Antibiotic stewardship can curb rise of deadly superbugs

The superbug Carbapenem-resistant Enterobacteriaceae (CRE) recently made headlines in the wake of a deadly, multi-state outbreak among hospitalized patients, but a new study reminds health leaders that improvements in antibiotic stewardship are sorely needed to mitigate the threat posed by not just CRE, but all varieties of these powerful pathogens.

The study, published in the February edition of JAMA Internal Medicine, measured the rate of Clostridium difficile infection in patients 18 and older who were being treated in an acute care teaching hospital from June 2010 through March 2014. Of the 34,298 patients studied, 255 developed a C difficile infection, and the study found that the incidence of infection was higher among patients who had contact with other patients who were given antibiotics while housed in the same hospital ward.

"The principal clinical implication of this study is that aggregate ward-level antibiotic use should be subject to surveillance by infection control and stewardship personnel," the study authors conclude. Specifically, researchers suggest that hospitals must strive to reduce overall antibiotic exposure and encourage clinicians to wash their hands before and after caring for patients who are being treated with antibiotics. Such efforts have the support of the Obama administration, as the president's recent budget proposal requests $1.2 million to boost the fight against antibiotic resistance, FierceHealthcare has reported.

Amid the recent outbreak of another superbug, CRE, hospitals around the country have had to swiftly tailor their protocols to address the infection risk posted by specialized devices known as duodenoscopes, which due to their design can harbor the pathogen even after staff clean it according to manufacturer standards.

UCLA's Ronald Reagan Medical Center, where two patients died after contracting CRE from contaminated duodenoscopes, has switched to gas sterilization of the devices, and says it has not had any new infections since doing so, FierceHealthcare reported. But senior Food and Drug Administration (FDA) official William Maisel, M.D., told the L.A. Times that the cleaning procedure is "not something that we routinely recommend" because residual ethylene oxide gas on the scopes can be harmful to patients.

Though the FDA knew about the potential CRE infection risk of duodenoscopes as early as the fall of 2013, as ABC News reported, it did not issue a warning about the devices until this past Thursday, and it stopped short of issuing a recall of the devices or updated protocols for sterilization.

"We believe that these products should be available and that healthcare providers are in the best position to make the determination about their needs," Maisel told the L.A. Times.

This position has led some to criticize the FDA's approach, including Democratic Rep. Ted Lieu of California, who wrote in a letter to the House Committee on Oversight and Government Reform that "current FDA-approved sterilization procedures have resulted in, and will continue to result in, CRE outbreaks and deaths."

To learn more:
- check out the study (subscription may be required)
- read the L.A. Times article
- here's the ABC News report
- read Lieu's letter

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