CLSI and APHL to Co-Host 12th Annual AST Update Webinars

From the press release:

The Clinical and Laboratory Standards Institute (CLSI) and the Association of Public Health Laboratories (APHL) will co-host the 12th annual educational update webinars for antimicrobial susceptibility testing (AST).

Each January, CLSI updates standards for AST. It is important for clinical laboratories to incorporate the new recommendations into routine practice to optimize detection and reporting of antimicrobial resistance. In January 2015, the annual update of the M100 AST tables (CLSI document M100-S25) was published. In addition, the standards that describe performance of disk diffusion and minimal inhibitory concentration tests in versions M02-A12 and M07-A10, respectively, were updated. Some highlights for 2015 include introduction of the Carba NP test for carbapenemases and expanded recommendations for quality control testing.
These changes and several other new recommendations found in M100-S25, M02-A12, and M07-A10 will be discussed during the webinar. In addition to the webinar, an optional postprogram self-assessment will be provided that will allow individuals to assess their knowledge regarding the most important AST and reporting issues for 2015. Laboratories can use this feature to augment competency assessment requirements for their staff.
The webinar will be led by Janet A. Hindler, MCLS, MT(ASCP), Senior Specialist, Clinical Microbiology, at the UCLA Health System in Los Angeles, California, USA.
Webinar information is as follows:
CLSI 2015 AST Update
February 4, 2015 • 1:00–2:30 PM Eastern (US) Time
February 5, 2015 • 3:00–4:30 PM Eastern (US) Time (repeat session)
Learner Level: This intermediate-level program is appropriate for laboratory professionals working in clinical and academic settings.
At the conclusion of this program, participants will be able to:
    • Identify the major changes found in the new CLSI document M100-S25.
    • Design a strategy for implementing the new practice guidelines into their laboratory practices.
    • Develop a communication strategy for informing clinical staff of significant AST and reporting changes.

Register for the upcoming webinars at www.aphl.org/clsi.

Go Outside And Play in the Dirt

Researchers may have made some headway in the fight against antimicrobial resistance. A paper published online in Nature today (abstract only unless you’re a subscriber) discusses a new method to grow bacteria that have previously been uncultivable. In doing so, researchers have discovered a new antibiotic they’re calling teixobactin that is active against gram-positive organisms (specifically, a precursor of peptidoglycan present in the cell wall). Initial tests suggest bacteria can’t form a resistance to this mode of action.

Maybe there’s something to the expression “throw some dirt on it and get back in the game” after all.

NPR and the Washington Post discuss this paper and its findings today, as well. It’s too soon to be excited, but I admit I’m cautiously optimistic.

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

The Future Cost of Antimicrobial Resistance

Over on Superbug, Maryn McKenna (are you following her yet? No? If you’re into infectious disease, you should) discusses a recent report on the global ramifications of antimicrobial resistance. In it, the authors project by 2050, 10 million deaths a year will be attributed to infections caused by six resistant organisms. (Those are: Klebsiella pneumoniae, E. coli, MRSA; HIV, TB and malaria.) These deaths will cause an estimated loss of 100 trillion dollars of lost gross national product.

So what can laboratory professionals and pathologists do to help stop these predictions from coming true? For starters:

  • Advocate for and implement antibiotic stewardship programs.
  • Educate the public about proper antibiotic use.
  • Practice good laboratory safety practices.

What else can labs, microbiologists, and pathologists do to stem the tide of antibiotic resistance?

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

New National Strategy for Antibiotic Resistance

Last week, the White House published a National Strategy for Combating Antibiotic Resistant Bacteria and President Obama signed an executive order that orders the implementation of the strategy. The report covers a lot of information, but two goals stuck out as being especially pertinent for laboratory professionals.

By 2020:

  • 95 percent of hospitals report data on their antibiotic use to the CDC
  • create regional laboratory networks for testing resistant bacteria and make the data publicly, electronically, available.

Both of these goals require the cooperation of clinical laboratories including (but certainly not limited to)  infrastructure upgrades, data collection, and procedural changes. In an era when laboratories have less resources than ever before, will this stretch microbiology departments too far? Based on available resources, are these goals attainable?

If you’d like a comprehensive overview of the government’s strategy, check out Maryn McKenna’s excellent post on Wired’s Superbug blog.

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

Antibiotic Stewardship

The draft of the federal budget released Tuesday allocates $30 million dollars in CDC funding in order to combat antibiotic resistance. Obviously the 2015 budget isn’t finalized, but even so, it’s encouraging that the Department of Health and Human Services recognizes the need for antibiotic stewardship.

What is antibiotic stewardship, you ask? Basically, it’s a program within a healthcare community that dictates the best practices for prescribing antibiotics. Such programs would be tailored for each setting based on population demographics and antibiograms. Perhaps a program would prohibit prescribing, say, ciprofloxacin for urinary tract infections because a rise in the percentage of strains of E. coli resistant to fluoroquinolones has been noted. Maybe the program would discourage prescribing more than two antibiotics at once to a patient, or suggest antibiotics other than vancomycin (such as levoquin) when treating MRSA.

Creating a stewardship program requires input from several departments (Infectious Disease, Pharmacy, Epidemiology, and the Microbiology Laboratory) as well as acceptance by the clinician population at large. In my experience, this has been the limiting factor. Physicians don’t like being told what they can and can’t do for their patients or the insinuation that they might lack the proper knowledge about antimicrobials and microbiology to provide good patient care. This is a hurdle that hospitals will have to overcome in order to make stewardship programs a success. (Mentioning that such programs can save money and shorten hospital stays could help tip the scales.)

If you’d like to institute a stewardship program at your institution, here are a few links to get you started:

CDC’s Vital Signs about prescribing practices
Antibiotic management guidelines at John Hopkins
Professional practice resources from the Association for Professionals in Infection Control and Epidemiology
The ever-insightful Maryn McKenna over at Superbug discusses the topic at length

Does your institution have an antibiotic stewardship program? If so, what steps did you have to take in order to implement it?

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.

To Test or Not to Test

Recently the editors of Lab Medicine received a request for information regarding referral of sensitivities from one site to another or to the same site within three days. Here are a few examples of what I mean so we’re all on the same page:

  1. A pan-sensitive Staphylococcus aureus is recovered from a left ankle wound on 1/28; the same organism is recovered from the same site on 1/31.
  2. An E. coli with a typical susceptibility pattern is recovered from a right knee incision on 2/3; the same organism is recovered from the right ankle on the same date.

Referring sensitivities can streamline processes; thereby saving time and money (for the lab as well as the patient). According to the CLSI guideline M100-S23 (January 2013), Enterobacter, Citrobacter, and Serratia may develop resistance within three to four days of treatment with third-generation cephalosporin; Staphylococcus spp. may develop resistance to during prolonged therapy with quinolones. Since resistance can develop over the course of the same disease occurrence, it’s advisable to retest the susceptibility after three days so therapy can be adjusted if needed.

As for referring one site to another—such a left ankle to a left knee—I couldn’t find any source that advocated this practice. However, I am aware of facilities that have implemented such policies. What policies does your microbiology department follow when referring one sensitivity result to another?

 

Swails

Kelly Swails, MT(ASCP), is a laboratory professional, recovering microbiologist, and web editor for Lab Medicine.