Antimicrobial Stewardship Down Under

If you’re an infectious disease/antimicrobial stewardship/microbiology geek, then the Australian blog AIMED is relevant to your interests. AIMED focuses on practical antimicrobial prescribing issues of relevance to hospital and community prescribers. It is supported by a local brains trust of General Practitioners, Pharmacologists, Pharmacists, Microbiologists and Infectious Disease Physicians. It also provides internet access to key Hunter New England resources for medical staff including guides to local antibiograms, infection control resources and personnel.

For those who don’t know, AIMED is an acronym for five principles that guide patient treatment with antimicrobials:

  • Antimicrobial selection and dosage
  • Indication for antimicrobial treatment
  • Microbiological assessment
  • Evaluate patient at 48-72 hours
  • Duration should be specified

If you’d like to learn more, check out their blog.

CMS Proposes Rule that Promotes Antibiotic Stewardship

In mid-June, CMS proposed a rule that, in part, will help promote antimicrobial stewardship in hospitals. The 60-day comment period is nearing its end, so if you have thoughts on this proposed rule, let them know.

CMS press release

 

Potential Antimicrobial Therapy Hiding in Plain Sight

Yesterday, Nature published a paper that might help in the fight against MRSA. In a nutshell, German researchers discovered that Staphylococcus lugdunensis–a common bacteria in commensal flora–produces a compound that reduces colonization with MRSA.

From the abstract:

“Notably, human nasal colonization by S. lugdunensis was associated with a significantly reduced S. aureus carriage rate, suggesting that lugdunin or lugdunin-producing commensal bacteria could be valuable for preventing staphylococcal infections.”

 

Carbapenem-Resistant Enterobacteriaceae Found in Rio de Janeiro’s Water

Recent studies conducted by Brazilian researchers found “super bacteria” in the waters where Olympic athletes will be competing. According to MercoPress, “The Brazilian group’s lead researcher, Renata Picao, said Rio’s “super bacteria” made its way into the city’s waterways through sewage from local hospitals, due to a lack of basic sanitation in the metropolitan area.”

A recent Lab Medicine podcast discusses laboratory testing for CRE. You can listen to it here.

Maryn McKenna writes extensively about antimicrobial resistance. You can watch to her recent TED talk (or read the transcript) to learn why the presence of CRE in Rio’s water is so concerning.

The World’s Most Ambitious Superbug

Researchers from the Walter Reed National Military Medical Center in Maryland discovered a strain of E. coli that carried 15 different genes that confer antibiotic resistance, including the resistance factor MCR, which confers resistance to colistin, a drug of last resort.

This particular E. coli was recovered from the urine of a 49-year-old woman.

The paper is currently available as an accepted manuscript posted online.

You can read Maryn McKenna’s report here.

 

Antimicrobial Testing–Are We Doing it Wrong?

Antibiotic resistance is a huge concern for microbiologists. In addition to stewardship programs and regulating agricultural use of antibiotics, is it time to re-examine clinical testing paradigms?

A recent study suggests that the typical way microbiologists test for antibiotic susceptibility–meuller-hinton plates and antibiotic disks–might be fallible. When his team tested Salmonella against polymyxin using typical methods, the organism tested sensitive; when the tested the same organism against the same antibiotic using medium that more closely resembled human cells, the organism tested resistant.

Bloomberg Business discusses the paper here. The article is worth your time, even if the info-graphic gives erroneous information (it mentions meuller-hinton broth instead of meuller-hinton agar plates).

Using Evolution to Thwart Resistance

The very act of using antibiotics contributes to antibiotic resistance. Bacteria are exposed to an antimicrobial agent and develop genetic strategies to survive repeated exposures. But what if using antibiotics in a certain sequence could revert resistant strains to the wild type? Researchers from California and Washington DC tested that theory and discovered some promising results.

You can read the PLOS ONE study and the Scientific American article to learn more.