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).

New test identifies antibiotic-resistant bacteria

New research suggests it is possible to quickly and accurately diagnose drug-resistant bacterial infections using existing hospital equipment | OnMedica

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

Image shows petri dish cultures infected with phage-galactose bacteria.

In a presentation at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), taking place this week in Vienna, researchers described how they were able to test bacteria to quickly tell whether they were resistant to the antibiotic of last resort, colistin, and how easily they might pass this resistance on to other bacteria.

Knowing which patients have these most dangerous infections means it is possible to use quarantine measures to halt their spread, say the scientists.

Read the full overview here

The presentation abstract is available here

Antimicrobial Resistance: resource handbook

This handbook collates national resources on antimicrobial resistance, antimicrobial stewardship and infection prevention and control | PHE

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Image source: PHE

This handbook identifies current national policy, guidance and supporting materials in relation to the infection prevention and control of healthcare associated infections (HCAI) and antimicrobial stewardship in order to aid in the reduction of antimicrobial resistance. It is designed to assist local health and social care professionals in quickly retrieving relevant information provided by Public Health England, the Department of Health and a wide variety of key stakeholders.

The handbook includes supporting materials relating to:

  • strategy and national guidance
  • policy and recommendations
  • education and training
  • guidance and tools
  • surveillance
  • international resources

Read the full overview here

The full handbook is available here

 

Reducing the impact of serious infections CQUIN

Resources to support delivery of the ‘Reducing the impact of serious infections (antimicrobial resistance and sepsis)’ CQUIN, parts 2c and 2d | NHS Improvement

  • Reducing the impact of serious infections CQUIN, parts 2c and 2d – questions and answersPDF, 185.4 KB – Questions and answers relating to parts 2c and 2d of the ‘Reducing the impact of serious infections’ CQUIN.
  • Part 2c data collection and submissionXLSX, 236.1 KB – PHE has developed this submission tool (and sample data collection form) to facilitate the submission of part 2c (antibiotic review). All data submitted will be available on AMR Fingertips.
  • Part 2d antibiotic consumption submission toolXLSM, 91.4 KB – The data submitted as part of this year’s antimicrobial resistance (AMR) CQUIN has been used to develop this baseline data. Providers that did not take part in the 2016/17 AMR CQUIN or submitted previous annual data should submit quarterly data from January to December 2016, using the antibiotic consumption spreadsheets available on the NHS England AMR CQUIN webpage. Without this data a baseline cannot be calculated for your provider.
  • Part 2d baseline dataXLS, 259.5 KB – Use this to submit quarterly antibiotic consumption data to PHE. All data once submitted will be available via AMR Fingertips after an eight week data cleaning period.

Interventions to improve antibiotic prescribing practices for hospital inpatients

Davey, P. et al. Cochrane Database of Systematic Reviews 2017, Issue 2. Art. No.: CD003543.

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Image source: Cochrane

Background: Antibiotic resistance is a major public health problem. Infections caused by multidrug-resistant bacteria are associated with prolonged hospital stay and death compared with infections caused by susceptible bacteria. Appropriate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. We updated this systematic review to evaluate the impact of interventions to improve antibiotic prescribing to hospital inpatients.

Objectives: To estimate the effectiveness and safety of interventions to improve antibiotic prescribing to hospital inpatients and to investigate the effect of two intervention functions: restriction and enablement.

Authors’ conclusions:  We found high-certainty evidence that interventions are effective in increasing compliance with antibiotic policy and reducing duration of antibiotic treatment. Lower use of antibiotics probably does not increase mortality and likely reduces length of stay. Additional trials comparing antibiotic stewardship with no intervention are unlikely to change our conclusions. Enablement consistently increased the effect of interventions, including those with a restrictive component. Although feedback further increased intervention effect, it was used in only a minority of enabling interventions. Interventions were successful in safely reducing unnecessary antibiotic use in hospitals, despite the fact that the majority did not use the most effective behaviour change techniques. Consequently, effective dissemination of our findings could have considerable health service and policy impact. Future research should instead focus on targeting treatment and assessing other measures of patient safety, assess different stewardship interventions, and explore the barriers and facilitators to implementation. More research is required on unintended consequences of restrictive interventions.

Read the full review here

UCLA Researchers Combat Antimicrobial Resistance Using Smartphones

A team of UCLA researchers has developed an automated diagnostic test reader for antimicrobial resistance using a smartphone | Infection Control Today

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The technology could lead to routine testing for antimicrobial susceptibility in areas with limited resources. Antimicrobial-resistant bacteria are posing a severe threat to global public health. In particular, they are becoming more common in bacterial pathogens responsible for high-mortality diseases such as pneumonia, diarrhea and sepsis. Part of the challenge in combatting the spread of these organisms has been the limited ability to conduct antimicrobial susceptibility testing in regions that do not have access to labs, testing equipment and trained diagnostic technicians to read such tests.

Read the full overview here

 

 

Antibiotic prescribing and resistance

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Public Health England has published English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report 2016.

The ESPAUR report includes national data on antibiotic prescribing and resistance, and hospital antimicrobial stewardship implementation. It forms a standard against which antimicrobial use and antimicrobial resistance can be compared in successive years and a resource for commissioning and implementing antimicrobial stewardship policies in England.

Additional link: PHE press release