Minnesota Department of Health MN Antibiotic Stewardship Collaborative Update Bulletin

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

Drug-resistant Shigella is on the World Health Organization's list of priority pathogens and is listed as a "serious threat" in CDC's report, "Antibiotic Resistant Threats in the U.S." In Minnesota's 2015 state antibiogram, what susceptibility patterns are reported for Shigella spp.?

a. Susceptibility: 100% ciprofloxacin, 98% azithromycin, 56% TMP/SMX, 86% ampicillin
b. Susceptibility: 90% ciprofloxacin, 89% azithromycin, 92% TMP/SMX, 80% ampicillin
c. Susceptibility: 100% ciprofloxacin, 75% azithromycin, 40% TMP/SMX, 60% ampicillin
d. Susceptibility: 80% ciprofloxacin, 98% azithromycin, 75% TMP/SMX, 75% ampicillin

Update from Your Minnesota Stewardship Collaborative

Celebrate Get Smart About Antibiotics Week!

Governor Mark Dayton proclaimed Nov. 14-20 “Get Smart About Antibiotics Week” in Minnesota. The proclamation can be viewed at Governor Dayton Proclamations. The week coincides with CDC’s observance of Get Smart About Antibiotics Week, World Antibiotic Awareness Week, European Antibiotic Awareness Day, Canada Antibiotic Awareness Week, and other similar observances across the world.

Tune into the Global #AntibioticResistance Twitter Chat on Friday, November 18! CDC will participate during 10-12CST. Join in to see what is happening around the world to address antibiotic resistance. 

 

News to Note

CDC has issued guidance for antibiotic stewardship in outpatient settings. Core Elements Outpatient Stewardship

• The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment.

Publication describes survey of veterinary prescribing practices in Washington State. Read the abstract

• Veterinarians (n=203, 82% small animal) in Washington State answered questions about prescribing.
• 91% of respondents see antimicrobial resistance as an important public health issue.
• Cost was identified as major barrier to culture and sensitivity testing.
• Beta-lactams and fluoroquinolones were the most commonly used drug classes across all systems and syndromes, and beta-lactams were most prescribed overall.
• Amoxicillin-clavulanate, cephalexin, metronidazole, and enrofloxacin were the most commonly mentioned individual drugs.

Study quantifies association between poverty and antimicrobial resistance prevalence. Read more

• Researchers identified significant negative association between income per capita and prevalence of some resistant pathogens.
• Used country-specific gross national income data and data on resistance of E. coli, Klebsiella spp, and Staphylococcus aureus from the ResistanceMap database.
• These findings contribute to the growing body of evidence that resource-poor settings should be a focus for support and interventions around resistance and antibiotic use. 

CDC reports first cases of Candida auris in United States. Read more

• Thirteen cases of C. auris, a serious and sometimes fatal fungal infection that is emerging globally, have been identified in the United States.
• C. auris is often resistant to antifungal drugs and tends to occur in hospitalized patients.
• The challenge of emerging antibiotic resistant threats like C. auris highlights the need for urgent, coordinated federal, state, local, and international public health response.

Study shows that Indian wastewater treatment plant has low bacterial diversity, likely high resistance. Read more

• Bacterial diversity in a waste water treatment plant receiving antibiotic-containing waste was found to be much lower than that found in regular waste water treatment plants.

• Because high bacterial diversity is important for treatment processes, these findings have implications for understanding efficiency of the treatment process.

New York State held an interdisciplinary summit for Antimicrobial Resistance Prevention and Control. Read more

• Participants were from healthcare, agriculture, veterinary care, academia, community groups, and government of all levels.

Upcoming Events

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: a. Susceptibility: 100% ciprofloxacin, 98% azithromycin, 56% TMP/SMX, 86% ampicillin

Shigella spp. cause acute infection of the gastrointestinal tract, which is usually self-limiting. When treatment is needed for patients in the U.S., azithromycin or a fluoroquinolone, such as ciprofloxacin, are recommended for Shigella resistant to ampicillin and trimethoprim/sulfamethoxazole (TMP/SMX) or when susceptibility is unknown (Red Book, 2015). In Minnesota, Shigella spp. frequently display non-susceptibility to TMP/SMX and ampicillin. Luckily, resistance to ciprofloxacin and azithromycin is limited in Minnesota and the wider U.S. Globally, however, fluoroquinolone-resistant Shigella spp. are a serious problem.

In Minnesota, multi-drug resistant Shigella has been seen in limited instances, as described in this Notes from the Field, describing resistant infections in men who have sex with men.

Antibiograms are a tabular display of susceptibilities of selected pathogens important to a region, health care network, or facility. In Minnesota, many human and animal health entities generate their own antibiograms from diagnostic laboratory data to use in determining empiric treatment and following trends in pathogen susceptibilities over time. The statewide antibiogram of human pathogens is informed by antimicrobial susceptibilities of selected pathogens submitted to the MDH Public Health Laboratory. Not all bacterial isolates are submitted to the Public Health Laboratory, so when reading the antibiogram, it is important to read the notes that describe methodology used to build the table.

View the state antibiogram at MDH's website.

 

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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