Minnesota Department of Health MN Antibiotic Stewardship Collaborative Update Bulletin

 

 

 

Stewardship quiz? You betcha! (scroll down for answer)

In the 2013 Minnesota Pollution Control Agency (MPCA) report on Pharmaceuticals, Personal Care Products, and Endocrine Active Chemical Monitoring in Lakes and Rivers, which of the following antibiotics was reported to be detected in one or more streams?

a. Sulfamethoxazole
b. Erythromycin
c. Ciprofloxacin
d. Virginiamycin
e. All except (c.)
f. All of the above

Update from Your Minnesota Stewardship Collaborative

Saint Cloud Hospital recognized by Collaborative Healthcare-Associated Infection Network (CHAIN) in inaugural award

Saint Cloud Hospital's catheter-associated urinary tract infection Quality Leadership Academy (QLA) earned the inaugural award for Excellence in Infection Prevention at the Fall meeting of CHAIN, held on September 28, 2016.

“QLA members are a collaborative, multidisciplinary team comprised of leaders, physicians, nursing, patient safety experts, and affected department stakeholders,” said Ellen Simonson, St. Cloud Hospital’s Director of Infection Prevention and Control. “The group incorporates principles of adaptive leadership to create an environment of improvement directed toward achievement...".  Read more

Do you know the difference between resistance and residue? Learn more from the National Pork Board

• Antibiotics are just one tool in the animal health toolbox used by your MN pork industry. Veterinary guidance, proper nutrition, clean water, proper air ventilation, temperature management, animal housing maintenance, vaccination,  biosecurity, animal care, and genetics all factor into keeping pigs healthy.
• Antibiotic resistance occurs when bacteria develop the capacity to inactivate or exclude antibiotics, or develop a mechanism to block the inhibitory or killing effects of antibiotics.
• Antibiotic residue refers to molecules that remain in meat from animals that have been treated with antibiotics. During the drug approval process, the FDA establishes tolerance levels or maximum residue limits (MRLs) in edible tissues to ensure consumer safety. A violative residue occurs when a food animal is marketed with drug residues exceeding the designated MRL, which is illegal. USDA’s Food Safety Inspection Service tests for violative drug residues at harvest to ensure that meat is safe to enter the food supply
• Also see Minnesota Pork Board's website for facts about pork production in MN and tips on cooking pork safely and deliciously!

Stay tuned for meeting announcements, including:

• Human Health Care Antibiotic Stewardship Conference (Winter 2017) 

News to Note

Joint Statement on the Importance of Outpatient Antibiotic Stewardship from 12 National Health Organizations released by CDC and Pew Charitable Trusts. Read more

• Provider and public health groups "...recognize that antibiotic resistance is a major threat to public health and commit to collective action to address this challenge by ensuring the appropriate use of these critical therapies"

On September 28, CMS issued a final rule for improvements in patient safety, care, and consumer protections for long-term care residents. Read more

• Among other changes, this rule makes updates to infection prevention requirements, including requiring an infection prevention and control officer and an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use
• This is the first comprehensive update to CMS rulings for long-term care facilities since 1991 

CDC funds 34 innovative projects to combat antibiotic resistance. Read more 

• Includes research on how microorganisms naturally present in the human body (referred to as a person’s microbiome) can be used to predict and prevent infections caused by drug-resistant organisms

British researchers explore prevalence and susceptibility of bacterial isolates from horses with synovial sepsis. Read the abstract from the Veterinary Journal

• Most of the 379 cases of synovial sepsis reviewed from 2004-2013 resulted from a joint-penetrating wound (85%) and were associated with Gram-positive bacterial infection (75%)
• Consistent with British Equine Veterinary Association antimicrobial use policy, bacteria isolated from synovial fluid showed greatest susceptibility to gentamicin, tetracyclines and trimethoprim-sulfamethoxazole, although there was considerable resistance to penicillin G
• Equine practitioners in the study area can use results in empiric antibiotic selection, while they also consider additional evidence, such as prior treatment and patient signalment, and await culture and sensitivity results
• Findings highlight importance of understanding epidemiology of syndromes and antibiograms of offending pathogens

Pennsylvania study finds high rates of carbapenem-resistant Klebsiella pneumoniae colonization and infection in long-term acute care hospital residents. Read the Infection Control and Hospital Epidemiology abstract

• During 2008-2013, 222 patients had culture positive for K. pneumoniae, 45% of which were carbapenem-resistant
• Of 52 carbapenem-resistant isolates tested, 83% and 94% were susceptible to tigecycline and colistin/polymixin B, respectively
• As compared to patients with carbapenem-susceptible K. pneumoniae cultures, those with resistance were more likely to have had a transplant, mechanical ventilation, fecal incontinence, and exposure to meropenem, vancomycin, and metronidazole in the previous 30 days
  
• Knowledge of risk factors for carbapenem-resistant K. pneumoniae colonization and infection can help guide screening and infection prevention activities
  

Upcoming Events

National Institute for Animal Agriculture 2016 Antibiotics Symposium

• November 1-3, 2016 in Herndon, VA
• Learn more 

ComplianceIQ Webinar on Veterinary Pharmacy Laws and Regulations

• October 28, 2016
• Learn more

One Health Day

• November 3, 2016
• Learn more

Get Smart About Antibiotics Week

• November 14–20, 2016
• Learn more

SHEA Antimicrobial Stewardship Workshop

• November 29-30, 2016 in San Diego, CA
• Learn more

Quiz Answer!

Correct Answer: f. All of the above

Antibiotics can be detected in our state’s surface water. In 2013, surface water from 11 lakes and 4 streams was analyzed for pharmaceuticals, personal care products, and other micropollutants by MPCA. Stream samples were taken from above and below wastewater treatment plant effluent outfall locations. Several pharmaceuticals were frequently detected, including the anti-diabetic medicine metformin, numerous antibiotics, antidepressants, blood pressure medications, illicit drugs, lipid regulators, and the x-ray contrasting pharmaceutical iopamidol.

Erythromicin, ciprofloxacin, sulfachloropyridazine, and carbadox were detected in one or more of the 11 lakes tested. Sulfamethoxazole and erythromycin were detected in all stream locations downstream of wastewater treatment plants, while trimethoprim, clarithromycin, virginiamycin, sulfamethazine, tylosin, and ciprofloxacin were found in a subset of downstream locations. Virginiamycin, sulfamethoxazole, erythromycin, trimethoprim, moxifloxacin, sulfamethazine, and carbadox were found upstream as well. 

According to MPCA, contamination of lake water is often explained by or correlated with lakeshore development and accompanying septic drain fields, agricultural row cropping, stormwater runoff, or livestock operations. However, PMCA has found that even remote lakes in Minnesota contain a surprising variety of pharmaceuticals, similar to the profile of chemicals in lakes with shoreline residential development. The agency postulates that atmospheric transport of fine particulate matter, to which drugs or other chemicals can be attached, and its subsequent deposition in surface water, is a possible explanation for the widespread presence of some of these chemicals in lakes.

More information is needed to understand the fate of individual antibiotics in the environment, effect of antibiotics on the natural microbial community, and the role of municipal wastewater treatment in antibiotic resistance control. However, you can do your part to keep contaminants out of the environment by disposing of antibiotics and other leftover pharmaceuticals at an official disposal location!

Read the 2013 MPCA Report

Learn more about proper disposal of antibiotics from MPCA

Learn more about MDH's health-based guidance for water

Find a pharmaceutical take-back location near you!

 

 

Handy Links

Minnesota One Health Collaborative

CDC: Antimicrobial Resistance

CDDEP: Antibiotic Resistance

CIDRAP: Antimicrobial Stewardship

CDC: Antibiotic Stewardship

MPCA: Chemicals in Our Water

FDA: Antimicrobial Resistance

USDA: Antimicrobial Resistance

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