https://www.cidrap.umn.edu/news-perspective/2022/10/stewardship-resistance-scan-oct-28-2022
Stewardship / Resistance Scan for Oct 28, 2022
Ceftriaxone-resistant bloodstream infections;
Inappropriate pediatric antibiotics in China
Filed Under:
Antimicrobial Stewardship
Poor outcomes seen in those with resistant E coli bloodstream infections
An analysis of patients with Escherichia coli bloodstream infections (BSIs) found notably poorer outcomes in those with ceftriaxone-resistant infections, US researchers reported yesterday in Open Forum Infectious Diseases.
For the multicenter prospective cohort study, researchers with the Antibacterial Resistance Leadership Group analyzed data on adult and pediatric patients with E coli BSIs at 14 US hospitals from Nov 12, 2020, to Apr 18, 2021. For each patient with a ceftriaxone-resistant (CRO-R) E coli BSI who was enrolled, the next consecutive patient with ceftriaxone-susceptible E coli BSI was included. The primary outcome was the desirability of outcome ranking (DOOR) at day 30 after collection of index culture, which the study authors say they chose because it captures a more wide-ranging experience of patients infected with drug-resistant pathogens.
A total of 300 patients (median age, 68 years) were included in the analysis, with 150 in the CRO-R group and 150 in the CRO-S group. Patients with CRO-R infections had more overall comorbidities than those with CRO-S infections. In the unadjusted DOOR analysis, there was a 58% probability of a worse clinical outcome in patients with CRO-R E coli BSI versus a CRO-S E coli BSI. No difference was observed in the inverse probability weighting analysis, which was used to reduce confounding and found a 54% probability of a worse outcome in patients with CRO-R infections.
Although the difference in mortality between the two groups was not statistically significant, patients with CRO-R E coli BSI were almost more likely to have longer hospital stays (8 vs 6 days), to remain in the hospital at day 30 (10% vs 4%), and to be transferred to long-term care facilities (22% vs 12%) than those with CRO-S infections.
"These findings underscore the importance of judicious antibiotic use to reduce the development of antibiotic resistance and its subsequent negative impacts 9 on patient outcomes," the study authors wrote.
Oct 27 Open Forum Infect Dis abstract
Study highlights inappropriate pediatric antibiotic use in China
A study of outpatient antibiotic prescribing at primary care institutions in southwest China found that more than 80% of prescriptions for children in 2020 were inappropriate, researchers reported this week in BMC Primary Care.
Using electronic prescription data from 75 primary care institutions in Guizhou province, researchers analyzed antibiotic prescriptions for children under 18 in 2020. They evaluated antibiotic appropriateness (including incorrect spectrum, unnecessary use, and combined use of antibiotics) based on guidelines from the National Health Commission of China and the US Centers for Disease Control and Prevention. They also identified potential risk factors for inappropriate use.
During the study period, 155,134 antibiotic prescriptions were written for 143,257 patients. Diseases of the respiratory system accounted for 86.8% of all antibiotic prescriptions (with acute upper respiratory tract infections accounting for 74.9%), followed by diseases of the digestive system (6%) and diseases of skin and subcutaneous tissue (2.1%). The main antibiotic class used was penicillins (63.7%), followed by cephalosporins (18.8%) and lincosamides (5.8%).
Of 137,284 visits analyzed, only 18.3% of antibiotic prescriptions were considered appropriate, and the percentages of unnecessary use, incorrect spectrum of antibiotics, and combined use of antibiotics were 76.9%, 2.4% and 2.4%, respectively. Physicians with lower professional titles and more than 40 years of work duration were relatively more likely to prescribe inappropriate antibiotics.
The study authors say the results suggest it may be necessary to provide a refresher course on antibiotic prescribing for providers in these institutions.
"The inappropriate use of antibiotics in children is still prominent in primary care institutions of southwest China," they wrote. "The education and training of physicians and caregivers in these institutions should be strengthened."
Oct 26 BMC Prim care study
Stewardship / Resistance Scan for Oct 28, 2022
Ceftriaxone-resistant bloodstream infections;
Inappropriate pediatric antibiotics in China
Filed Under:
Antimicrobial Stewardship
Poor outcomes seen in those with resistant E coli bloodstream infections
An analysis of patients with Escherichia coli bloodstream infections (BSIs) found notably poorer outcomes in those with ceftriaxone-resistant infections, US researchers reported yesterday in Open Forum Infectious Diseases.
For the multicenter prospective cohort study, researchers with the Antibacterial Resistance Leadership Group analyzed data on adult and pediatric patients with E coli BSIs at 14 US hospitals from Nov 12, 2020, to Apr 18, 2021. For each patient with a ceftriaxone-resistant (CRO-R) E coli BSI who was enrolled, the next consecutive patient with ceftriaxone-susceptible E coli BSI was included. The primary outcome was the desirability of outcome ranking (DOOR) at day 30 after collection of index culture, which the study authors say they chose because it captures a more wide-ranging experience of patients infected with drug-resistant pathogens.
A total of 300 patients (median age, 68 years) were included in the analysis, with 150 in the CRO-R group and 150 in the CRO-S group. Patients with CRO-R infections had more overall comorbidities than those with CRO-S infections. In the unadjusted DOOR analysis, there was a 58% probability of a worse clinical outcome in patients with CRO-R E coli BSI versus a CRO-S E coli BSI. No difference was observed in the inverse probability weighting analysis, which was used to reduce confounding and found a 54% probability of a worse outcome in patients with CRO-R infections.
Although the difference in mortality between the two groups was not statistically significant, patients with CRO-R E coli BSI were almost more likely to have longer hospital stays (8 vs 6 days), to remain in the hospital at day 30 (10% vs 4%), and to be transferred to long-term care facilities (22% vs 12%) than those with CRO-S infections.
"These findings underscore the importance of judicious antibiotic use to reduce the development of antibiotic resistance and its subsequent negative impacts 9 on patient outcomes," the study authors wrote.
Oct 27 Open Forum Infect Dis abstract
Study highlights inappropriate pediatric antibiotic use in China
A study of outpatient antibiotic prescribing at primary care institutions in southwest China found that more than 80% of prescriptions for children in 2020 were inappropriate, researchers reported this week in BMC Primary Care.
Using electronic prescription data from 75 primary care institutions in Guizhou province, researchers analyzed antibiotic prescriptions for children under 18 in 2020. They evaluated antibiotic appropriateness (including incorrect spectrum, unnecessary use, and combined use of antibiotics) based on guidelines from the National Health Commission of China and the US Centers for Disease Control and Prevention. They also identified potential risk factors for inappropriate use.
During the study period, 155,134 antibiotic prescriptions were written for 143,257 patients. Diseases of the respiratory system accounted for 86.8% of all antibiotic prescriptions (with acute upper respiratory tract infections accounting for 74.9%), followed by diseases of the digestive system (6%) and diseases of skin and subcutaneous tissue (2.1%). The main antibiotic class used was penicillins (63.7%), followed by cephalosporins (18.8%) and lincosamides (5.8%).
Of 137,284 visits analyzed, only 18.3% of antibiotic prescriptions were considered appropriate, and the percentages of unnecessary use, incorrect spectrum of antibiotics, and combined use of antibiotics were 76.9%, 2.4% and 2.4%, respectively. Physicians with lower professional titles and more than 40 years of work duration were relatively more likely to prescribe inappropriate antibiotics.
The study authors say the results suggest it may be necessary to provide a refresher course on antibiotic prescribing for providers in these institutions.
"The inappropriate use of antibiotics in children is still prominent in primary care institutions of southwest China," they wrote. "The education and training of physicians and caregivers in these institutions should be strengthened."
Oct 26 BMC Prim care study