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Supply Chain Risk

Stewardship / Resistance Scan for Nov 21, 2019

Study on CRE in US military health system notes high risk of death

A study of hospitalized patients in the US military health system database shows that carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with longer and more costly hospitalizations and a significant increase in the risk of in-hospital death, researchers reported yesterday in the American Journal of Infection Control.

For the retrospective study, the researchers with the Uniformed Services University analyzed data on patients admitted to one of the many US military treatment facilities for at least 2 days with a CRE infection from October 2008 through September 2015. The aim of the study was to analyze risk factors for CRE infection and evaluate important healthcare outcomes in this patient population. Multivariable logistics regression was used to identify comorbid conditions associated with CRE infections, and a high-dimensional propensity score was used to evaluate CRE-associated in-hospital mortality, length of stay, and hospitalization costs.

Of 1,162,686 hospitalized patients, the researchers identified 143 with a CRE infection over the 7-year study period. Compared with patients without CRE infection, most were older men admitted to large hospitals. Analysis of cultures from the patients showed that most CRE isolates were highly resistant to other antibiotic classes. The conditions associated with CRE infection included manipulation of the gastrointestinal tract, musculoskeletal trauma, orthopedic procedures, septicemia, and exposure to broad-spectrum beta-lactam antibiotics. The in-hospital mortality rate for patients with CRE infection was 9.1%, compared with 0.46% for those without.

After propensity score adjustment, CRE infection was associated with a triple increase in the odds of in-hospital death (adjusted odds ratio, 3.34; 95% confidence interval [CI], 1.82 to 6.12),  significantly higher hospitalization costs (attributable difference, $206,664; P < .001), and longer hospital stays (attributable difference, 28.8 days; P < .001).

The authors say their study “highlights the importance of initiatives aimed at curbing the spread of these costly infections.”
Nov 20 Am J Infect Control abstract


New international group to monitor antibiotic resistance in the environment

An international team of scientists this week launched a new effort to track antibiotic resistance in the environment.

The primary goal of the international collaboration, dubbed EMBARK (Establishing a Monitoring Baseline for Antimicrobial Resistance in Key environments), is to understand how common antibiotic resistance is in the environment, and what type of resistance mechanisms are most frequently found in different settings. The data will then be used to standardize different methods of resistance surveillance and identify high-priority targets for monitoring. 

The group, which includes scientists from Sweden, Germany, France, China, and Pakistan, also aims to create an early-warning system by developing and evaluating methods to detect new and emerging resistance mechanisms that could spread from the environment to humans.

EMBARK leaders say they hope to develop monitoring tools and methods that are affordable, easy to use, and modular.

“This is crucial, since effective antibiotic resistance monitoring may be most urgent and important in countries that may not be able to afford it,” EMBARK coordinator Johan Bengtsson-Palme, PhD, said in a video on the group’s website. “Our long-term goal is to develop a monitoring protocol that can be adapted to the available budget and still be relevant and comparable between countries and different situations.”

EMBARK has received €1.4 million ($1.5 million US) in funding from the Joint Programming Initiative on Antimicrobial Resistance.
Nov 18 EMBARK launch announcement

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