By Bojana Beovic
ASM Microbe 2016 is plenty of sessions on Antimicrobial Stewardship. Lucky you a team of ESGAP member is live reporting on them!!. This piece deals with Saturday afternoon symposium on success stories in antimicrobial stewardship, which included five very different but at the same time very relevant topics in antimicrobial stewardship in various settings.
– Benedikt Huttner, our ESGAP colleague from Switzerland, covered the primary care and focused primarily on public campaigns world-wide. The impact of interventions varies from statistically significant albeit not major changes to no effect. Most of effective public campaigns were done in the high income countries, much less is known about the campaigns and their efficacy in other parts of the world. There are several problems related to public campaigns, one of the most important ones is the message which may not always be directed towards lesser use of antibiotics. The discussion revealed also the problem of funding and potential worse efficacy of under-funded campaigns.
– Jeffrey Lipman from Australia focused on successful interventions in ICU and stressed the importance of dosing. Higher creatinine clearances seen in some studies in more than one half of ICU patient population lead to low levels of drugs, poor efficacy and development of resistance, especially if coupled with prolonged antibiotic courses. In ICU patients, therapeutic drug monitoring should be available not only for aminoglycosides and glycopeptides but also for beta-lactam antibiotics. The lack of the therapeutic drug monitoring for betalactams is not a technical problem but a problem of the lack of demand of clinicians being not aware of suboptimal treatment of their ICU patients.
– Patricia Munoz from Spain addressed antifungal stewardship in immunocompromised patients. She described a successful antifungal stewardship program which led to the improvement of treatment and substantial cost saving. She underlined two important parts of the programme: the need for a well educated ID physician who is trusted by the primary team treating the immunocompromised patients and the introduction of novel tests such as combination of beta-D-glucan and CAGTA.
– Charles Haskins from USA described the antimicrobial stewardship efforts in paediatrics and divided his talk in traditional, fantastic or science fiction and horror part. He showed some effective and some less effective or transiently effective interventions in primary care and in the hospitals, and not yet well defined role of viral tests, biomarkers and rapid bacterial diagnostics which should apparently be accompanied by an ID advice. In the horror part he presented a recent study published in JAMA on the potential effectiveness of azithromycin in the prevention of recurrent respiratory infection with wheezing in children. The study did not investigate the impact of the azithromycin prophylaxis on the antimicrobial resistance in respiratory pathogen. The results of the study might have a deleterious effect when not used critically.
– Frank Aarestrup from Denmark presented the successful ban of antibiotics being used as growth-promoters in food animals in Denmark. The ban was followed by a decrease of total antibiotic use, but there was a moderate increase in antimicrobial consumption afterwards. A “yellow card” system labelling the farms with higher use had a transient effect. He also described a similar situation in the Netherlands, where the ban did not cause a substantial decrease of antibiotic use. A substantial decrease of antibiotic use was only reached with a consensus between the food industry and the public health sector. Unfortunately, an increase in the prevalence of ESBL positive Escherichia coli in food animals is widespread and originates from a few centres which export broilers and pigs Europe-wide. Interestingly, the stop in using antibiotics as growth promotors was associated with an unexpected and not completely understood increase in weight weight gain in food animals. In the last part of his talk he mentioned genomic sequencing in sewage water which can be done anywhere in the world and the data may be processed and made public in real time with the use of modern technology.