Stewardship/Resistance Analysis of May 16, 2022

Study finds MRSA and VRE can persist in nursing homes

Environmental screening of individual rooms in a nursing home revealed high levels of circulation and persistence of methicillin resistance Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), according to a study published today in Antimicrobial stewardship and healthcare epidemiology.

In the prospective cohort study, researchers examined five high-touch surfaces in a group of nine single-occupancy rooms in a nursing home three times a week for 34 weeks. They also examined the patients if they agreed to participate. Overall, 146 separate occupancy events were captured during the study, with 387 study visits and 4,670 swabs collected.

Screening revealed that all rooms were contaminated with VRE, and eight of the nine were also contaminated with MRSA. Re-contamination of a room with MRSA or VRE was observed on 43 (23%) of 185 occasions, with potential persistence occurring on 25 (32.9%) of 76 occasions.

Whole genome sequencing of 67 non-redundant isolates identified at least 6 clades of enterococci and 10 clades of MRSA, indicating a high degree of diversity and likely multiple introductions into the facility during the study period, including including one case of a persistent strain of MRSA in a healthy environment. room before the next patient is admitted.

The researchers, who presented the study at the Society for Healthcare Epidemiology (SHEA) Spring Conference last month, say the results indicate that active surveillance screening and recurrent assessment of terminal cleaning procedures should be considered in the context of nursing homes.
May 16 Antimicrobial Steward Healthc Epidemiol abstract

Multiple factors influence antimicrobial use in cats and dogs, data show

In another study presented at the SHEA Spring Conference and published in Antimicrobial Stewardship and Healthcare Epidemiology today, researchers have identified several factors associated with antimicrobial prescriptions in dogs and cats.

Using demographic, clinical, and prescription data from a small animal teaching hospital’s electronic medical records system from 2018 to 2020, researchers assessed the association between demographic and clinical factors of systemic prescriptions of antimicrobial drugs in dogs and cats. Of 11,685 dogs with 14,328 admissions (mean age 7.4 years; 47% female), they found that female sex, longer admission, history of chemotherapy within 30 days of admission, surgery at admission or in the past 30 days, intensive care unit (ICU admission) and oxygen delivery were associated with an increased likelihood of any antimicrobial prescription.

In 3,371 cats with 4,088 admissions (mean age, 8.6 years; 39% female), researchers found that female sex, longer admission, older age (over 8 years), admission in ICU, surgery on admission and no requirement for oxygen supply or urinary catheterization were associated with an increased likelihood of any antimicrobial prescription.

The researchers say the results can inform veterinary antimicrobial stewardship efforts and can be useful for comparing antimicrobial use at institutional or multi-institutional scales.
May 16 Antimicrobial Steward Healthc Epidemiol abstract

Surveillance system linked to antibacterial decline in NICUs

The implementation of a mandatory surveillance system in neonatal ICUs (NICUs) in Germany has been associated with reduced consumption of antibacterials among preterm infants, researchers reported late last week in the Infection Diary.

For the study, a team of German researchers analyzed data on antibacterial use in 231 NICUs in Germany from 2013, when a module assessing antibacterial use in very young newborns low birth weight (VLBW) was added to the German national surveillance system for nosocomial infections. for Newborns (NEO-KISS) – through 2019. NEO-KISS assesses the incidence of antibacterial use, hospital-acquired infections, and multidrug-resistant organisms in preterm infants during hospital care. The primary outcome assessed was antibacterial consumption during days of treatment (DOT) per 1000 patient days (PD).

A total of 2,090,241 patient days with 344,929 days of antibacterial use were observed. Over the entire study period, consumption of antibacterials was 430.4 DOT/1,000 PD, but consumption fell from 474.3 DOT/1,000 PD in 2013 to 382.1 DOT/1,000 PD in 2019, a decrease of 19.5%.

Of all neonates under surveillance, 72.9% received antibacterial treatment. The use of extended-spectrum penicillins, other aminoglycosides, glycopeptide antibacterials, and third-generation cephalosporins has declined, while the use of macrolides and combination penicillins, including beta-lactamase inhibitors, increased over time.

The analysis also revealed that serious healthcare-associated infections continuously decreased over the study period. Regression analysis identified year of birth as an independent protective factor for antibacterial prescribing in general.

The study authors say that although the underlying reasons for the reduction cannot be directly identified, they note that the implementation of surveillance systems can stimulate activities aimed at improving prescribing at local and national levels. , such as establishing benchmarks for the use of antibacterials.

“Assessment of antibacterial consumption could further assist in implementing additional targeted antimicrobial management measures, potentially further reducing antibacterial consumption and improving antibacterial prescriptions on NICUs beyond VLBW,” they wrote.
May 14 J Infect study

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