Table 1 Summary of abstracts presented at the 2013 World Healthcare-Associated Infections Forum
From: Antimicrobial resistance: a global view from the 2013 World Healthcare-Associated Infections Forum
I. Antimicrobial use and resistance | ||||
|---|---|---|---|---|
Author | Short title | Study design | Setting | Key findings |
Balkhy et al. | Susceptibility of isolates from patients with VAP in Saudi Arabia | Retrospective susceptibility study | Single adult ICU, Saudi Arabia, 2004 – 2009 | • Acinetobacter spp. was highly resistant (70 – 90%) to all tested antimicrobials including carbapenems (78% had four-class MDR) |
• Klebsiella spp. had low (0 – 14%) resistance with no detected MDR | ||||
Carrel et al. | MRSA and proximity to concentrated animal feeding operations | Retrospective unmatched case-control study | Veterans Affairs Hospital, Iowa, USA, 2009 – 2011 | • High swine exposure (residential proximity to CAFOs) was associated with an increased risk of MRSA colonization |
Dantes et al. | National burden of invasive MRSA infections, USA 2011 | Prospective, population-based surveillance study | USA, 2011 | • Compared to 2005, hospital-onset MRSA infections decreased by 54%, but community-associated infections remain stable |
• Invasive MRSA infections are now more common among persons in the community than hospitalized patients | ||||
Datta et al. | Quantifying MDRO exposure from patients in a single hospital to all California facilities | Retrospective case-cohort study | California hospitals and long-term-care facilities, 2005 – 2009 | • Within a 5-year period, 1,198 patients with MRSA in a single hospital later exposed 137 hospitals and 103 LTCF |
Gastmeier et al. | Dramatic increase of vancomycin-resistant enterococci in Germany with a belt of high proportions | Prospective surveillance study | > 600 ICUs and > 300 surgical wards throughout Germany, 2007 – 2012 | • Healthcare-associated VRE colonization and infections are increasing dramatically in Germany, particularly SSI and primary BSI |
• There is a belt of significantly higher VRE proportions running through the middle of Germany | ||||
Gikas et al. | Antimicrobial use and HAI prevalence in Greek hospitals | Antimicrobial and HAI point prevalence study | 37 hospitals, Greece, 2012 | • 54.7% of hospitalized patients were receiving an antimicrobial (a slight increase from 51.4% ten years before) |
• ICU and surgery patients received the highest proportion of antimicrobials | ||||
• 9% of patients had documentation of a HAI | ||||
Gniadkowski et al. | Obstacles in controlling KPC spread in Poland | Retrospective surveillance study | Poland, 2008 – June 2013 | • KPC-producing enterobacteriaceae have spread rapidly throughout Poland since their emergence in 2008 |
• Most common infection type is UTI; infections are most commonly reported by ICUs | ||||
Hsueh PR | Antimicrobial drug resistance in Asia Pacific | Prospective and retrospective surveillance studies | Taiwan, 2002 – 2011 | • VRE infections in Taiwanese ICUs are increasing dramatically |
• ESBL-producing Escherischia coli infections have been increasing in Asia Pacific | ||||
• Resistance to colistin (polymyxin B) is emerging in A. baumannii and Pseudomonas aeruginosa | ||||
Kaku et al. | Trends of antimicrobial resistance in a Japanese hospital | Retrospective surveillance study | Tertiary care hospital, Japan, 2012 – April 2013 | • ESBL-producing bacteria are increasing in prevalence |
• Trends in MRSA and multi-resistant Pseudomonas are stable | ||||
Mushtaq et al. | Prevalence of carbapenemase carriage among inpatients in Karachi | Prospective surveillance study | Tertiary care hospital, Pakistan, 2012 | • Of 469 patients sampled on admission by rectal swab, 36% were positive for blaNDM and 92% for blaCTX-M-15 |
Reuland et al. | Risk factors for carriage of ESBL-producing enterobacteriaceae in the community | Prospective cohort study with nested, unmatched case-control study | Adult, community-dwelling volunteers, Netherlands, 2012 | • Of 1713 stool samples from community-dwelling volunteers, 8% were positive for ESBL-producing enterobacteriaceae |
• Significant risk factors were hospital admission in a foreign country, antimicrobial use, and antacid use | ||||
• ESBL-encoding genes CTX-M-15 and -14 were significantly associated with travel to Africa and the Middle and Far East, while CTX-M-1 had no association with travel | ||||
Thu le et al. | Antimicrobial use and resistance in surgical patients in Vietnam | Literature review | Vietnamese hospitals, 2010 – 2012 | • Antimicrobials are prescribed inappropriately in Vietnamese surgical patients |
• The chief reason for prolonging antimicrobial therapy was the perception of a “poor environment” | ||||
II. Emergence and control of endemic resistance | ||||
Author | Short title | Study design | Setting | Key findings |
Adler et al. | Characteristics of an outbreak caused by OXA-48-producing CRE in a neonatal ICU in Jerusalem | Combined retrospective and prospective before-after cohort study | Neonatal ICU, Israel, 2012 | • At the peak of the outbreak, one third of ICU patients acquired OPE |
• After the implementation of a bundled intervention, which included cohorting colonized patients, frequent rectal surveillance, and improving the implementation of infection control practices, no new cases were detected over the following three months | ||||
Baltieri et al. | Prevention of Staphylococcus aureus infection in the NICU: routine surveillance and decolonization | Combined retrospective and prospective before-after cohort study | Brazilian NICU, 2010 – 2012 | • In response to increasing MRSA prevalence, universal NICU screening and decolonization (nasal mupirocin and oral hygiene with chlorhexidine for one week) were implemented |
• The fraction of MRSA infections decreased from 2% to 0.4% after bundle implementation; there was no significant impact on MSSA infections | ||||
• There was no microorganism replacement phenomenon | ||||
Cheung et al. | Overcoming hand hygiene fatigue by involving the link nurses | Before-after study | Tertiary care hospital, Hong Kong, 2008 – 2012 | • The activities of link nurses helped to increase compliance with hand hygiene practices from 50% to 83% |
Fournier et al. | Emerging MDRO: same risk of outbreaks? | Prospective surveillance study | 38 hospitals, France, 2010 – March 2013 | • Incidence of secondary cases of VRE and CRE was significantly lower if cohorting and dedicated nursing staff and/or barrier precautions were employed within two days of detection of the index case |
• If these measures were delayed beyond two days, VRE spread was more significant than that of CRE | ||||
Grall et al. | Can the medical device DAV132 decrease the impact of antibiotics on fecal microbiota? | Experimental animal models (porcine, canine, murine) | France, 2013 | • DAV132 is an oral medical device designed to deliver an adsorbent to the distal ileum that interferes with antibiotic absorption distal to the ileocecal junction |
• DAV132 captured gut antibiotic residues in dogs treated with intravenous levofloxacin without impacting blood pharmacokinetics and, in mice, significantly reduced the impact of cefotaxime on resistance to colonization by beta-lactam resistant enterobacteriaceae | ||||
III. Antimicrobial conservation | ||||
Author | Short title | Study design | Setting | Key findings |
Awang Jalil et al. | Infection prevention and control strategies of MDR infections in a neonatal ICU | Before-after study | Neonatal ICU, Malaysia, 2012 – April 2013 | • An antimicrobial conservation program with dedicated staff was implemented, with resultant improvement in hand hygiene practices (95% compliance) and a sharp decline in HAI sepsis rates |
Bailin et al. | Antimicrobial treatment for UTI among patients with total hip or knee arthroplasty | Two-stage combined retrospective and prospective cohort study | Tertiary care hospital, USA, 2011 – 2012 | • Pre-operative screening for UTI was conducted in 95% of patients undergoing total hip or knee arthroplasty, regardless of symptoms; post-operative removal of the urinary catheter was also followed by urinalysis in 99% of patients regardless of symptoms |
• Nearly half (45.5%) of patients received antimicrobials pre- or post-operatively | ||||
• In the prospective study, receipt of antimicrobials was not associated with signs and symptoms of UTI | ||||
Bavestrello et al. | Impact of intervention on antimicrobial consumption in aquaculture in Chile | Before-after economic analysis | Chile, 2008 – 2009 | • After regulations on antimicrobial use in the salmon industry were introduced in late 2008, importation of fluoroquinolones decreased dramatically |
Edmunds et al. | Assessing the need for antimicrobial use guidelines among staff of a Saudi Arabian hospital | Voluntary survey | Tertiary care hospital, Saudi Arabia, 2013 | • Physicians’ responses to clinical vignettes in this survey showed good awareness of appropriate antibiotic options for various infections |
• Correct answers were not associated with age group, gender, or training status | ||||
Glass-Kaastra et al. | Variation in antimicrobial use patterns in Canadian Provinces | Retrospective population-level surveillance study | Canadian provinces, 2000 – 2010 | • Although overall antimicrobial use is declining, patterns of use vary by province |
• Quebec had the lowest overall antimicrobial use, Newfoundland the highest | ||||
Guzman-Blanco et al. | Pan-American Health Organization guideline for treatment of infectious diseases in Latin America | International guideline | Latin America, 2013 | • This guideline was recently updated to include recent surveillance data from Central and South America |
Koo et al. | Appropriateness of continued use of empirical vancomycin | Retrospective cohort study | Tertiary care hospital, South Korea 2012 | • Only 37.8% of systemic vancomycin prescriptions for 339 hospitalized patients over the year were deemed appropriate |
Ling et al. | Case-control study to determine risk factors for CRE carriage | Retrospective matched (1:2) case-control study | Tertiary care hospital, Singapore, 2011 – 2013 | • Significant risk factors were overseas hospitalizations in the past year, ICU admission, and exposure to carbapenems and fluoroquinolones |
Mehtar and Hara | Antimicrobial stewardship in Africa-humble beginnings | Descriptive epidemiologic study | African hospitals, 2011 – 2012 | • Only 14% of hospitals responding to a ESCMID survey reported having an ACP in place |
• The new Infection Control Africa Network is implementing ACP education programs in some African countries; long-distance learning and communication will employ mobile phone technology | ||||
Moro et al. | Impact of a regional intervention program to control carbapenemase-producing Klebsiella pneumonia (CPKP) | Before-after study | 17 hospitals, Italy (Emilia-Romagna), 2011 – 2013 | • Given the rapid spread of CRE in Italy, a bundled intervention targeting patients at increased risk for CRE was implemented in mid-2011 in the county of Emilia-Romagna |
• A significant deceleration in the spread of CRE was observed overall; in 5 hospitals the incidence rate of CPKP decreased from 32 to 15 cases/100,000 hospital patient-days | ||||
Ndoye | Antibiotic control in Senegal | Before-after study | Community hospitals, Senegal, 2008 – 2012 | • Despite a national initiative issued in 2008 to establish site-based antibiotic conservation, regular assessments through 2012 reveal that nearly 60% of facilities have not begun any preparatory activity, and no facility has implemented recommended interventions fully |
• The chief reason appears to be a shortage of dedicated human resources | ||||
Nicolle | Antimicrobial stewardship in long-term-care facilities: what is effective? | Systematic literature review | Published studies retrieved through Medline & Embase, 1998 – 2013 | • Engagement of internists and promoting infectious diseases consultations were very effective; strategies incorporating education, local guidelines, and feedback were less so |
• Specific programs to decrease UTI prophylaxis and treatment of asymptomatic bacteriuria were successful | ||||
Nussenblatt et al. | Inappropriate diagnosis and treatment of VAP is common in ICUs | Prospective observational study | ICUs in a single tertiary care center, USA, 2009 – 2010 | • Antibiotics were continued for more than 3 days in patients without VAP (77%) |
• Those patients with inappropriately long antibiotic courses trended toward more symptomatic CDI and longer hospital stays | ||||
Pulcini and Carlet for WAAAR | A multidisciplinary initiative to save antibiotics: the World Alliance Against Antibiotic Resistance | Cross-disciplinary alliance | 42 countries represented, 2011 – | • This alliance of nearly 500 individuals from 42 countries was formed in 2011 |
• Non-profit organization composed of antimicrobial prescribers (physicians, veterinarians) and consumers, including politicians and environmentalists) open to all people worldwide | ||||
• Goal is to decrease AMR’s prevalence | ||||
Skov et al. | Reducing antibiotic usage in Denmark: a campaign launch | Ongoing campaign | Danish general practitioners and general public, 2012 – | • In response to increasing AMR prevalence, a campaign to reduce unnecessary antimicrobial consumption has been launched |
• The campaign targets prescribers (physicians) and consumers (general public) | ||||