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Stewardship / Resistance Scan for Aug 07, 2020

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Survey finds widespread broad-spectrum antibiotic use in COVID patients

A web-based survey of physicians in 23 countries indicates widespread broad-spectrum antibiotic use in COVID-19 patients, an international team of researchers reported today in the Journal of Antimicrobial Chemotherapy.

The 16-question survey, which was completed by 166 physicians at 82 hospitals, asked respondents about what influenced their decision to provide antibiotic treatment to COVID-19 patients, the local antibiotic guidelines in relation to COVID-19, the antibiotics most commonly chosen for empiric treatment, and duration of therapy. The questions on the decision for antibiotic therapy used a 5-point grading scale (1 = least important and 5 = most important), while specific pathogen coverage used a 4-point (1 = strongly disagree and 4 = strongly agree) bi-modal scale.

Most of the respondents worked in university affiliated hospitals (71.7%), over three-quarters (78.2%) were involved in direct care of COVID-19 patients, and more than half (50.3%) were specialists in infectious diseases.

The existence of local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% of participants, and 82.9% said the guidelines did not differ from those for community-acquired pneumonia. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and standard deviation [SD] = 1.095). On the bi-modal 4-point score, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05) and Pseudomonas aeruginosa (mean score = 2.13 and SD = 1.07).

Less than one-third of participants (29.1%) said they chose not to prescribe any antibiotic for patients on the ward, while 52.4% reported prescribing a combination of beta-lactams and macrolides or fluoroquinolones. For patients in the intensive care unit, 63% of respondents prescribed piperacillin/tazobactam. The mean reported duration of antibiotic treatment was 7.12 days (SD = 2.44).

“This study is a real-time and first-hand picture of what is going on in antibiotic prescribing in COVID-19 patients and a stimulus for much-needed research in this field,” the authors wrote.
Aug 7 J Antimicrob Chemother study

 

Scientists in Taiwan detect MCR genes in human Klebsiella isolates

Scientists in Taiwan have detected colistin-resistance genes in human Klebsiella pneumoniae isolates, according to research today in Clinical Microbiology and Infection.

In a letter to the editor, scientists from Taiwan’s National Institute of Infectious Diseases and Vaccinology report the detection of MCR-1, MCR-3, and MCR-8 genes in six clinical isolates from elderly, hospitalized patients collected by the Taiwan Surveillance of Antimicrobial Resistance program in 2018. Sanger sequencing revealed they were MCR-1.1, MCR-3.5, and MCR-8.2. All isolates were resistant to multiple antibiotics but susceptible to carbapenems and amikacin.

Whole-genome sequencing indicated that the plasmids carrying the genes are similar to those that have been found in different species of Enterobacteriaceae in animals and humans in Taiwan, and carried several other antibiotic resistance genes.

The authors of the study note that while MCR genes have been detected in Escherichia coli from humans, animals, and the environment in several countries, there have been few reports of MCR genes in K pneumoniae.

“In conclusion, plasmids carrying either mcr1mcr3, or mcr8 have spread to several clinical K. pneumoniae isolates from different regions of Taiwan,” the authors wrote. “Their transferability, persistence, potential to spread, ongoing evolution and concomitant multiple antimicrobial resistance genes necessitate continuous monitoring.”
Aug 7 Clin Microbiol Infect abstract



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