Becker's Clinical Quality & Infection Control

52 ANTIBIOTIC RESISTANCE & STEWARDSHIP Nearly 70% of pediatric caregivers work around programs to cut antibiotic resistance, survey finds By Anuja Vaidya W hile most providers believe that programs aiming to reduce the threat of antimicrobial resistance can improve pediatric care, many admit they use workarounds from time to time, according to survey results published in Infection Con- trol & Hospital Epidemiology. Researchers conducted a survey at large children's hospital from February 2017 through June 2017. e survey included both closed- and open-ended questions. ey invited 394 caregivers to take the survey, and they received responses from 160. ey found 92.4 percent of prescribers believed that antimicrobial stewardship programs improve the quality of care, and 73.8 percent reported that these programs make room for their own judgment. However, 68.7 percent of respondents reported occasionally en- gaging in workarounds. e reasons for engaging in workarounds included not wanting to change therapy that appears to be working and the desire to do everything possible for patients. Twenty-six percent also said they believe that antimicrobial steward- ship programs can threaten efficiency. Additional analysis showed that prescribers perceived that following antimicrobial stewardship programs involved too many phone calls and caused communication breakdowns with the pharmacy, among other issues. n Highly resistant E. coli strain found in NYC hospital patients By Mackenzie Bean E Researchers identified a highly resistant strain of E. coli in four patients at a hospital in New York City, according to a study published in Antimicrobial Agents and Chemotherapy. The E. coli strain contains a gene called mcr-1, which renders the bacteria resistant to colistin — an antibi- otic of last resort for many drug-resistant infections. Researchers identified the bacteria while moni- toring patients with weakened immune systems as part of a prospective surveillance study. Three of the patients harboring the antibiotic-resistant E. coli strain exhibited no symptoms of infection, which increases the risk of unknowingly spreading the bacteria to others. "While mcr-1 has been described from other parts of the world, it has been very rare in the U.S.," lead author Anne-Catrin Uhlemann, MD, PhD, associate professor at Columbia University's Vagelos College of Physicians and Surgeons in New York City, said in a press release. "The detection of this cluster demonstrates the po- tential for silent dissemination of mcr-1 in the U.S. hospital setting, through asymptomatic coloniza- tion," Dr. Uhlemann added. "Our findings represent the earliest known documented healthcare-asso- ciated cluster of mcr-1 in the United States and predates a recent report that occurred in 2017." n 54% of children with community- associated C. diff recently used antibiotics, study shows By Anuja Vaidya A study published in Epidemiology & Infection found recent antibiotic use was strongly linked to the onset of community-associated Clostridioides difficile infections in young children. The research team enrolled children between the ages of 1 and 5 years from eight U.S. sites between October 2014 and February 2016. They matched children with a positive C. diff specimen to a control group. The C. diff patients had not been admitted to a healthcare facility in the 12 weeks prior, nor did they have a history of C. diff infection. There were 68 pairs of patients in the study. The following factors were more common among C. diff pa- tients compared to controls: • A comorbidity (33.3 percent among C. diff patients versus 12.1 percent among controls) • Recent antibiotic use (54.4 percent versus 19.4 percent) • Recent higher-risk outpatient exposures (34.9 percent versus 17.7 percent) • Recent exposure to a household member with diarrhea (41.3 percent versus 21.5 percent) Researchers also found antibiotic exposure in the prior 12 weeks was significantly associated with community-associated C. diff infection. n

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