Becker's Clinical Quality & Infection Control

52 ANTIBIOTIC RESISTANCE & STEWARDSHIP Virus found in pond proves effective against antibiotic-resistant infection By Brian Zimmerman R esearchers used a bacteriophage, a bacteria-killing virus found in a pond, to cure a Pseudomonas aeruginosa in- fection a patient contracted in his chest aer open heart surgery, according to a case study published in the journal Evolution, Medicine, & Public Health. Bacteriophages are biologically incompat- ible with any organism except the specific bacterial strain it's evolved to infect. Unlike antibiotics, phages do not target the good bacteria carried in the human microbiome. While fighting bacterial infections with phages is not a new concept, it hasn't been common practice since the early 20th centu- ry, according to a report from Motherboard. However, amid rising rates of antibiotic resistance, the treatment option is garnering renewed attention from some researchers. e case study involved a 76-year-old male patient who experienced a P. aeruginosa aortic gra infection aer open heart surgery in 2012. In 2016, the patient opted for an experimental procedure that involved treat- ing the infected area with antibiotics and a bacteriophage — found in Dodge Pond in Connecticut — that matched the bacterial strain causing his infection. e patient has not experienced a recurrent infection since the procedure, despite being taken off pre- scription antibiotics shortly aer surgery. "In our case, only partial removal of the aor- tic gra was possible, greatly increasing the reinfection risk and necessitating continued lifelong suppressive antibiotics," wrote the study's authors. "e patient has not had a recurrent infection in the 18 months since discontinuing antibiotics aer the emergent surgery. Due to these circumstances, we argue that the phage therapy played a signifi- cant role in contributing to the eradication of the P. aeruginosa infection." Researchers acknowledged further research is needed to better understand the possible efficacy of phage therapy to treat antibiot- ic-resistant infections. n Audit, feedback essential to success of antibiotic stewardship programs By Anuja Vaidya A study published in Clinical Infectious Diseases examined the key resources and strategies aiding the success of antibiotic stewardship programs in the acute care setting. Researchers conducted a survey of 244 members from three infectious diseases subspecialty societies involved in antibiotic stewardship. They analyzed survey responses and also studied the relationship between stewardship program staffing levels and self-reported effectiveness. The common strategies that helped antibiotic steward- ship succeed were: • Prior authorization for select antibiotics • Antibiotic reviews with prospective audit and feed- back • Guideline development Additionally, researchers found each 0.5 increase in phar- macist and physician full-time equivalent support predict- ed a 1.48-fold increase in the odds of a program demon- strating effectiveness. The ability to perform prospective audit and feedback brought about the predicted increase. "Prospective audit and feedback should be the corner- stone of stewardship programs, and both physician lead- ership and pharmacists with expertise in stewardship are crucial for success," the study's authors concluded. n 32% of hospitalized children worldwide given antibiotics as preventive measure By Anuja Vaidya A study published in the Journal of the Pediatric Infec- tious Diseases Society examined antibiotic pre- scriptions for hospitalized children worldwide. Researchers studied antibiotic prescriptions for 6,818 pediatric inpatients at 226 hospitals in 41 countries, including four in the U.S. They analyzed the prescriptions for one day in 2012. Researchers found 11,899 total antibiotic prescriptions, of which 28.6 percent were for prophylactic use. Of hospital- ized children who received at least one antibiotic prescrip- tion, 32.9 percent received the medication to prevent a potential infection rather than to treat a current one. They also found of the antibiotics prescribed for prophy- lactic use, 26.6 percent were to mitigate potential infec- tions linked with an upcoming surgery, and the remaining 73.4 percent of the prescriptions were to potentially prevent other types of infections. Around 51 percent of all preventive prescriptions were for broad-spectrum antibiotics, and two or more system- ic antibiotics were prescribed at the same time in 36.7 percent of cases. "This pattern and high rate of prophylactic prescribing in- dicates a clear overuse of antibiotics," said study author Dr. Markus Hufnagel of the University of Freiburg in Germany. n

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