1.5/100 beds and 20,000-36,000 yearly CRE surveillance samples.

Conclusions: A multifaceted hospital-wide intervention program is required to control CRE in hospital settings.

Full reference: Hussein, K. et al. (2017) The association between infection control interventions and CRE incidence in an endemic hospital. Journal of Hospital Infection. Published online: 22 July 2017

Scientists stumble across new method of making antibiotics

Cancer researchers may have stumbled across a solution to reverse antibiotic drug resistance and stop infections like MRSA. | Via ScienceDaily

Experts warn we are decades behind in the race against superbugs having already exploited naturally occurring antibiotics, with the creation of new ones requiring time, money and ingenuity.

But a team of scientists at the University of Salford say they may have found a very simple way forward — even though they weren’t even looking for antibiotics.

And they have created and validated several new antibiotics already — many of which are as potent, or more so, than standard antibiotics, such as amoxicillin.

“A little like Alexander Fleming, we weren’t even looking for antibiotics rather researching into new compounds that might be effective against cancer stem cells,” explains Michael P. Lisanti, Chair of Translational Medicine at the University’s Biomedical Research Centre.

“I think we’ve accidentally invented a systemic way of creating new antibiotics which is simple, cheap and could be very significant in the fight against superbugs,” added Dr Federica Sotgia, a co-author on the study.

Full story at ScienceDaily

Full reference:  Bela Ozsvari et al.  Mitoriboscins: Mitochondrial-based therapeutics targeting cancer stem cells (CSCs), bacteria and pathogenic yeast | Oncotarget, Advance Publications | published online July 7th 2017

Impact of an antimicrobial stewardship program to optimize antimicrobial use for outpatients at emergency department

Antimicrobial stewardship programs (ASPs) have proven to be effective in optimizing antibiotic use for inpatients. However, Emergency Department (ED)’s fast-paced clinical setting can be challenging for a successful ASP | The Journal of Hospital Infection

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Aim: In April 2015, an ASP was implemented in our ED and we aimed to determine its impact on antimicrobial use for outpatients.

Methods: Monocentric study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016).

For each period, antimicrobial prescriptions for all adult outpatients (hospitalized for <24hours) were evaluated by an infectious disease specialist (IDS) and an ED physician to assess compliance with local prescribing guidelines. Inappropriate prescriptions were then classified.

Findings: Before and after ASP, 34,671 and 35,925 consultations were registered at our ED, of which 25,470 and 26,208 were outpatients. Antimicrobials were prescribed in 769 (3.0%) and 580 (2.2%) consultations, respectively (p<0.0001). There were 484 (62.9%) and 271 (46.7%) (p<0.0001) instances of non-compliance with guidelines before and after ASP implementation. Non-compliances included unnecessary antimicrobial prescriptions, 197 (25.6%) vs. 101 (17.4%) (p<0.0005); inappropriate spectrum, 108 (14.0%) vs. 54 (9.3%) (p=0.008); excessive treatment duration, 87 (11.3%) vs. 53 (9.1%) (p>0.05); and inappropriate choices, 11 (1.4%) vs. 15 (2.6%) (p>0.05).

Conclusions: The implementation of an ASP dramatically decreased the number of unnecessary antimicrobial prescriptions, but had little impact on most other aspects of inappropriate prescribing.

Full reference: Dinh, A. et al. (2017) Impact of an antimicrobial stewardship program to optimize antimicrobial use for outpatients at emergency department. The Journal of Hospital Infection. Published online: 8th July 2017

Risk factors for development of surgical site infections among liver transplantation recipients

Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation | American Journal of Infection Control

Highlights: 

  • There is a little research about surgical site infection in liver transplantation.
  • Liver transplant recipients are exposed to different risk factors for SSI.
  • There is no consensus in literature about risk factor for SSI among LT recipients.

Full reference: Oliveira, R.A. et al. (2017) Risk factors for development of surgical site infections among liver transplantation recipients: An integrative literature review. American Journal of Infection Control | Available online: 6th July 2017

 

Beyond hand hygiene: preventing cross-contamination on hospital wards

Hospital-acquired infections are the most common adverse event for inpatients worldwide | BMJ Quality & Safety

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Background: Efforts to prevent microbial cross-contamination currently focus on hand hygiene and use of personal protective equipment (PPE), with variable success. Better understanding is needed of infection prevention and control (IPC) in routine clinical practice.

Results: We found that healthcare workers’ routine IPC work goes beyond hand hygiene and PPE. It also involves, for instance, the distribution of team members during rounds, the choreography of performing aseptic procedures and moving ‘from clean to dirty’ when examining patients. We account for these practices as the logistical work of moving bodies and objects across boundaries, especially from contaminated to clean/vulnerable spaces, while restricting the movement of micro-organisms through cleaning, applying barriers and buffers, and trajectory planning.

Conclusions: Attention to the logistics of moving people and objects around healthcare spaces, especially into vulnerable areas, allows for a more comprehensive approach to IPC through better contextualisation of hand hygiene and PPE protocols, better identification of transmission risks, and the design and promotion of a wider range of preventive strategies and solutions.

Full reference: Hor, S. et al. (2017) Beyond hand hygiene: a qualitative study of the everyday work of preventing cross-contamination on hospital wards. BMJ Quality & Safety. 26:552-558.