Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2022/02/stewardship-resistance-scan-feb-08-2022
Stewardship / Resistance Scan for Feb 08, 2022
Procalcitonin testing and antibiotic use; Ceftriaxone-resistant gonorrhea in UK
Filed Under:
Gonorrhea; Antimicrobial Stewardship
Procalcitonin testing during COVID tied to initial drop in UK antibiotic use
The introduction of procalcitonin (PCT) testing at UK hospitals during the first wave of the COVID-19 pandemic was associated with an immediate but not sustained decline in antibiotic prescribing, researchers reported today in the Journal of Antimicrobial Chemotherapy.
During the first wave of the pandemic, many National Health Service (NHS) hospitals introduced PCT testing, which looks for an inflammatory biomarker that rises in bacterial respiratory tract infections, to guide antibiotic decision-making, particularly in emergency departments (EDs) and acute medical units (ACUs).
To evaluate the impact of PCT testing on antibiotic use, a team of researchers conducted a retrospective, controlled interrupted time series analysis of antibiotic dispensing, hospital activity, and PCT testing at 105 NHS hospitals/hospital trusts in England and Wales from Feb 24 to Jul 5, 2020.
In the main analysis, there was a statistically significant decrease of –1.08 (95% confidence interval [CI], –1.81 to –0.36) defined daily doses (DDD) per admission per week per trust immediately following the introduction of PCT testing in EDs/ACUs. But that was followed by a statistically significant increase of 0.05 (95% CI, 0.02 to 0.08) DDD per admission per week per trust. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions. PCT testing was not associated with any change in antibiotic prescribing in the intensive care unit.
"We found that the initial impact of PCT testing was gradually lost over time," the study authors write. "Of note, this is an absolute effect, not relative to other trusts/hospitals, and is likely related to sustainability, which is a challenge for any antibiotic stewardship intervention."
The authors add, however, that the initial impact of PCT testing represents an 18% reduction from the national median of 5.9 DDD per admission per week per trust, and that further research should be done to determine the patient-level impact and its potential for clinical effectiveness.
Feb 8 J Antimicrob Chemother abstract
Three cases of ceftriaxone-resistant gonorrhea reported in England
The UK Health Security Agency (UKHSA) yesterday reported three new cases of ceftriaxone-resistant gonorrhea.
The recently diagnosed cases involve a woman in London in her 20s and a heterosexual couple from the Midlands in their 20s. There are currently no known connections between the cases.
Ceftriaxone-resistant strains of gonorrhea are most common in the Asia-Pacific region but have been occasionally identified in people who've travelled or moved to the United Kingdom from that region. On Dec 24, 2021, UKHSA reported a case of ceftriaxone-resistant gonorrhea in a man who acquired the infection in London in November.
Since 2019, ceftriaxone has been the primary antibiotic used to treat gonorrhea infections in the United Kingdom. Previous treatment guidelines recommended dual therapy with ceftriaxone and azithromycin, but azithromycin is no longer recommended because of high levels of resistance.
"After a couple of years without any cases of this hard-to-treat form of gonorrhoea, we have now seen 4 cases in the last 2 months," Katy Sinka, PhD, who heads the UKHSA's Sexually Transmitted Infection (STI) section, said in a press release. "It's too soon to say whether this will be the start of a longer-term trend, but we do know that STIs are on the rise in general."
UKHSA officials say they are awaiting follow-up tests in the three cases to see if treatment has been successful.
Feb 7 UKHSA press release
Dec 24 UKHSA press release
Stewardship / Resistance Scan for Feb 08, 2022
Procalcitonin testing and antibiotic use; Ceftriaxone-resistant gonorrhea in UK
Filed Under:
Gonorrhea; Antimicrobial Stewardship
Procalcitonin testing during COVID tied to initial drop in UK antibiotic use
The introduction of procalcitonin (PCT) testing at UK hospitals during the first wave of the COVID-19 pandemic was associated with an immediate but not sustained decline in antibiotic prescribing, researchers reported today in the Journal of Antimicrobial Chemotherapy.
During the first wave of the pandemic, many National Health Service (NHS) hospitals introduced PCT testing, which looks for an inflammatory biomarker that rises in bacterial respiratory tract infections, to guide antibiotic decision-making, particularly in emergency departments (EDs) and acute medical units (ACUs).
To evaluate the impact of PCT testing on antibiotic use, a team of researchers conducted a retrospective, controlled interrupted time series analysis of antibiotic dispensing, hospital activity, and PCT testing at 105 NHS hospitals/hospital trusts in England and Wales from Feb 24 to Jul 5, 2020.
In the main analysis, there was a statistically significant decrease of –1.08 (95% confidence interval [CI], –1.81 to –0.36) defined daily doses (DDD) per admission per week per trust immediately following the introduction of PCT testing in EDs/ACUs. But that was followed by a statistically significant increase of 0.05 (95% CI, 0.02 to 0.08) DDD per admission per week per trust. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions. PCT testing was not associated with any change in antibiotic prescribing in the intensive care unit.
"We found that the initial impact of PCT testing was gradually lost over time," the study authors write. "Of note, this is an absolute effect, not relative to other trusts/hospitals, and is likely related to sustainability, which is a challenge for any antibiotic stewardship intervention."
The authors add, however, that the initial impact of PCT testing represents an 18% reduction from the national median of 5.9 DDD per admission per week per trust, and that further research should be done to determine the patient-level impact and its potential for clinical effectiveness.
Feb 8 J Antimicrob Chemother abstract
Three cases of ceftriaxone-resistant gonorrhea reported in England
The UK Health Security Agency (UKHSA) yesterday reported three new cases of ceftriaxone-resistant gonorrhea.
The recently diagnosed cases involve a woman in London in her 20s and a heterosexual couple from the Midlands in their 20s. There are currently no known connections between the cases.
Ceftriaxone-resistant strains of gonorrhea are most common in the Asia-Pacific region but have been occasionally identified in people who've travelled or moved to the United Kingdom from that region. On Dec 24, 2021, UKHSA reported a case of ceftriaxone-resistant gonorrhea in a man who acquired the infection in London in November.
Since 2019, ceftriaxone has been the primary antibiotic used to treat gonorrhea infections in the United Kingdom. Previous treatment guidelines recommended dual therapy with ceftriaxone and azithromycin, but azithromycin is no longer recommended because of high levels of resistance.
"After a couple of years without any cases of this hard-to-treat form of gonorrhoea, we have now seen 4 cases in the last 2 months," Katy Sinka, PhD, who heads the UKHSA's Sexually Transmitted Infection (STI) section, said in a press release. "It's too soon to say whether this will be the start of a longer-term trend, but we do know that STIs are on the rise in general."
UKHSA officials say they are awaiting follow-up tests in the three cases to see if treatment has been successful.
Feb 7 UKHSA press release
Dec 24 UKHSA press release
