Becker's Clinical Quality & Infection Control

27 ANTIBIOTIC RESISTANCE & STEWARDSHIP Antibiotic Stewardship Reduces C. Diff Incidence 32% By Anuja Vaidya A study published in e Lancet Infectious Diseases examined the effect of antibiotic stewardship on the incidence of infec- tion and colonization with antibiotic-resistant bacteria as well as Clostridium difficile infections. Researchers searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Web of Science for studies that analyzed antibiotic stewardship program efficacy with regard to antibiotic-resistant bacteria and C. diff. Studies included were published between Jan. 1, 1960, and May 31, 2016. Researchers excluded studies involving long-term care facilities. Researchers analyzed 32 studies, which included 9.05 million patient-days and 159 estimates of incidence ratios of target infections and colonization. e study shows that antibiotic stewardship programs reduced the inci- dence of infections and colonization with: • Multidrug-resistant Gram-negative bacteria by 51 percent • Extended-spectrum β-lactamase-producing Gram-negative bacte- ria by 48 percent • Meticillin-resistant Staphylococcus aureus by 37 percent e programs also reduced the incidence of C. diff infections by 32 percent. Additionally, researchers found antibiotic stewardship programs were more effective when implemented with infection control measures, especially hand-hygiene interventions, than when implemented alone. n Kaiser Achieves 22% Reduction in Antibiotic Use With EHR Alerts By Brian Zimmerman D igital alerts helped physicians at 126 Kaiser Per- manente locations in Southern California reduce antibiotic prescriptions for sinusitis, according to a study published in The American Journal of Managed Care. From September 2014 through April 2015, researchers conducted an analysis of 21,949 initial acute sinusitis encounters in adults at primary and urgent care settings, with 10,491 of the encounters occurring before the im- plementation of the alert intervention. The alert appeared on the EHR to notify physicians when antibiotic prescrib- ing may not be the best course of treatment. An analysis revealed a 22 percent reduction in antibiotic use after the intervention. "[H]ealth systems are discovering that stopping a com- mon behavior, like prescribing antibiotics, can be even more difficult than spreading the use of a new test or treatment," said lead author Adam Sharp, MD, an emer- gency department physician at the Kaiser Permanente Los Angeles Medical Center. "Our research builds on research conducted at the U.S. Department of Veterans Affairs, the [CDC] and studies being conducted around the country to better understand how to limit routine use of unwarranted antibiotics." n Tetracyclines Linked to Lower C. Diff Risk Compared to Other Antibiotics By Anuja Vaidya A study published in Clinical Infectious Diseases examined the risk of developing Clostridium difficile infection with tetracyclines compared to other antibiotics. Researchers searched Medline, Embase and Web of Science from January 1978 through December 2016 to identify studies that assessed the association between tet- racycline use and risk of C. diff. They included six studies, four case control and two cohort, with patient recruitment between 1993 and 2012. The researchers found that that tetracyclines were associ- ated with a decreased risk of C. diff. Additionally, sub- group analysis of studies that evaluated the risk of C. diff with doxycycline alone also demonstrated a decreased risk of the infection. "It may be reasonable to use tetracyclines whenever appro- priate to decrease CDI associated with antibiotic use," study authors concluded. n FDA Website to Improve Management of Antibiotic Use By Alia Paavola T he FDA launched a new website Dec. 13 aimed at improving access to timely information about bacteria and fungi susceptibility to drugs, to help healthcare professionals make appropriate choic- es when prescribing antibiotics and antifungal drugs. Mandated by the 21st Century Cures Act, the website is part of an effort to combat the rising number of antibiotic resistant infections. "Antimicrobial resistance remains one of our most press- ing public health challenges. While we're continuing our policy efforts to encourage the development of new drugs and limit the use of antibiotics in livestock, we also need to take new steps to encourage more appropriate use of these treatments in patient care," said FDA Com- missioner Scott Gottlieb, MD. Bacteria and fungi mutate over time, which may result in decreased susceptibility to some antibacterial or antifun- gal drugs. The website will provides timely, direct access to information about which drugs are most likely to work on a specific bacterial or fungal infection. n

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