Minnesota Department of Health MN Antibiotic Stewardship Collaborative Update Bulletin

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

Some strains of Pseudomonas aeruginosa are resistant to all, or nearly all, antibiotics including aminoglycosides, cephalosporins, fluoroquinolones, and carbapenems. CDC conducts surveillance for multi-drug resistant P. aeruginosa infections acquired in health care settings.

What percent of healthcare-associated P. aeruginosa infections reported to CDC in 2014 were multi-drug resistant?

a. 20.4%
b. 3.8%
c. 46.2%
d. 13.5%

Update from Your Minnesota Stewardship Collaborative

Minnesota Antibiotic Stewardship Honor Roll for Hospitals Now Open for Applications!

In collaboration with Minnesota Hospital Association, Stratis Health, APIC Minnesota, and the Minnesota Collaborative Healthcare-Associated Infection Network, the Antibiotic Stewardship Collaborative is pleased to introduce the Minnesota Antibiotic Stewardship Honor Roll for Hospitals! Objectives for this honor roll are to: encourage hospital commitment to antibiotic stewardship, share stewardship activities happening across the state, provide incentive for program improvement, and publicize the importance of antibiotic responsibility.

Visit the Minnesota Antibiotic Stewardship Honor Roll website for more information and to apply for this three-tiered recognition program.  

Lights, Camera, Action for Antibiotics Video Contest

The Minnesota Department of Health invites Minnesota high schools and youth programs to help increase antibiotic awareness through the Lights, Camera, Action for Antibiotics Video Contest. Students will produce a 30-second video to spread the word about antibiotic resistance and good antibiotic use in human health care. Individual students, teachers, or schools can sign up to participate today!

Visit the video contest website for more details.

July Marks One Year of Minnesota One Health Antibiotic Stewardship Collaborative Activity

A summary of the Minnesota One Health Antibiotic Stewardship Collaborative's Year One successes and next steps was shared with the Commissioners of Agriculture, Health, Pollution Control Agency, and the Board of Animal Health's Executive Director. We are grateful for the ongoing support of these key state agencies, as well as for the dedication of our other state, university, clinical, and industry partners who have made the work of the Collaborative possible this year. A Year One summary document will be posted on the website’s Plan and Data page. 

News to Note

Pew Report Describes How Behavioral Science Strategies Can Help Improve Antibiotic Prescribing Habits.

• This Pew Charitable Trusts report suggests that professionals looking to move the needle on outpatient antibiotic stewardship must consider multiple factors that influence the decision to prescribe.
• When considering an antibiotic prescription in outpatient practice, patient satisfaction and relationships, time constraints, diagnostic uncertainty, and the organizational challenges of the outpatient setting all are influential in the decision.
• The report also includes some potential strategies to incorporate these known behavioral hurdles. 
• Read the full Pew report.

New Meta-Analysis Shows the Impact of Antibiotic Stewardship Programs on Infections and Colonization.

• A review and meta-analysis published in Lancet Infectious Disease provides new evidence that antibiotic stewardship works to decrease infections and colonization caused by antibiotic-resistant bacteria and Clostridium difficile infection in hospitals.
• Read the CIDRAP article summary and find a link to the abstract.

New Colistin Resistance Gene, mcr-3,  Identified, Published in mBio.

• A third mobile colistin resistance gene, mcr-3, has been identified in a swine fecal specimen in China, adding to the international attention and that has followed detection of mcr-1 and mcr-2 and several variants.
• Read the full mBio publication here.

International Society for Companion Animal Infectious Disease (ISCAID) Releases New Practice Guidelines for Respiratory Disease. 

• ISCAID adds Antimicrobial use Guidelines for Treatment of Respiratory Tract Disease in Dogs and Cats to their portfolio of treatment guidelines, which includes antimicrobial use guidelines for urinary disease and canine superficial bacterial folliculitis.
• Read the full respiratory tract disease guideline article here.
• Find all ISCAID guidelines on their website.

Banfield Pet Hospital Report on Companion Animal Antimicrobial Use Available. 

• Banfield Pet Hospital has released a report titled, Are We Doing Our Part to Prevent Superbugs? Antimicrobial Usage Patterns Among Companion Animal Veterinarians.
• Key among the findings is that adherence to recommended first-line treatments for common conditions can be improved considerably, especially for canine bronchitis, for which only 24.7% of episodes were treated with a guideline-concordant antimicrobial.
• Read more and download the report on the Banfield website.

Pew Charitable Trusts Authors Two New Reports on Antibiotic Use in Animal Agriculture.

• Pew's systematic evaluation of the scientific evidence linking antibiotic use in animal agriculture to human health reinforces that, despite a need for more research, measurement of actual antibiotic use on farms, and quantification of risk, antibiotic stewardship is essential in food animal production, using antibiotics only when needed to preserve animal health. Read the full publication in BMC Veterinary Research here.
• An online report from Pew discusses the role of antibiotic alternatives in animal agriculture. Read the report on Pew's website.

Upcoming Events

Engage with the Minnesota Antibiotic Stewardship Collaborative 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.
• Thanks to our hosts, Minnesota Pollution Control Agency, we will be in the always-popular Eco Experience Building!

CHAIN 2017 Fall Conference

• The Minnesota Collaborative Healthcare-Associated Infection Network (CHAIN) 2017 Fall Conference will be held on Wednesday, September 27, from 1:00-4:30PM at the Earle Brown Heritage Center in Brooklyn Center. 
• Learn about the latest evidence-based approaches for reducing and preventing healthcare-associated infections (HAIs) in Minnesota.
• Winners of the CHAIN Award for Excellence will be recognized at the conference. Nominations for this award are now being accepted. Find more information on the Award for Excellence on the CHAIN website.

APIC Minnesota 2017 Fall Conference

• September 28-29, 2017 at the Earle Brown Heritage Center in Brooklyn Center.
• Minnesota Association for Professionals in Infection Control and Epidemiology (APIC) Fall Conference website

Quiz Answer!

Correct Answer: d. 13.5%

Pseudomonas aeruginosa has natural resistance to multiple antibiotics, including penicillins, first and second generation cephalosporins, chloramphenicol, and tetracycline. Multi-drug resistant P. aeruginosa are resistant to an antibiotic in at least three of the following drug classes: fluoroquinolones, extended-spectrum cephalosporins, aminoglycosides, carbapenems, and piperacillin. The bacteria can also form a biofilm, making infections difficult to treat. The Centers for Disease Control and Prevention (CDC) estimates that 51,000 healthcare-associated P. aeruginosa infections occur in the United States each year, and more than 6,000 (13%) of these are multidrug-resistant. Approximately 400 deaths per year are attributed to these infections.

Did you know that, since July 1, 2016, all carbapenem-resistant P. aeruginosa (CRPA) has been reportable for residents of Hennepin and Ramsey Counties? In the first year of surveillance, Minnesota Department of Health received 460 reports of CRPA, associated with 239 unique patients. In two patients, there was a carbapenemase (NDM, n=1 and VIM, n=1) identified. Monitoring for carbapenemases is important, given the ability of carbapenemase-associated resistance to be transmissible among bacteria and patients. 

Multi-drug resistant P. aeruginosa is also a problem in clinical veterinary medicine, but there is limited scientific literature exploring the patterns or trends of resistant P. aeruginosa infections in the United States. A 2008 publication (Rubin J et al. Vet Micro 2008;131(1):164-72) reported that P. aeruginosa isolates from canine infections have variable resistance patterns, making antibiotic sensitivity testing an important part of treatment. All isolates demonstrated both intrinsic (natural) resistance and resistance to antibiotics commonly used in veterinary medicine. Two isolates demonstrated resistance to carbapenems, antibiotics not commonly used in veterinary medicine. Authors concluded that there might not be sufficient approved veterinary drugs with anti-Pseudomonas activity. More current research or summary reports are needed to understand P. aeruginosa resistance trends in the veterinary setting.

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

Use the CDC Patient Safety Atlas to explore healthcare-associated infections in the United States.

Read about Minnesota Department of Health's CRPA reporting requirements.

 

 

Handy Links

Minnesota One Health Antibiotic Stewardship 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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