Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2022/02/stewardship-resistance-scan-feb-21-2022
Stewardship / Resistance Scan for Feb 21, 2022
Guideline-discordant dental antibiotics; Canadian antibiotic access proposal
Filed Under:
Antimicrobial Stewardship
Guideline-discordant dental antibiotics linked to increased C diff risk
A study of US veterans who developed Clostridioides difficile infection (CDI) within 30 days of a dental antibiotic prescription found that nearly 80% received guideline-discordant antibiotics, researchers reported today in Infection Control & Hospital Epidemiology.
Using data on Veterans Affairs (VA) patients with dental antibiotic prescriptions, a team of VA researchers found that 212,763 patients had an antibiotic prescribed by a VA dentist within 7 days of a dental encounter from 2015 through 2019, and 108 (0.05%) had a positive C difficile diagnostic test within 30 days.
Of the patients with CDI, 79.7% received antibiotics that were discordant with guidelines from the American Dental Association and the American Heart Association (AHA), which recommend antibiotic prophylaxis only for patients with a pre-existing cardiac condition who are undergoing gingival manipulation or being treated for acute apical abscess.
Of those with discordant prescriptions, only 19.4% had a pre-existing cardiac condition. In addition, 24.4% had prosthetic joints and 4.6% were immunocompromised. Furthermore, 59.3% had a chronic gastrointestinal issue, 34.3% had gastroesophageal reflux disease, and 50.0% had been prescribed either a proton pump inhibitor or H2 receptor antagonist for gastric conditions; all three factors have been associated with increased CDI risk.
The analysis also found that 89% with a documented penicillin allergy receive clindamycin, which the AHA recommends against because of the documented increased risk of CDI and other adverse events.
"Although our current results do not causally link the dental antibiotics to the subsequent CDI event, the antibiotics prescribed by a dentist represent an additional exposure," the authors write. "We recommend increased vigilance by dentists to antimicrobial stewardship, awareness of identified risk factors, and an increased adherence to guidelines."
Feb 21 Infect Control Hosp Epidemiol abstract
Canadian proposal aims to boost access to new antibiotics
The Canadian Antimicrobial Innovation Coalition (CAIC) and McMaster University last week released a proposal to boost access to new and innovative antibiotics in Canada.
The proposal contains 30 recommendations that aim to rectify the lack of access in Canada to several new antibiotics that have been approved and marketed in the United States and Europe in recent years. A July 2021 study published in Clinical Infectious Diseases found that, of 18 novel antibiotics approved and commercially launched in 14 high-income countries over the past decade, only 2 have been introduced in Canada.
In addition, the proposal also notes that several new antibiotics already approved in Canada are rarely used owing to costs and administrative barriers, resulting in overuse of first-line drugs in Canada.
Among the recommendations made in the proposal are guaranteed minimum revenue agreements for manufacturers of novel antibiotics that would delink sales volume from return on investment; expedited and streamlined marketing approval of select priority antibiotics that have already been approved by the US Food and Drug Administration or the European Medicines Agency; specific funding envelopes to help Canadian hospitals buy new antibiotics; national forecasts for the antibiotics that will be needed by Canadian patients; and investments in antibiotic stewardship.
"Part of the reason we're seeing drugs approved elsewhere but not here in Canada is because approval costs are high, our population is relatively small, and physicians try to use new antibiotics only as a last resort to reduce the chance of resistance to them developing," project chair Lori Burrows, PhD, of McMaster University, said in a press release. "We believe that this can be rectified through incentivization and regulatory improvements, as other G7 countries are doing."
The authors of the proposal suggest piloting it in a select region of the country using a limited number of novel antibiotics that have already been approved in Canada.
Feb 15 McMaster press release
Dec 2021 McMaster/CAIC antibiotic access and capacity proposal
Stewardship / Resistance Scan for Feb 21, 2022
Guideline-discordant dental antibiotics; Canadian antibiotic access proposal
Filed Under:
Antimicrobial Stewardship
Guideline-discordant dental antibiotics linked to increased C diff risk
A study of US veterans who developed Clostridioides difficile infection (CDI) within 30 days of a dental antibiotic prescription found that nearly 80% received guideline-discordant antibiotics, researchers reported today in Infection Control & Hospital Epidemiology.
Using data on Veterans Affairs (VA) patients with dental antibiotic prescriptions, a team of VA researchers found that 212,763 patients had an antibiotic prescribed by a VA dentist within 7 days of a dental encounter from 2015 through 2019, and 108 (0.05%) had a positive C difficile diagnostic test within 30 days.
Of the patients with CDI, 79.7% received antibiotics that were discordant with guidelines from the American Dental Association and the American Heart Association (AHA), which recommend antibiotic prophylaxis only for patients with a pre-existing cardiac condition who are undergoing gingival manipulation or being treated for acute apical abscess.
Of those with discordant prescriptions, only 19.4% had a pre-existing cardiac condition. In addition, 24.4% had prosthetic joints and 4.6% were immunocompromised. Furthermore, 59.3% had a chronic gastrointestinal issue, 34.3% had gastroesophageal reflux disease, and 50.0% had been prescribed either a proton pump inhibitor or H2 receptor antagonist for gastric conditions; all three factors have been associated with increased CDI risk.
The analysis also found that 89% with a documented penicillin allergy receive clindamycin, which the AHA recommends against because of the documented increased risk of CDI and other adverse events.
"Although our current results do not causally link the dental antibiotics to the subsequent CDI event, the antibiotics prescribed by a dentist represent an additional exposure," the authors write. "We recommend increased vigilance by dentists to antimicrobial stewardship, awareness of identified risk factors, and an increased adherence to guidelines."
Feb 21 Infect Control Hosp Epidemiol abstract
Canadian proposal aims to boost access to new antibiotics
The Canadian Antimicrobial Innovation Coalition (CAIC) and McMaster University last week released a proposal to boost access to new and innovative antibiotics in Canada.
The proposal contains 30 recommendations that aim to rectify the lack of access in Canada to several new antibiotics that have been approved and marketed in the United States and Europe in recent years. A July 2021 study published in Clinical Infectious Diseases found that, of 18 novel antibiotics approved and commercially launched in 14 high-income countries over the past decade, only 2 have been introduced in Canada.
In addition, the proposal also notes that several new antibiotics already approved in Canada are rarely used owing to costs and administrative barriers, resulting in overuse of first-line drugs in Canada.
Among the recommendations made in the proposal are guaranteed minimum revenue agreements for manufacturers of novel antibiotics that would delink sales volume from return on investment; expedited and streamlined marketing approval of select priority antibiotics that have already been approved by the US Food and Drug Administration or the European Medicines Agency; specific funding envelopes to help Canadian hospitals buy new antibiotics; national forecasts for the antibiotics that will be needed by Canadian patients; and investments in antibiotic stewardship.
"Part of the reason we're seeing drugs approved elsewhere but not here in Canada is because approval costs are high, our population is relatively small, and physicians try to use new antibiotics only as a last resort to reduce the chance of resistance to them developing," project chair Lori Burrows, PhD, of McMaster University, said in a press release. "We believe that this can be rectified through incentivization and regulatory improvements, as other G7 countries are doing."
The authors of the proposal suggest piloting it in a select region of the country using a limited number of novel antibiotics that have already been approved in Canada.
Feb 15 McMaster press release
Dec 2021 McMaster/CAIC antibiotic access and capacity proposal
