Issue link: https://beckershealthcare.uberflip.com/i/774606
26 ANTIBIOTIC RESISTANCE & STEWARDSHIP 'Nightmare Bacteria' Detected on US Pig Farm By Brian Zimmerman B acteria with genetic resistance to last-resort antibiotics called carbapen- ems were detected on a U.S. pig farm for the first time, according to a new study published in the journal Antimicrobial Agents and Chemotherapy. For the study, researchers collected fecal sam- ples from 1,500 sows and tested the pigs' envi- ronment four times over the course of a five- month period. On the third visit, researchers collected 24 environmental samples from two nursery units on the farm. e gene that al- lows for carbapenem resistance — IMP-27 — was detected in 11 of the 24 samples. While no pig was made ill by the gene, the study's results suggest carbapenem-resistant Entero- bacteriaceae could colonize in human han- dlers of raw meat and one day disseminate from person to person. "e last terrible shoe may have just dropped when it comes to drug-resistant infections. is is just one more warning that doctors may soon have nothing le in their toolkit to save patients when these bugs strike," Da- vid Wallinga, MD, senior health officer at the Natural Resources Defense Council, a non- profit environmental advocacy group, said in a news release. "Our overuse of antibiotics in livestock is creating reservoirs for the spread of resistance — and this study strongly sug- gests resistance to carbapenems is no excep- tion. To save our miracle drugs, we have got to stop wasting them on animals that aren't sick." CRE are considered by the CDC to be one of the major threats created by antibiotic re- sistance. Tom Frieden, MD, the director of the organization, has previously referred to CRE as "nightmare bacteria." CRE infections usually occur in the healthcare setting, caus- ing approximately 9,300 infections and 600 deaths in U.S. hospitals annually. n CDC Publishes Antibiotic Stewardship Guidance for Outpatient Settings: 4 Core Elements By Heather Punke R oughly 60 percent of U.S. antibiotic use in humans is received in outpatient settings, according to the CDC, making that care setting critically important in the fight against antibiotic resistance. In that vein, the agency released the "Core Elements of Outpatient Antibiotic Stewardship" in November. The CDC previously published "Core Elements of Hospital Antibiotic Stewardship Programs" and "Core Elements of Antibiotic Steward- ship for Nursing Homes" in 2014 and 2015. This new addition gives outpatient clinicians and facilities a frame- work for antibiotic stewardship. It was developed by building on known best practices for stewardship across care settings and con- ducting a narrative review of evidence on outpatient antibiotic stew- ardship interventions. Subject-matter experts reviewed the docu- ment and provided feedback until it resulted in the core elements released in November. According to the CDC, the core elements of antibiotic stewardship for outpatient care are: 1. Commitment — Be dedicated to and accountable for optimizing antibiotic prescribing. 2. Action for policy and practice — Put at least one policy or practice in place to improve antibiotic prescribing, assess its effectiveness and change as needed. 3. Tracking and reporting — Monitor prescribing practices and offer feedback to clinicians. Have clinicians assess their own prescribing practices as well. 4. Education and expertise — Give educational resources to clinicians and patients about antibiotic prescription. n Antibiotic-Resistant Bacteria Detected in Polluted Air By Brian Zimmerman T races of antibiotic-resistant bacteria were detected in polluted city air, suggesting smog may be contributing to the rise of drug-resistant infections, according to a recent study published in Microbiome. For the study, researchers examined 864 sam- ples of DNA extracted from humans, animals and different environments from around the world. In air samples taken from cities, re- searchers detected genetic material associated with the development of antibiotic resistance, though it wasn't clear if the bacteria were alive or not in the air. "This may be a more important means of trans- mission than previously thought," said Joakim Larsson, a professor at Sahlgrenska Academy and director of the Centre for Antibiotic Resis- tance Research at the University of Gothenburg in Sweden. "Of particular concern is that we found a series of genes that provide resistance to carbapenems, a group of last resort antibiot- ics taken for infections caused by bacteria that are often very difficult to treat ... it is reasonable to believe that there is a mixture of live and dead bacteria, based on experience from other studies of air." Dr. Larsson's team will next attempt to deter- mine if sewage treatment plants are facilitat- ing the spread of antibiotic-resistant bacteria through the air. n