Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2022/03/stewardship-resistance-scan-mar-04-2022
Stewardship / Resistance Scan for Mar 04, 2022
Antibiotic resistance in Middle East; Antibiotic use and preterm birth
Filed Under:
Antimicrobial Stewardship
High levels of drug resistance found in Eastern Mediterranean region
An analysis of data on bloodstream infections (BSIs) from countries in the World Health Organization (WHO) Eastern Mediterranean Region shows a high prevalence of antimicrobial resistance (AMR) in the region and limited capacity to prevent the emergence and spread of resistant pathogens, WHO researchers reported yesterday in Emerging Infectious Diseases.
Using data reported to the WHO through the Global Antimicrobial Resistance Surveillance System (GLASS) by 11 to 14 countries in the region from 2017 through 2019, the researchers assessed the proportion of BSIs—which are among the most serious and life-threatening infections and are the main sustainable development goal indicator for AMR—that were caused by six resistant organisms.
They also measured the prevalence of antimicrobial use in hospitalized patients and evaluated the regional capacities of antimicrobial stewardship (AMS) and infection prevention and control (IPC) programs.
In 2019, the median proportion of BSIs caused by carbapenem-resistant Acinetobacter spp (CRAsp) was highest, at 70.3%, followed by third-generation cephalosporin (3GC)-resistant Klebsiella pneumoniae (66.3%). The lowest median proportion was for carbapenem-resistant Escherichia coli (4.6%).
The proportion of resistance tended to increase over time, from 71.4% in 2017 to 74.5% in 2019 for CRAsp, from 55.3% to 65.4% for 3GC-resistant K pneumoniae, from 36.6% to 45.8% for methicillin-resistant Staphylococcus aureus, and from 24.2% to 37.5% for carbapenem-resistant K pneumoniae. Egypt and Pakistan had the highest proportion of resistance for five of the six pathogens.
Data from 128 hospitals in 7 countries showed that 53.3% of hospitalized patients received one or more antimicrobial agents, ranging from 38.7% to 77.7% across countries, with high prescribing of 3GC and carbapenems.
Among 22 countries in the region, 13 had a national IPC program, but in 8 of those countries, the existing structures were not functioning. Assessment of national AMS core capacities in 20 countries found only 1 had dedicated funding for AMS, 4 had established national AMS technical working groups, and 1 had developed an AMS implementation plan.
The study authors note that the proportion of BSIs caused by CRAsp in the region is extremely high compared with the United States (33.9%) and the European Union (32.6%).
"Overall, the magnitude of the problem and the limited capacity to respond emphasize the need for regional political leadership in addressing AMR," they wrote.
Mar 3 Emerg Infect Dis study
Study ties antibiotics in pregnancy with higher risk of preterm birth
A study of first pregnancies in Sweden found that antibiotic use during pregnancy or 3 months before conception was associated with an increased risk of preterm birth, particularly during the first and second trimesters and in mothers with chronic diseases, researchers reported this week in the Journal of Antimicrobial Chemotherapy.
In the population-based cohort study, a team of Swedish and Belgian researchers analyzed data on all first pregnancies and maternal prescription drug exposure in Sweden from 2006 through 2016 using multivariable logistic regression to assess the risk of preterm birth associated with gestational or recent preconception antibiotic exposure. Other covariates considered in the analysis included common maternal chronic comorbidities (hypo- and hyperthyroidism, hypertension, or diabetes mellitus), trimester, antibiotic class, and treatment duration.
Compared with non-users, antibiotic exposure was associated with increased risks of preterm birth in mothers with comorbidities (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18 to 1.48) and without (OR, 1.09; 95% CI 1.06 to 1.13). Preconception use showed no association, while risk was increased for first- and second-trimester use and decreased for third-trimester use.
Increased risks were seen for the following antibiotic groups in mothers without and with comorbidities, respectively: macrolides, lincosamides, and streptogramins (OR, 1.63; 95% CI, 1.45 to 1.83 and OR, 2.48; 95% CI, 1.72 to 3.56); quinolones (OR, 1.60; 95% CI, 1.32 to 1.94 and OR, 2.11; 95% CI, 1.12 to 4.03); non-penicillin beta-lactams (OR, 1.15; 95% CI, 1.07 to 1.24 and OR, 1.39; 95% CI, 1.07 to 1.83); other antibacterials (OR, 1.09; 95% CI, 1.03 to 1.14 and OR, 1.38; 95% CI, 1.16 to 1.63); and penicillins (OR, 1.04; 95% CI, 1.01 to 1.08 and OR, 1.23; 95% CI, 1.09 to 1.40). Antibiotic indications, which could also affect preterm birth, were not available.
The study authors say that while the findings do not establish causality and that the underlying mechanism of the association between antibiotic use and preterm birth could not be assessed, they add more weight to recent evidence on the role of microbiome changes and the risk of preterm birth and highlight the need to reconsider the risks and benefits of antibiotics in pregnant women.
Mar 2 J Antimicrob Chemother study
Stewardship / Resistance Scan for Mar 04, 2022
Antibiotic resistance in Middle East; Antibiotic use and preterm birth
Filed Under:
Antimicrobial Stewardship
High levels of drug resistance found in Eastern Mediterranean region
An analysis of data on bloodstream infections (BSIs) from countries in the World Health Organization (WHO) Eastern Mediterranean Region shows a high prevalence of antimicrobial resistance (AMR) in the region and limited capacity to prevent the emergence and spread of resistant pathogens, WHO researchers reported yesterday in Emerging Infectious Diseases.
Using data reported to the WHO through the Global Antimicrobial Resistance Surveillance System (GLASS) by 11 to 14 countries in the region from 2017 through 2019, the researchers assessed the proportion of BSIs—which are among the most serious and life-threatening infections and are the main sustainable development goal indicator for AMR—that were caused by six resistant organisms.
They also measured the prevalence of antimicrobial use in hospitalized patients and evaluated the regional capacities of antimicrobial stewardship (AMS) and infection prevention and control (IPC) programs.
In 2019, the median proportion of BSIs caused by carbapenem-resistant Acinetobacter spp (CRAsp) was highest, at 70.3%, followed by third-generation cephalosporin (3GC)-resistant Klebsiella pneumoniae (66.3%). The lowest median proportion was for carbapenem-resistant Escherichia coli (4.6%).
The proportion of resistance tended to increase over time, from 71.4% in 2017 to 74.5% in 2019 for CRAsp, from 55.3% to 65.4% for 3GC-resistant K pneumoniae, from 36.6% to 45.8% for methicillin-resistant Staphylococcus aureus, and from 24.2% to 37.5% for carbapenem-resistant K pneumoniae. Egypt and Pakistan had the highest proportion of resistance for five of the six pathogens.
Data from 128 hospitals in 7 countries showed that 53.3% of hospitalized patients received one or more antimicrobial agents, ranging from 38.7% to 77.7% across countries, with high prescribing of 3GC and carbapenems.
Among 22 countries in the region, 13 had a national IPC program, but in 8 of those countries, the existing structures were not functioning. Assessment of national AMS core capacities in 20 countries found only 1 had dedicated funding for AMS, 4 had established national AMS technical working groups, and 1 had developed an AMS implementation plan.
The study authors note that the proportion of BSIs caused by CRAsp in the region is extremely high compared with the United States (33.9%) and the European Union (32.6%).
"Overall, the magnitude of the problem and the limited capacity to respond emphasize the need for regional political leadership in addressing AMR," they wrote.
Mar 3 Emerg Infect Dis study
Study ties antibiotics in pregnancy with higher risk of preterm birth
A study of first pregnancies in Sweden found that antibiotic use during pregnancy or 3 months before conception was associated with an increased risk of preterm birth, particularly during the first and second trimesters and in mothers with chronic diseases, researchers reported this week in the Journal of Antimicrobial Chemotherapy.
In the population-based cohort study, a team of Swedish and Belgian researchers analyzed data on all first pregnancies and maternal prescription drug exposure in Sweden from 2006 through 2016 using multivariable logistic regression to assess the risk of preterm birth associated with gestational or recent preconception antibiotic exposure. Other covariates considered in the analysis included common maternal chronic comorbidities (hypo- and hyperthyroidism, hypertension, or diabetes mellitus), trimester, antibiotic class, and treatment duration.
Compared with non-users, antibiotic exposure was associated with increased risks of preterm birth in mothers with comorbidities (odds ratio [OR], 1.32; 95% confidence interval [CI], 1.18 to 1.48) and without (OR, 1.09; 95% CI 1.06 to 1.13). Preconception use showed no association, while risk was increased for first- and second-trimester use and decreased for third-trimester use.
Increased risks were seen for the following antibiotic groups in mothers without and with comorbidities, respectively: macrolides, lincosamides, and streptogramins (OR, 1.63; 95% CI, 1.45 to 1.83 and OR, 2.48; 95% CI, 1.72 to 3.56); quinolones (OR, 1.60; 95% CI, 1.32 to 1.94 and OR, 2.11; 95% CI, 1.12 to 4.03); non-penicillin beta-lactams (OR, 1.15; 95% CI, 1.07 to 1.24 and OR, 1.39; 95% CI, 1.07 to 1.83); other antibacterials (OR, 1.09; 95% CI, 1.03 to 1.14 and OR, 1.38; 95% CI, 1.16 to 1.63); and penicillins (OR, 1.04; 95% CI, 1.01 to 1.08 and OR, 1.23; 95% CI, 1.09 to 1.40). Antibiotic indications, which could also affect preterm birth, were not available.
The study authors say that while the findings do not establish causality and that the underlying mechanism of the association between antibiotic use and preterm birth could not be assessed, they add more weight to recent evidence on the role of microbiome changes and the risk of preterm birth and highlight the need to reconsider the risks and benefits of antibiotics in pregnant women.
Mar 2 J Antimicrob Chemother study
