Becker's Clinical Quality & Infection Control

18 ANTIBIOTIC RESISTANCE & STEWARDSHIP Poor Diagnosis of Fungal Infections Fuels Antibiotic Resistance By Brian Zimmerman I mproper diagnosis of fungal infections around the world results in the over-prescription of antibiotics, thereby exacerbating the grow- ing problem of antimicrobial resistance, according to a research paper published in January in the CDC's journal Emerging Infectious Disease. While rapid diagnostic tests for fungal infections are available and in- expensive, they are not being used by enough clinicians, the paper's au- thors argue. e paper cites four common clinical scenarios that can be worsened by the absence of routine diagnostic testing for fungal infections. • e misdiagnosis of tuberculosis in patients infected with the fungus Aspergillus, which can be treated with antifungal medications and not antibiotics. • Inaccurate diagnosis of fungal sepsis in hospitals and intensive care units among patients with invasive candidiasis, which are fungal in- fections caused by yeasts that can be treated without antibiotics. • Misdiagnosis of chronic obstructive pulmonary disease in patients with fungal asthma. • Treatment and detection issues among HIV-positive patients with fungal pneumonia. "Fungal disease diagnostics are critical in the AMR fight and will im- prove survival from fungal disease across the world," said Dr. David Denning, Global Action Fund for Fungal Infections president and a professor of infectious diseases in global health at the University of Manchester in the U.K. "e close link between fungal diagnostics and antibacterial prescribing needs a great deal more attention." n Support for Prescribers Reduces Unnecessary Antibiotic Use By Heather Punke H ospitals across the globe have taken varied approaches to anti- biotic stewardship in efforts to combat the growth of antibiotic resistance. A Cochrane Review found a number of interventions are effective at reducing unnecessary antibiotic use. Researchers reviewed 221 studies from the U.S., Europe, Asia, South America and Australia and assessed the effectiveness and safety of antibi- otic prescription interventions. Interventions fall in two large categories: restrictive and enabling. Restric- tive tactics apply rules to make physicians prescribe properly, while en- abling tactics give advice or feedback to physicians to help them make prescribing decisions. The researchers found interventions that included restrictive or enabling techniques were more effective than interventions that involved distribut- ing guidelines alone. Adding enabling techniques typically increased the effectiveness of restrictive tactics. The most effective enabling techniques were goal-setting, feedback and action planning, but they were used in just 10 percent of interventions. "We found high-certainty evidence that interventions are effective in in- creasing compliance with antibiotic policy and reducing duration of anti- biotic treatment," the study concludes. The study's lead author, Dr. Peter Davey with the University of Dundee in the U.K., added, "We do not need more studies to answer the question of whether these interventions reduce unnecessary antibiotic use, but we do need more research to understand why the most effective behavior change techniques are not more widely adopted within hospital settings … Appro- priate antibiotic use in hospitals should ensure effective treatment of patients with infection and reduce unnecessary prescriptions. Successful adoption of the interventions we have studied could have considerable impact on health service, policy, and future decision-making for patients." n E. coli Resistant to Last- Resort Antibiotic Found in California for First Time By Heather Punke L os Angeles County has identified an E. coli strain with the mcr-1 gene, which makes it resistant to colistin — known as the antibiotic of last resort — for the first time the state of California, according to a January health alert from the county public health department. This is the sixth time an E. coli isolate with the mcr-1 gene has been identified in the U.S. Its first U.S. appearance was in Pennsylvania in April 2016. Los Angeles public health officials believe the E. coli infection was acquired during international travel, and they do not believe it has spread in the healthcare environment. "The appearance of mcr-1 in Los Angeles serves as a reminder of the importance of in- fection control measures and antibiotic stew- ardship," the LA County health alert says. The health alert urges hospital-based health- care providers to follow Standard and Con- tact Precautions for patients with suspected or confirmed colonization or infection with bacteria that are mcr-1 positive. n

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