Becker's Clinical Quality & Infection Control

21 ANTIBIOTIC RESISTANCE Antibiotic Resistance Detected in Cluster of Gonorrhea Infections By Brian Zimmerman R esearchers with the Hawaii De- partment of Health identified a cluster of Neisseria gonor- rhoeae infections that displayed a decreased susceptibility to the double-antibiotic combination used to eliminate the infection after other drugs have failed, according to a pre- sentation given Sept. 21 at the CDC's 2016 STD Prevention Conference. The infections were detected in sev- en people (six men and one woman) in Honolulu, none of whom reported having sexual partners in common, traveling abroad or taking antibiotics While all patients received successful treatments using the dual antibiotic, the cluster represents the first cases of decreased ceftriaxone susceptibil- ity and very high-level azithromycin resistance occurring in the same isolate in the United States. "Our last line of defense against gon- orrhea is weakening," said Jonathan Mermin, MD, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. "If resistance continues to increase and spread, current treatment will ultimately fail and 800,000 Americans a year will be at risk for untreatable gonorrhea." n Community Hospital Antibiotic Use on Par With Larger Hospitals, Despite Seeing Less Complex Patients By Brian Zimmerman R ates of antibiotic use in small community hospitals are similar to those of large community hospitals and academic medical centers, according to a study published in the journal Clinical Infectious Diseases. For the study, researchers from Intermountain Medical Center and the Uni- versity of Utah School of Medicine, both in Salt Lake City, analyzed monthly antibiotic use reports compiled from 2011 to 2013 at four large hospitals and 15 small community hospitals across the Intermountain Healthcare system. e median use rate for small community hospitals was 436 days of antibiotic therapy per 1,000 patient days. For the large hospitals, the average rate was 509 days of therapy per 1,000 patient days. e comparable rates of antibiotic use may be cause for concern because larger hospitals tend to treat more complex patients and the small commu- nity hospitals examined in the study did not have antibiotic stewardship programs in play. "In order to holistically address the growing problem of antibiotic-resistant bacteria, the infectious disease community must respond to antibiotic use in all hospitals, not just the large academic medical facilities," said lead author Eddie Stenehjem, MD, an infectious disease physician and researcher at Inter- mountain Medical Center. "Small hospitals are least likely to have stewardship programs even though antibiotic usage patterns are similar to larger facilities. We need to bring stewardship support to all hospitals, but the challenges come in knowing how to do that." Many small community hospitals have limited access to the resources neces- sary to build effective antimicrobial stewardship programs and meet the new national standards requiring all hospitals to have such programs in place by 2017. n Physicians Prescribe Wrong Antibiotics Half of the Time By Brian Zimmerman P atients treated for ear infections, sore throats and sinus infections are prescribed the incorrect antibiotic nearly 50 percent of the time, according a research letter pub- lished in JAMA Internal Medicine. The findings build on previous research pub- lished in May, which found 30 percent of outpatient, oral antibiotic prescriptions may be prescribed unnecessarily. In accordance with the previous study, re- searchers examined 2010-2011 data from the National Ambulatory Medical Care and Nation- al Hospital Ambulatory Medical Care surveys to assess antibiotic prescribing practices involving more than 5,000 patients. Analysis revealed appropriate antibiotics were prescribed least frequently for adults with a sinus infection and a sore throat at a rate of 37 percent. Pediatric ear infection patients re- ceived the highest rate of appropriate antibi- otics at 67 percent. Collectively, patients were prescribed the correct antibiotic 52 percent of the time. "These findings indicate that the problem of inappropriate antibiotic prescribing includes not only prescriptions that are unnecessary altogether, but also selection of inappropriate agents. As a result, stewardship interventions should address both antibiotic overuse and inappropriate antibiotic selection to improve patient safety and healthcare quality," conclud- ed the authors. n

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