MN Antibiotic Stewardship Collaborative Update Bulletin

Minnesota Department of Health sent this bulletin at 10/27/2017 07:56 AM CDT
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Updates and News from the Minnesota One Health Antibiotic Stewardship Collaborative

November 27, 2017

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Stewardship quiz? You betcha!

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Methicillin-resistant Staphylococcus aureus (MRSA) is a challenging source of healthcare and community-associated infections in humans. Which of the following presents a growing problem in companion animal medicine, which specializes in treating dogs and cats?

 

a. Methicillin-resistant S. aureus (MRSA)

b. Methicillin-resistant S. pseudointermedius (MRSP)

c. Ciprofloxacin-resistant Salmonella

d. Vancomycin-resistant S. aureus (VRSA)

 

The answer is at the bottom of this newsletter.

Update from Your Minnesota Stewardship Collaborative

New Resources Posted on the One Health Antibiotic Stewardship Website!

Policy Writing Support for Nursing Homes

Pharmaceutical Disposal Regulations, Practices and Challenges Webinar

  • Learn about pharmaceutical disposal in Minnesota from experts at Pollution Control Agency and Board of Pharmacy. Listen to the webinar.

Webinar Series: Antibiotic Stewardship in Long-Term Care

  • View a five-part weekly series on antibiotic stewardship in long-term care, October 4–November 1. View archived webinars days after the live session.

New Fact Sheets in Fact Sheet Series

Minnesota Antibiotic Stewardship Honor Roll for Hospitals

  • Keep an eye out in early November for the inaugural list of honorees!
  • Apply anytime. Annually renewable. New hospitals will be added quarterly.
  • 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.

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News to Note

AMA Journal of Ethics Asks, “Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?”

American Association of Bovine Practitioners Releases Antimicrobial Stewardship Guidelines

JAMA Letter: Peer Benchmarking Helps Primary Care Physicians Maintain Appropriate Prescribing Practices

  • In the 12 months following a randomized study of appropriate antibiotic prescribing in primary care practices, physicians whose study intervention had been peer-to-peer comparison of prescribing practices were observed to maintain lower rates of inappropriate prescribing than a control group.
  • Other study interventions (suggested antibiotic alternatives and inclusion of prescribing justification) did not result in post-study rates significantly different from the control group.

Macrolide Prescribing an Important Target for Antibiotic Stewardship

  • A new publication in Open Forum Infectious Diseases describes macrolide use in outpatient settings during 2008–2011.
  • Co-authors analyzed diagnosis and prescribing data from the National Ambulatory Medical Care Survey, finding that conditions for which macrolides are first-line therapy only accounted for 5% of macrolide prescribing.
  • Diagnoses most commonly associated with macrolide prescriptions were sinusitis (18% of visits), bronchitis/bronchiolitis (14%), viral upper respiratory infection (11%), and pharyngitis (11%), for which macrolides are not recommended first-line therapy.
  • Prescribing varied by specialty, with family practitioners selecting macrolides for children more frequently than pediatricians.

Community-Acquired Clostridium difficile and Antibiotic Prescribing for Dental Procedures

  • In a 2017 IDWeek abstract, Minnesota Department of Health reports that 926/1,626 (57%) people with community-associated C. difficile infection during 2009–2015 reported taking a course of antibiotics prior to illness.
  • 136 (15%) of patients received the prescription for a dental procedure.
  • In 34% of cases, the dental antibiotics were not recorded in primary medical records, highlighting a gap in information sharing across care settings.
  • Dentists are partners in antibiotic stewardship and should be included in efforts to improve prescribing. Minnesota’s Dental Association, Board of Dentistry and One Health Antibiotic Stewardship Collaborative have joined to develop an antibiotic sheet for dental professionals. 

Cochrane Systematic Review Describes Safety of Procalcitonin-Guided Antibiotic Treatment

  • Procalcitonin, a blood marker associated with bacterial infection, is used as a clinical tool to support initiation and de-escalation of antibiotic therapy.
  • Results of a Cochrane meta-analysis show that 30-day mortality and duration of antibiotic therapy were significantly lower among patients receiving procalcitonin-guided therapy than among control patients.
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Upcoming Events

Drug Take-Back Day is October 28, 2017!

  • Learn where you can dispose of your leftover pharmaceuticals on FDA’s website.

U.S. Antibiotic Awareness Week is November 13–19!

  • Learn about the event and how you can promote antibiotic stewardship on CDC’s website.

AHRQ Safety Program for Improving Antibiotic Use to begin in December

  • Hospital registration is open. Interested hospitals can listen to an informational webinar on November 9.

CE from Society of Infectious Diseases Pharmacists

  • Society of Infectious Diseases Pharmacists (SIDP) and American Society of Consultant Pharmacists are offering a Long-Term Care (LTC) Antimicrobial Stewardship Certificate Program.
  • Learn more about the program on the SIDP website.

Quiz Answer!

b. Methicillin-resistant S. pseudointermedius (MRSP)

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Methicillin-resistant Staphylococcus aureus (MRSA) is of great concern to human health, with serious infections originating in the community and in healthcare settings. MRSA has also been identified in diagnostic specimens from dogs and cats (“companion animals”), but it is not a frequent cause of clinical infection. In fact, MRSA found on our companion animals might actually be transferred from humans carrying the bacteria (Morris 2006). A growing clinical problem in companion animal veterinary medicine is Methicillin-resistant Staphylococcus pseudointermedius (MRSP; Lloyd 2012). S. pseudointermedius is a major cause of canine pyoderma, and risk factors for canine MRSP colonization include hospitalization and antibiotic treatment (Nienhoff 2011). In one UK laboratory study, MRSP made up 14% of coagulase-positive canine staphylococci isolates (Steen 2010). A recent Canadian study of S. pseudointermedius in dogs found that 78/100 were colonized, and that the frequency of colonization with pan-susceptible isolates decreased from 46% to 30% of colonized dogs. (Priyantha 2016). Resistance was highest to penicillin, ampicillin, tetracycline, oxacillin, erythromycin, clindamycin, and trimethoprim-sulfamethoxazole. Multidrug resistance (resistance to three or more drug classes) was found in 15/221 (6.8%) S. pseudointermedius isolates.

Find a link to clinical practice guidelines, including Guidelines for the Diagnosis and Antimicrobial Therapy of Canine Superficial Bacterial Folliculitis on the Minnesota One Health Antibiotic Stewardship Companion Animal Resources page. 

Learn about what companion animal veterinarians can do on AVMA’s “Antimicrobial Use in Companion Animal Practice” webpage. 

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 References

Lloyd et al. Multi-resistant Staphylococcus pseudintermedius: a wake-up call in our approach to bacterial infection. Jrnl Small Animal Pract. 2012; 53: 145-146

Morris et al. Screening of Staphylococcus aureus, Staphylococcus intermedius, and Staphylococcus schleiferi isolates obtained from small companion animals for antimicrobial resistance: a retrospective review of 749 isolates (2003-04). Vet Derm. 2006; 17: 332-337.

Nienhoff et al. Meticillin-resistant Staphylococcus pseudintermedius among dogs admitted to a small animal hospital. Vet Micro. 2011; 150: 191-197.

Priyatha et al. Antimicrobial susceptibility of Staphylococcus pseudintermedius colonizing healthy dogs in Saskatoon, Canada. Can Vet J. 2016 Jan; 57(1): 65–69.

Steen. Differing patterns of antimicrobial sensitivity amongst meticillin-resistant coagulase positive Staphylococcus isolated from canines. Proceedings of the British Veterinary Dermatology Study Group Spring Meeting, 2010.

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