Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2020/03/stewardship-resistance-scan-mar-12-2020
Stewardship / Resistance Scan for Mar 12, 2020
MDR Klebsiella in Arizona nursing home; Pharmacy-led UTI testing
Filed Under:
Antimicrobial Stewardship
[h=3]MDR Klebsiella cluster detected in Arizona nursing home[/h] A paper today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report describes a small cluster of multidrug-resistant Klebsiella pneumoniae detected at an Arizona nursing home.
The cluster was first detected in August 2018 when the Mariposa County Department of Public Health (MCDPH) identified two isolates of carbapenemase-producing K pneumoniae (KPC-KP) in urine samples from two residents of a ventilator-capable unit in a skilled nursing facility. Both residents had urinary tract infections and resided in neighboring rooms. Further analysis of the isolates by the CDC's Antibiotic Resistance Laboratory Network suggested healthcare-associated transmission, and the Arizona Department of Health Services investigated the cluster to prevent additional cases.
Immediate contact screening for KPC-KP colonization among 26 residents who were in the ventilator-capable unit at the same time as the index patients detected KPC-KP isolates in five asymptomatic contacts, three of which had indistinguishable pulsed-field gel electrophoresis patterns from the isolates in the two index patients, a finding that further supported healthcare-associated transmission. A site visit to the facility in September 2018 to observe infection control practices found missed opportunities for hand hygiene before and after physical contact with residents, and lapses in aseptic technique during routine sterile procedures.
Re-screening of the 26 contacts in November 2018 to determine whether MCDPH's recommended control measures were successful in containing the cluster identified three additional cases of KPC-KP colonization.
The authors of the report conclude, "Closer adherence to CDC recommendations that could prevent health care–associated KPC-KP transmission include housing together residents with infection, improving adherence to hand hygiene, using gowns and gloves when interacting with residents who require mechanical ventilation or have tracheostomies, and implementing contact precautions for uncontained body fluids."
Mar 12 MMWR Notes from the field
[h=3]Pharmacy-led UTI test demonstrates benefits in UK pilot study[/h] A community pharmacy-led test-and-treat service for women with uncomplicated urinary tract (UTI) infections helped support appropriate use of antibiotics and reduced demand on other National Health Services (NHS) resources, English researchers reported today in JAC-Antimicrobial Resistance.
In the pilot study, researchers analyzed data on 764 women who presented to 23 pharmacies with UTI symptoms from December 2018 to April 2019. The test-and-treat service, developed by a team of physicians, pharmacists, and microbiologists, clinically assessed women aged 16 to 64 years for the possibility of uncomplicated UTI, with treatment based on the outcome of a urine dipstick test and National Institute for Health and Care Excellence guidelines. A novel smartphone app provided instructions on use and analysis of the dipstick test and recorded test results. Women were either advised on self-care, supplied with antibiotics, or referred to their general practitioner (GP).
Urine dipstick test results indicated 372 of 496 women (75%) were likely to have a lower UTI, and 360 of 372 of these women (96.8%) purchased antibiotics. Analysis of data indicating what action the women would have taken had the service not been available showed that nearly three-quarters (214/301, 71.1%) would have visited their GP, and more than one-third (116/301, 35.8%) would have attempted self-treatment.
"As pharmacists working within the community become more integrated into primary care networks, there is an opportunity for them to embed services such as this to support self-care and appropriate use of NHS resources," the study authors write. "This would support changing behaviour of patients with UTIs to utilize community pharmacies as the first port of call (i.e. changing to a 'pharmacy first' mentality) and allow for effective triage and treatment within this environment."
Mar 12 JAC-Antimicrobial Resistance study
Stewardship / Resistance Scan for Mar 12, 2020
MDR Klebsiella in Arizona nursing home; Pharmacy-led UTI testing
Filed Under:
Antimicrobial Stewardship
[h=3]MDR Klebsiella cluster detected in Arizona nursing home[/h] A paper today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report describes a small cluster of multidrug-resistant Klebsiella pneumoniae detected at an Arizona nursing home.
The cluster was first detected in August 2018 when the Mariposa County Department of Public Health (MCDPH) identified two isolates of carbapenemase-producing K pneumoniae (KPC-KP) in urine samples from two residents of a ventilator-capable unit in a skilled nursing facility. Both residents had urinary tract infections and resided in neighboring rooms. Further analysis of the isolates by the CDC's Antibiotic Resistance Laboratory Network suggested healthcare-associated transmission, and the Arizona Department of Health Services investigated the cluster to prevent additional cases.
Immediate contact screening for KPC-KP colonization among 26 residents who were in the ventilator-capable unit at the same time as the index patients detected KPC-KP isolates in five asymptomatic contacts, three of which had indistinguishable pulsed-field gel electrophoresis patterns from the isolates in the two index patients, a finding that further supported healthcare-associated transmission. A site visit to the facility in September 2018 to observe infection control practices found missed opportunities for hand hygiene before and after physical contact with residents, and lapses in aseptic technique during routine sterile procedures.
Re-screening of the 26 contacts in November 2018 to determine whether MCDPH's recommended control measures were successful in containing the cluster identified three additional cases of KPC-KP colonization.
The authors of the report conclude, "Closer adherence to CDC recommendations that could prevent health care–associated KPC-KP transmission include housing together residents with infection, improving adherence to hand hygiene, using gowns and gloves when interacting with residents who require mechanical ventilation or have tracheostomies, and implementing contact precautions for uncontained body fluids."
Mar 12 MMWR Notes from the field
[h=3]Pharmacy-led UTI test demonstrates benefits in UK pilot study[/h] A community pharmacy-led test-and-treat service for women with uncomplicated urinary tract (UTI) infections helped support appropriate use of antibiotics and reduced demand on other National Health Services (NHS) resources, English researchers reported today in JAC-Antimicrobial Resistance.
In the pilot study, researchers analyzed data on 764 women who presented to 23 pharmacies with UTI symptoms from December 2018 to April 2019. The test-and-treat service, developed by a team of physicians, pharmacists, and microbiologists, clinically assessed women aged 16 to 64 years for the possibility of uncomplicated UTI, with treatment based on the outcome of a urine dipstick test and National Institute for Health and Care Excellence guidelines. A novel smartphone app provided instructions on use and analysis of the dipstick test and recorded test results. Women were either advised on self-care, supplied with antibiotics, or referred to their general practitioner (GP).
Urine dipstick test results indicated 372 of 496 women (75%) were likely to have a lower UTI, and 360 of 372 of these women (96.8%) purchased antibiotics. Analysis of data indicating what action the women would have taken had the service not been available showed that nearly three-quarters (214/301, 71.1%) would have visited their GP, and more than one-third (116/301, 35.8%) would have attempted self-treatment.
"As pharmacists working within the community become more integrated into primary care networks, there is an opportunity for them to embed services such as this to support self-care and appropriate use of NHS resources," the study authors write. "This would support changing behaviour of patients with UTIs to utilize community pharmacies as the first port of call (i.e. changing to a 'pharmacy first' mentality) and allow for effective triage and treatment within this environment."
Mar 12 JAC-Antimicrobial Resistance study