antibiotics

Assessing the prevalence of MRSA and VRSA in Ethiopia

norvillephillip Uncategorized , , , , ,

I’ve written this post in preparation for this week’s Journal Club in partnership with the Healthcare Infection Society themed around their MRSA article collection: “‘MRSA The Enduring Foe”. Having spent a lot of time working on MRSA as part of my PhD and it regularly cropping up as an organism of concern in IPC I was interested to read about the author’s experience, particularly in a less economically developed country. 

Why I chose this article:

  • I agree with Jon from his blog last week that MRSA isn’t the foe that it once was, but it is still highly relevant and topical, especially from a global health perspective.
  • It’s less frequent to encounter vancomycin-resistant Staphylococcus aureus (VRSA) so I was interested in prevalence of VRSA.
  • I was interested to read about the prevalence of MRSA and VRSA in wound infections in a less economically developed country. 
  • MRSA has been reported at very high prevalence levels in Africa previously so I was interested if this study was comparable.

Design and methods:

  • The study was undertaken at Nekemte Specialized Hospital in Western Ethiopia. 
  • Over a six month period swabs were taken from patients presenting with wound infections and 384 wound swabs (from 384 patients) were taken. 
  • Wound swabs were plated onto chromogenic agar and antibiotic susceptibility to vancomycin and cefoxitin was assessed using disc diffusion.

Key findings:

  • The majority of wounds (63%) were deep wounds and 30.7% of study subjects had wound infections on their legs, followed by 20.6% on their feet and 16% on their hands. 
  • S. aureus was isolated from 28.4% of wounds.
  • 6.4% of S. aureus isolates were sensitive to all antibiotics tested. 
  • The prevalence of MRSA and VRSA among the isolates was 40.4% and 7.3% respectively.
  • From a total of 44 MRSA isolates, 72.7% of them showed multidrug resistance.
  • MRSA resistance against other antibiotics was also shown in the present for ciprofloxacin (45.5%), cotrimoxazole (40.9%), gentamicin (36.4%), chloramphenicol (34%), clindamycin (25%), erythromycin (15.9%), and vancomycin (9.1%).
  • Age, sex, educational level, and marital status were not predictors for the prevalence of MRSA.
  • The depth of the wound, history of wound infection, and history of antibiotic use in the last 6 months was significantly associated with the prevalence of MRSA. 

Points for discussion:

  • The prevalence of S. aureus wound infection is consistent when compared to similar geographical regions but lower than the pooled national prevalence estimate. The rates of S. aureus wound infection reported in this study seem to be quite comparable with UK data.
  • The high prevalence of multidrug resistance in the MRSA isolates is concerning! 
  • What is the correct method to detect VRSA? Disc diffusion is not recommended by CDC.  
  • What are the treatment options given the resistance to multiple antibiotics observed in the MRSA isolates?  
  • What are the best options for decolonisation of S. aureus prior to surgery given the incidence of study participants who developed wound infections following surgery. 
  • Some of the prevalence rates of MRSA referenced in this study were truly staggering! 86% of all S.aureus isolate were MRSA in this study from Nigeria! 
  • The prevalence of VRSA (7.3%)  was significantly higher than other studies.  
  • What do these results mean in the context of the antimicrobial resistance (AMR) pandemic? 

What this means for IPC

  • Depth of the wound, the patient’s setting, previous wound infections, and antibiotic treatment in the previous six months were significantly associated with MRSA wound infection so should be considered as risk factors.
  • Prevention is better than cure, given the limited treatment options when resistance to multiple antibiotics is reported. 

Finally, I hope you can join us for Journal Club Wednesday (register here).

AMR strategy in the UK: IPC is high on the agenda (hooray)

Jon Otter (@jonotter) antimicrobial resistance , , , , , ,

The Department of Health have published a new 5 year National Action Plan to combat AMR (2019-2024) to follow on from the 2013-2018 edition. IPC and antimicrobial stewardship are high on the agenda – but we have a long way to go if we are to fulfil the 20 year vision for AMR: ‘By 2040, our vision is of a world in which antimicrobial resistance is effectively contained, controlled and mitigated.’

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A Reflection from HIS 2018: What is the main driver for C. difficile infection? Antibiotics or C. difficile acquisition?

Jon Otter (@jonotter) C. difficile , , , , ,

I made a flying visit to HIS today in Liverpool to have a debate with Prof Mark Wilcox on whether or not antibiotics are the most important factor in healthcare-associated C. difficile infection. Mark was arguing for the motion, and I was arguing against it. And the result…well you’ll have to read to the bottom!

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Reflecting on the ESPAUR 2018 report

Jon Otter (@jonotter) Antibiotic resistance , , , ,

The 2018 ESPAUR report was published a few weeks ago. It’s freely available for your perusal here, and packed full of juicy info. Here’s a few reflections on the report.

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Going for GNBSI

Jon Otter (@jonotter) GNBSI , , , , , , , ,

We’ll be publishing the results of the vote on whether or not we can halve HA-GNBSI by 2021 later this week. Right now, it looks like Martin is heading for a comfortable, if somewhat depressing victory (“No, we can’t halve GNBSI by 2021”) but there’s still time to ride a wave of positivity and vote with me that “Yes, we can halve GNBSI by 2021”. So, I thought that now would be an appropriate time to review the recent JHI paper that both Martin and I referred to, providing some enhanced epidemiological data on E. coli BSIs in England.

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The English C. difficile miracle: is it all about fluoroquinolones?

Jon Otter (@jonotter) C. difficile , , , , ,

A new Lancet ID study suggests that restriction of fluoroquinolone usage has been the main driver of the national reduction in C. difficile infection in England. This paper is challenging in terms of some of the accepted approaches to controlling the transmission of C. difficile: if it’s all about reducing fluoroquinolones (and antimicrobials in general) and nothing to do with these measures, then why invest so much time and energy in isolation of symptomatic cases, cleaning and disinfection etc?

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Chased by an antibiotic-induced C difficile-shaped shadow

Jon Otter (@jonotter) Antibiotic resistance, C. difficile , , , , ,

shadow-abx

A fascinating new JAMA Internal Medicine study suggests that being admitted to a room when the prior occupant had taken antibiotics increases the risk of the subsequent occupant of the same room developing C. difficile infection (CDI). Quite a few convincing epi studies have showed that admission to a room when the prior occupant was known to have a number of key pathogens (including C. difficile) increased the chance of acquisition for the subsequent occupant. But this study extends the ‘prior room occupancy’ concept into a new dimension!

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Antimicrobials, anti-infectives or antibiotics?

Jon Otter (@jonotter) Antibiotic resistance , , , , , ,

antimicrobial terminology

I am currently reading ‘The Drugs Don’t Work’ by Professor Dame Sally Davies, Dr Jonathan Grant and Professor Mike Catchpole (yes, I know I’m several years late to this particular party). I might do a book review for the blog once I’ve finished it – but an interesting question emerged in the early chapters. The author seem to make a point of referring to ‘antimicrobials’ rather than ‘antibiotics’ in the early part of the book, but later on, antibiotics appears as a common term. Which got me to thinking about what is the most appropriate generic term for what most people would term ‘antibiotics’ (what your GP gives you when you’ve got a snuffle, I mean potentially serious bacterial infection)?

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Poultry production and antimicrobial resistance in India

Andreas Voss (@AVIPNL) Antibiotic resistance , ,

Schermafbeelding 2016-03-31 om 00.46.37

Take a look at these three stories on intensive poultry production and antimicrobial resistance in India published yesterday on the Bloomberg website. In accordance with what the movie industry does, these articles should be accompanied by a warning: “These articles contains scenes that some readers may find disturbing”. As the editor of the articles said in an email to colleagues that forwarded it to me: “I think you’ll agree that these are important stories and deserve attention (and hopefully a response from the appropriate authorities and the community).” Obviously, I do agree.

http://www.bloomberg.com/news/features/2016-03-29/antibiotic-apocalypse-fear-stoked-by-india-s-drugged-chickens

http://www.bloomberg.com/news/articles/2016-03-29/hen-s-eye-view-of-drug-use-in-the-fastest-growing-chicken-market

http://www.bloomberg.com/news/articles/2016-03-29/baby-s-death-shows-global-threat-from-wonder-drug-s-demise

Antibiotic surgical prophylaxis: stewardship’s ‘elephant in the room’?

Jon Otter (@jonotter) Antibiotic resistance , ,

Doxycycline_100mg_capsules

We are all pretty comfortable with the idea that we have used too many antibiotics in the past and now we are reaping the consequences. I think we are also all in agreement that we need to start using antibiotics much more rationally – and keep the big guns firmly on the top shelf, double-wrapped in password-protected packaging that you can only access with a fingerprint and retinal scan (whilst acknowledging that they will still somehow be prescribed by a junior doctor at 3am for a sniffle). But I get the feeling that we all have a bit of a blind spot (or soft spot) for surgical prophylaxis. Here, the situation is different, surely, because the consequence of an SSI is so great that the likely ‘cost’ of widespread surgical prophylaxis is outweighed by the gain of fewer SSIs? But has this become stewardship’s elephant in the room? We are comfortable talking about restricting carbapenem use in acute hospitals, but I don’t hear as much discussion about stopping the use of antibiotics for surgical prophylaxis! On one level, isn’t this is the same arguments as for ‘selective’ digestive or oral decontamination (SDD / SOD) in the ICU? Here, the argument in factor of SDD / SOD is compelling: fewer deaths and less spread of resistant bacteria. But indiscriminate use of antibiotics, which is bound to fuel antibiotic resistance in the long run, just cannot be a good idea, particularly in the high-risk ICU population.

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