https://www.cidrap.umn.edu/news-perspective/2022/08/stewardship-resistance-scan-aug-10-2022
Stewardship / Resistance Scan for Aug 10, 2022
Healthcare-associated infections in India;
Pan-resistant fungal infection
Filed Under:
Antimicrobial Stewardship;
Healthcare-Associated Infections;
Fungal Infection
Hospital data from India show high rate of healthcare infections, antibiotic resistance
Data from a healthcare-associated infection (HAI) surveillance network in India shows high rates of bloodstream and urinary tract infections (UTIs) and very high levels of antibiotic resistance, researchers reported in The Lancet Global Health.
The data come from a network of 26 public and private tertiary-level hospitals in India created to implement HAI surveillance using standardized HAI surveillance methods that more accurately reflect resources available in Indian hospitals. Each hospital enrolled at least one intensive care unit (ICU) treating adult patients, one ICU treating adult surgical patients, and one pediatric ICU, and collected surveillance data on bloodstreams infections and UTIs, along with pathogen and antibiotic susceptibility test results. Neonatal ICUs reported only bloodstream infections.
From May 2017 through October 2018, the hospitals reported 2,622 bloodstream infections and 737 UTIs from 89 ICUs. Central line-associated bloodstream infection rates were highest in neonatal ICUs (more than 20 per 1,000 central line days), and catheter-associated UTI rates were highest in pediatric medical ICUs (4.5 per 1,000 urinary catheter days). Hospitals identified 2,828 pathogens in the 2,622 bloodstream infections reported and 809 in the 737 UTIs reported. Klebsiella spp (24.8%) were the most frequent pathogens reported in bloodstream infections, followed by Acinetobacter spp (21.3%), and Candida spp (29.4%) were the most frequently reported pathogens in UTIs.
Carbapenem resistance was common in Gram-negative infections, occurring in 72.4% of bloodstream infections and 76.3% of UTIs caused by Klebsiella spp, 77.2% of bloodstream infections and 75.7% of UTIs caused by Acinetobacter spp, 63.7% of bloodstream infections and 71.9% of UTIs caused by Pseudomonas spp, and 58% of bloodstream infections and 62% of UTIs caused by Escherichia coli.
"Healthcare-associated bloodstream infections and UTIs, particularly antibiotic-resistant infections, are major problems across network hospitals, and focused efforts targeting prevention of priority HAIs are underway," the study authors wrote. "Data produced by this network can be used as a foundation for developing a better understanding of the burden of HAIs across India."
Sep 2022 Lancet Glob Health study
Report describes pan-resistant, environmentally-acquired fungal infection
A case report published today in Emerging Infectious Diseases describes a fatal, pan-resistant fungal infection in an immunocompromised patient in the United States.
The infection was caused by Aspergillus fumigatus, the most common cause of invasive aspergillosis, a life-threating fungal infection that occurs when A fumigatus spores in the environment are inhaled. The patient was a 65-year-old man undergoing treatment for acute myeloid leukemia who was hospitalized for progressive graft-versus-host disease following an allogeneic stem cell transplant.
After 23 days of hospitalization and onset of hypoxemic respiratory failure, the patient was diagnosed with multifocal pneumonia, and bronchial cultures were positive for A fumigatus. The patient died on hospital day 28 from sepsis. Subsequent antifungal susceptibility testing and DNA sequence analysis showed resistance to the triazole antifungals itraconazole and voriconazole, with an environmentally-acquired gene mutation that can cause pan-triazole resistance.
The authors of the report say that while triazole resistance can occur through exposure to long-term triazole therapy, it's also been linked to agricultural use of triazole fungicides, which are chemically similar to triazole antifungals. They note that reports of environmentally acquired triazole-resistant A fumigatus infections are increasing, and say systematic clinical and environmental surveillance for triazole resistance is needed in the United States to determine the spread of the fungus and guide clinical treatment. Use of triazole fungicides by US farmers increased fourfold from 2006 to 2016.
"This report underscores the potential severity of triazole-resistant A. fumigatus infections in immunocompromised persons," they wrote. "Furthermore, clinicians should consider the possible presence of drug-resistant A. fumigatus in patients with invasive aspergillosis who do not improve with first-line therapy."
Aug 10 Emerg Infect Dis research letter
Stewardship / Resistance Scan for Aug 10, 2022
Healthcare-associated infections in India;
Pan-resistant fungal infection
Filed Under:
Antimicrobial Stewardship;
Healthcare-Associated Infections;
Fungal Infection
Hospital data from India show high rate of healthcare infections, antibiotic resistance
Data from a healthcare-associated infection (HAI) surveillance network in India shows high rates of bloodstream and urinary tract infections (UTIs) and very high levels of antibiotic resistance, researchers reported in The Lancet Global Health.
The data come from a network of 26 public and private tertiary-level hospitals in India created to implement HAI surveillance using standardized HAI surveillance methods that more accurately reflect resources available in Indian hospitals. Each hospital enrolled at least one intensive care unit (ICU) treating adult patients, one ICU treating adult surgical patients, and one pediatric ICU, and collected surveillance data on bloodstreams infections and UTIs, along with pathogen and antibiotic susceptibility test results. Neonatal ICUs reported only bloodstream infections.
From May 2017 through October 2018, the hospitals reported 2,622 bloodstream infections and 737 UTIs from 89 ICUs. Central line-associated bloodstream infection rates were highest in neonatal ICUs (more than 20 per 1,000 central line days), and catheter-associated UTI rates were highest in pediatric medical ICUs (4.5 per 1,000 urinary catheter days). Hospitals identified 2,828 pathogens in the 2,622 bloodstream infections reported and 809 in the 737 UTIs reported. Klebsiella spp (24.8%) were the most frequent pathogens reported in bloodstream infections, followed by Acinetobacter spp (21.3%), and Candida spp (29.4%) were the most frequently reported pathogens in UTIs.
Carbapenem resistance was common in Gram-negative infections, occurring in 72.4% of bloodstream infections and 76.3% of UTIs caused by Klebsiella spp, 77.2% of bloodstream infections and 75.7% of UTIs caused by Acinetobacter spp, 63.7% of bloodstream infections and 71.9% of UTIs caused by Pseudomonas spp, and 58% of bloodstream infections and 62% of UTIs caused by Escherichia coli.
"Healthcare-associated bloodstream infections and UTIs, particularly antibiotic-resistant infections, are major problems across network hospitals, and focused efforts targeting prevention of priority HAIs are underway," the study authors wrote. "Data produced by this network can be used as a foundation for developing a better understanding of the burden of HAIs across India."
Sep 2022 Lancet Glob Health study
Report describes pan-resistant, environmentally-acquired fungal infection
A case report published today in Emerging Infectious Diseases describes a fatal, pan-resistant fungal infection in an immunocompromised patient in the United States.
The infection was caused by Aspergillus fumigatus, the most common cause of invasive aspergillosis, a life-threating fungal infection that occurs when A fumigatus spores in the environment are inhaled. The patient was a 65-year-old man undergoing treatment for acute myeloid leukemia who was hospitalized for progressive graft-versus-host disease following an allogeneic stem cell transplant.
After 23 days of hospitalization and onset of hypoxemic respiratory failure, the patient was diagnosed with multifocal pneumonia, and bronchial cultures were positive for A fumigatus. The patient died on hospital day 28 from sepsis. Subsequent antifungal susceptibility testing and DNA sequence analysis showed resistance to the triazole antifungals itraconazole and voriconazole, with an environmentally-acquired gene mutation that can cause pan-triazole resistance.
The authors of the report say that while triazole resistance can occur through exposure to long-term triazole therapy, it's also been linked to agricultural use of triazole fungicides, which are chemically similar to triazole antifungals. They note that reports of environmentally acquired triazole-resistant A fumigatus infections are increasing, and say systematic clinical and environmental surveillance for triazole resistance is needed in the United States to determine the spread of the fungus and guide clinical treatment. Use of triazole fungicides by US farmers increased fourfold from 2006 to 2016.
"This report underscores the potential severity of triazole-resistant A. fumigatus infections in immunocompromised persons," they wrote. "Furthermore, clinicians should consider the possible presence of drug-resistant A. fumigatus in patients with invasive aspergillosis who do not improve with first-line therapy."
Aug 10 Emerg Infect Dis research letter