Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2021/12/stewardship-resistance-scan-dec-13-2021
Stewardship / Resistance Scan for Dec 13, 2021
Decline in antibiotics for respiratory infections; Resistance gene increase in E coli
Filed Under:
Antimicrobial Stewardship; E coli
UK study shows drop in antibiotics for respiratory infections during COVID
Antibiotic prescribing for respiratory tract infections (RTIs) fell in England during the first year of the pandemic, researchers reported today in the Journal of Antimicrobial Chemotherapy.
To assess changes in antibiotic prescribing for RTIs for 2020-2021, researchers with England's National Institute for Health Research extracted data from two large UK databases for primary and secondary care. They measured RTI antibiotic prescribing in prescription items per 1,000 population from January 2014 through February 2021 for primary care, and in defined daily doses per 1,000 population per day from January 2016 through February 2021 for secondary care. Previous research has shown that antibiotic prescribing in primary care in England fell by 14% from 2015 through 2019.
The analysis found that during 2020-2021, antibiotic prescriptions for RTIs in primary care fell an additional 12.4% per season compared with the pre-COVID period, with a sharp drop during the winter—a season that typically sees the highest level of antibiotic prescribing for RTIs. In winter 2020-2021, during the pandemic, RTI antibiotic prescriptions were cut nearly in half compared with the 2019-2020 winter. When the researchers combined antibiotic prescribing for RTIs in primary care with that of hospital emergency departments to account for possible shifts in health-seeking behaviors, the trend was similar to that primary care prescribing alone.
The study authors say COVID-19 restrictions, drastic reductions in person-to-person contact, and avoidance of healthcare settings likely all played a role in reduced RTI prescribing. They also note that the findings highlight the need for better rapid diagnostics to further reduce unnecessary antibiotics for RTIs.
"Rapid diagnostics in the community, such as lateral flow tests, have been effective in detecting SARS-CoV-2 and are quicker and cheaper than PCR tests," they write. "Diagnostics to differentiate viral and bacterial aetiologies could spare unnecessary antibacterial use and reduce GP [general practitioner] attendance in future winters."
Dec 13 J Antimicrob Chemother study
Resistance genes, multidrug resistance rising in E coli from food animals
In another study published today in the same journal, a team of Swiss researchers found that the prevalence of antimicrobial resistance genes (ARGs) and multidrug resistance (MDR) in Escherichia coli obtained from food-producing animals has been rising since 1980.
For the study, researchers with Switzerland's Institute of Integrative Biology and Institute for Environmental Decisions retrieved 7,632 E coli genomes from poultry, cattle, and swine from public databases and screened them for ARGs. They then compared resistance trends inferred from the genomic data with trends reported by phenotypic surveillance systems in the United States and Europe. The genomes originated predominantly from the United States (63.4%), followed by Europe (17.3%), Asia (13.2%), Africa (1.7%), Central and South America (1.7%), and Oceania (1.2%).
The analysis showed an increase in multidrug resistance (MDR) over time. In 1980, the E coli genomes carried, on average, genes conferring resistance to 1.69 antimicrobial classes in swine, 1.41 in swine, and 1 in cattle. By 2018, MDR rates increased 1.6 times, with E coli genomes carrying an average of genes conferring resistance to 2.65 antimicrobial classes in swine, 2.22 in poultry, and 1.58 in cattle.
The highest resistance levels were observed for tetracyclines (42.2% to 69.1%), penicillins (19.4% to 47.5%), and streptomycin (28.6% to 56.6%). The trends were consistent with resistance trends reported from phenotypic international surveillance programs.
Among the specific ARGs in which an increase was observed was the extended-spectrum cephalosporin gene bla[SUB]cmy-2[/SUB], which is noteworthy because extended-spectrum beta-lactam antibiotics are not approved for use as growth promoters in Europe or the United States. The study authors say the presence of this ARG could be linked to use of these antimicrobials in food-producing animals prior to their ban, or to co-selection with other resistance genes.
"Furthermore, the increase in bla[SUB]CMY-2[/SUB] is concerning as this gene has been commonly identified in plasmids that might facilitate its dissemination in food animals," they write.
Dec 13 J Antimicrob Chemother abstract
Stewardship / Resistance Scan for Dec 13, 2021
Decline in antibiotics for respiratory infections; Resistance gene increase in E coli
Filed Under:
Antimicrobial Stewardship; E coli
UK study shows drop in antibiotics for respiratory infections during COVID
Antibiotic prescribing for respiratory tract infections (RTIs) fell in England during the first year of the pandemic, researchers reported today in the Journal of Antimicrobial Chemotherapy.
To assess changes in antibiotic prescribing for RTIs for 2020-2021, researchers with England's National Institute for Health Research extracted data from two large UK databases for primary and secondary care. They measured RTI antibiotic prescribing in prescription items per 1,000 population from January 2014 through February 2021 for primary care, and in defined daily doses per 1,000 population per day from January 2016 through February 2021 for secondary care. Previous research has shown that antibiotic prescribing in primary care in England fell by 14% from 2015 through 2019.
The analysis found that during 2020-2021, antibiotic prescriptions for RTIs in primary care fell an additional 12.4% per season compared with the pre-COVID period, with a sharp drop during the winter—a season that typically sees the highest level of antibiotic prescribing for RTIs. In winter 2020-2021, during the pandemic, RTI antibiotic prescriptions were cut nearly in half compared with the 2019-2020 winter. When the researchers combined antibiotic prescribing for RTIs in primary care with that of hospital emergency departments to account for possible shifts in health-seeking behaviors, the trend was similar to that primary care prescribing alone.
The study authors say COVID-19 restrictions, drastic reductions in person-to-person contact, and avoidance of healthcare settings likely all played a role in reduced RTI prescribing. They also note that the findings highlight the need for better rapid diagnostics to further reduce unnecessary antibiotics for RTIs.
"Rapid diagnostics in the community, such as lateral flow tests, have been effective in detecting SARS-CoV-2 and are quicker and cheaper than PCR tests," they write. "Diagnostics to differentiate viral and bacterial aetiologies could spare unnecessary antibacterial use and reduce GP [general practitioner] attendance in future winters."
Dec 13 J Antimicrob Chemother study
Resistance genes, multidrug resistance rising in E coli from food animals
In another study published today in the same journal, a team of Swiss researchers found that the prevalence of antimicrobial resistance genes (ARGs) and multidrug resistance (MDR) in Escherichia coli obtained from food-producing animals has been rising since 1980.
For the study, researchers with Switzerland's Institute of Integrative Biology and Institute for Environmental Decisions retrieved 7,632 E coli genomes from poultry, cattle, and swine from public databases and screened them for ARGs. They then compared resistance trends inferred from the genomic data with trends reported by phenotypic surveillance systems in the United States and Europe. The genomes originated predominantly from the United States (63.4%), followed by Europe (17.3%), Asia (13.2%), Africa (1.7%), Central and South America (1.7%), and Oceania (1.2%).
The analysis showed an increase in multidrug resistance (MDR) over time. In 1980, the E coli genomes carried, on average, genes conferring resistance to 1.69 antimicrobial classes in swine, 1.41 in swine, and 1 in cattle. By 2018, MDR rates increased 1.6 times, with E coli genomes carrying an average of genes conferring resistance to 2.65 antimicrobial classes in swine, 2.22 in poultry, and 1.58 in cattle.
The highest resistance levels were observed for tetracyclines (42.2% to 69.1%), penicillins (19.4% to 47.5%), and streptomycin (28.6% to 56.6%). The trends were consistent with resistance trends reported from phenotypic international surveillance programs.
Among the specific ARGs in which an increase was observed was the extended-spectrum cephalosporin gene bla[SUB]cmy-2[/SUB], which is noteworthy because extended-spectrum beta-lactam antibiotics are not approved for use as growth promoters in Europe or the United States. The study authors say the presence of this ARG could be linked to use of these antimicrobials in food-producing animals prior to their ban, or to co-selection with other resistance genes.
"Furthermore, the increase in bla[SUB]CMY-2[/SUB] is concerning as this gene has been commonly identified in plasmids that might facilitate its dissemination in food animals," they write.
Dec 13 J Antimicrob Chemother abstract
