Minnesota Department of Health MN Antibiotic Stewardship Collaborative Update Bulletin

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

CDC has identified fluconazole-resistant Candida, a cause of human fungal infections, as a serious threat. It is estimated that 7% of Candida bloodstream isolates are resistant to fluconazole.

A rise in invasive infections caused by which of the following Candida species has influenced the overall increase in rates of Candida fluconazole resistance?

a. Candida parapsilosis
b. Candida glabrata
c. Candida krusei
d. Candida dubliniensis 

Update from Your Minnesota Stewardship Collaborative

April 29 is National Prescription Drug Take-Back Day!

The U.S. Drug Enforcement Agency (DEA) has named Saturday, April 29, 2017 as National Prescription Drug Take-Back Day. Goals of the day are to provide safe, convenient, and responsible means of disposing prescription drugs and to educate the public about reducing the risk for medication abuse. See the Minnesota Pollution Control Agency website to find a take-back location and learn more about the importance of properly disposing of extra medications, including antibiotics. We can all help to prevent misuse of excess prescription medications and keep them out of our lakes and streams!

Gap Analysis Template for Acute Care Facilities Posted 

We have posted a gap analysis template that can be used by acute care hospitals for antibiotic stewardship program assessment. The template is structured based on the Joint Commission standard for antibiotic stewardship, effective on January 1, 2017. Find the template on the Human Health Resources Page, under the "Inpatient Facilities" heading. http://www.health.state.mn.us/onehealthabx/human.html

Honor Roll for Acute Care Antibiotic Stewardship Programs Coming Soon!

Details and materials for application will be available in May on the One Health Antibiotic Stewardship website and by email communication from state stewardship partners. Stay tuned!

News to Note

German Study Shows Higher Antibiotic Prescribing Among Urologists.

• A German study has shown that, as compared to a number of other specialties, urologists prescribed antibiotics more often and were equally likely to select broad-spectrum options for uncomplicated urinary tract infection.
• This study highlights the importance of understanding prescribing behaviors and stewardship knowledge within specific settings of care.
• There is a role for setting-specific promotion of prescribing best practices and antibiotic stewardship messaging.
• Read the abstract for this article in the International Nephrology and Urology journal.

New Article Describes Where to Start for Antibiotic Stewardship in the ICU.

• In the most recent edition of ICU Management and Practice, an intensivist describes why antibiotic stewardship is important in the intensive care unit (ICU) and provides suggestions on where to start.
• Read the article, titled "Antimicrobial Stewardship in the ICU".

Study Quantifies How Often MRSA Contaminates Gloves and Gowns of Nursing Home Health Care Staff. 

• Infection prevention and control is a key step in combatting antibiotic resistance, according to CDC.
• A new American Journal of Infection Control study describes how often gloves and gowns of health care workers are contaminated with MRSA after interacting with MRSA-colonized residents.
• The frequency of glove (7-37%) and gown (0-19%) contamination varied by type of patient contact, a finding which supports the use of risk-based precautions when working with residents colonized with important drug-resistant pathogens.
• Read the abstract on the American Journal of Infection Control website.

Society for Healthcare Epidemiology of America (SHEA) has Announced a “Race Against Resistance” Education Scholarship. 

• Healthcare providers new to antibiotic stewardship and interested in learning how to create, lead and research antibiotic stewardship concepts are encouraged to apply.
• Deadline is May 5, 2017. Learn more about this scholarship on the SHEA website.

Study Describes Antimicrobial Resistance Among Coagulase-Positive Staphylococcus in Australian Companion Animals.

• Researchers have described the antibiotic resistance profiles of clinical coagulase-positive Staphylococcus isolates (n=888) from cats, dogs, and horses across Australia during January 2013-January 2014.
• S. pseudointermedius (71%) and S. aureus (13%) were most commonly isolated, with methicillin resistance rates of 11.8% and 12.8%, respectively. 
• Methicillin resistance was frequently accompanied by fluoroquinolone and clindamycin resistance.
• Authors conclude that the proportion of coagulase-positive Staphylococcus displaying methicillin resistance is "moderate", but highlight the need for antibiotic stewardship, biosecurity, and infection control procedures in veterinary practice to prevent escalation of the problem.
• Read the open-access PlosOne article on Australian companion animal Staphylococcus here.

Upcoming Events

Come Learn About Antibiotic Resistance and Stewardship at the 2017 Minnesota State Fair!

• Members of the Minnesota One Health Antibiotic Stewardship Collaborative will be at the 2017 State Fair to discuss the problem of resistance, how antibiotic stewardship can make an impact, and how you play a role in addressing this important issue.
• Keep an eye out for more details!

Quiz Answer!

Correct Answer: b. C. glabrata

Invasive fungal infections are an important cause of patient illness and mortality and are a common problem in health care settings. The fungus Candida is the most common cause of healthcare-associated bloodstream infections in the United States. Of the 7% of Candida bloodstream infections that are resistant to the antifungal fluconazole, most are caused by C. glabrata. Of further concern, the rate of resistance to echinocandin antifungals is increasing among C. glabrata isolates. Echinocandins are frequently used to treat C. glabrata infections, which are often resistant to fluconazole.

Antibiotic use likely contributes to the problem of Candida infections, and antibiotic stewardship can be a part of the solution. How, you ask? CDC reports that antibiotics might reduce the bacterial population of the gastrointestinal tract, creating favorable conditions for Candida growth.

Read about the "serious" threat level of Candida in the CDC report, Antibiotic Resistance Threats in the U.S., 2013.

Read about antifungal resistance on CDC'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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