Becker's Clinical Quality & Infection Control

19 ANTIBIOTIC RESISTANCE & STEWARDSHIP VA Stewardship Program Reduces Antibiotic Use, C. diff Infections, Study Shows By Heather Punke T he Veterans Health Administration's Antimicrobial Steward- ship Initiative led to a 12 percent decrease in overall antibi- otic use and reduced readmissions, mortality and Clostridi- um difficile infections, according to a study in Infection Control & Hospital Epidemiology. e VHA started the initiative in 2010, holding in-person education- al conferences, supporting champions, creating online resources and hosting monthly webinars. By 2014, the VA published Directive 1031, which requires all VA facilities to implement, maintain and evaluate an antimicrobial stewardship program, according to Medical Xpress. By 2015, 92 percent of facilities had written stewardship policies in place, according to the study. The VHA allowed for an a la carte ap- proach to these programs, allowing facilities to include varied, but evidence-based, practices depending on what worked for them. "One of the key findings of this report is that a 'one-size-fits-all' strate- gy to implementation of an antimicrobial stewardship program is not necessary to assure success," Allison Kelly, MD, manager of the VHA's National Antimicrobial Stewardship Initiative, told Medical Xpress. These programs led to a 12 percent decrease in antibiotic use from 2010 through the first quarter of 2015. The VHA also reported de- creasing readmission and mortality rates and fewer C. diff infec- tions, which the study attributed to the stewardship programs. "e VHA has shown that improving antimicrobial usage in a large healthcare system may be achieved through national guidance and re- sources with local implementation of antimicrobial stewardship pro- grams," the study concludes. n E. coli Can Develop Antibiotic Resistance in Just Days, Researchers Find By Brian Zimmerman A ntibiotics can stimulate rapid bacterial mutations causing drug resistance in just days, according to a research article published in January in Nature Ecology & Evolution. For the study, researchers exposed E. coli bacteria to eight rounds of antibiotics over four days in a laboratory setting. With each round of treatment, the bacteria's resistance to the drugs grew, as researchers expected. However, they also found E. coli cells mutated at higher rates after antibiotic exposure and grew three times the size of an E. coli sample not exposed to the drugs. When the antibiotics were removed from the scenario, the genetic mutations remained. "Our research suggests there could be added benefits for E. coli bacteria when they evolve resistance to clinical levels of anti- biotics," said lead author Robert Beardmore, PhD, a professor in biosciences at the University of Exeter in England. "It's often said that Darwinian evolution is slow, but nothing could be further from the truth, particularly when bacteria are exposed to antibi- otics. Bacteria have a remarkable ability to rearrange their DNA and this can stop drugs working, sometimes in a matter of days." E. coli causes diarrhea, stomach pain and kidney failure. n New Antibiotic Combinations Prove Effective Against E. coli By Heather Punke A team of biologists from UCLA found two combinations of antibiotics that were ex- tremely successful in reducing growth of E. coli bacteria, according to UCLA. Their findings were published in the Journal of the Royal Society Interface. The team tested every possible combination of a group of six antibiotics, including some combina- tions of three drugs at once. Two of those combina- tions of three drugs of different classes were more successful than expected. "We have a logical, methodical way to identify three- drug combinations to pursue," said Pamela Yeh, PhD, the study's lead author. "We think it's vital to have this framework for identifying the best possible combina- tions of antibiotics." More research is needed to identify which drug com- binations would be most effective on different diseas- es and different parts of the body. The team is now working to test combinations of four antibiotics. n

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