Stewardship / Resistance Scan for Dec 30, 2019

first_imgNew clindamycin-resistant C difficile strain identified in VA patientsA surveillance study of patients in a Veterans Administration (VA) long-term care facility and its affiliated acute care hospital detected the clonal outbreak of a newly recognized Clostridioides difficile strain, researchers reported yesterday in Emerging Infectious Diseases.The strain, which was detected in 15 patients at the Louis Stokes VA Hospital in Cleveland, was identified as restriction endonuclease analysis (REA) group DQ, ribotype (RT)591, and is closely related to the epidemic BI/RT027 strain associated with numerous healthcare facility outbreaks and an increasing number of illnesses and deaths. Whole-genome sequencing and multi-locus sequence typing (MLST) showed that the strains share several genetic and phenotypic characteristics and reside in the same clade (MLST 2), but form a separate cluster.Antimicrobials susceptibility testing of the DQ/RT591 isolates revealed high-level resistance to clindamycin and azithromycin. The seven C difficile infections caused by DQ/RT591 were healthcare associated, and all patients in whom DQ/RT591 was confirmed had received antibiotics within 90 days before testing. DQ/RT591 did not appear to carry the same level of severity that BI/RT027 has exhibited.”Because REA DQ/RT591 is closely related to BI/RT027, further monitoring is required to determine whether this strain carries increased risk for illness and death or has the capability of widespread dissemination,” the authors of the study write.Dec 29 Emerg Infect Dis study Study: Empiric fluoroquinolones effective against bloodstream infectionsA study conducted at a hospital in South Carolina has found that, in the absence of antibiotic resistance risk factors, empirical fluoroquinolones were as effective as broad-spectrum beta-lactams for treating gram-negative bloodstream infections (GN-BSIs), researchers reported late last week in the Journal of Global Antimicrobial Resistance.In the retrospective, 1:2 matched cohort study, researchers from the University of South Carolina examined clinical outcomes in adults without risk factors for antibiotic resistance who were hospitalized with GN-BSIs and treated empirically with either fluoroquinolones (74 patients) or broad-spectrum beta-lactams (148 patients). The primary outcomes studied were early treatment failure at 72 to 96 hours, 28-day mortality, and hospital length of stay.Early treatment failure rates were comparable in the fluoroquinolone and broad-spectrum beta-lactam groups (27% vs 30%, respectively; odds ratio, 0.82; 95% confidence interval [CI], 0.43 to 1.54; P = .53), as were 28-day mortality rates (8.9% vs 9.7%, respectively; hazard ratio [HR], 0.74; 95% CI, 0.26 to 1.90; P = 0.54). The median hospital length of stay was 6.1 days in the fluoroquinolone group and 7.1 days in the broad-spectrum beta-lactam group (HR, 0.73; 95% CI, 0.54 to 0.99; P = 0.04).Transition from intravenous to oral therapy also occurred earlier in the fluoroquinolone group (3.0 vs 4.9 days, P < 0.001). The researchers suggest the earlier transition to oral therapy for fluoroquinolone patients may be the reason for the shorter hospital stays. Dec 27 J Glob Antimicrob Resist abstractlast_img

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