Stewardship/Resistance Analysis February 08, 2022

Procalcitonin testing during COVID linked to initial drop in UK antibiotic use

The introduction of procalcitonin testing (PCT) in UK hospitals during the first wave of the COVID-19 pandemic was associated with an immediate but unsustained drop in antibiotic prescribing, researchers reported today. researchers in the Journal of Antimicrobial Chemotherapy.

During the first wave of the pandemic, many National Health Service (NHS) hospitals introduced the PCT test, which looks for an inflammatory biomarker that increases in bacterial respiratory tract infections, to guide treatment decision-making. antibiotics, especially in emergency departments (ED) and acute care. medical units (UCA).

To assess the impact of PCT testing on antibiotic use, a team of researchers conducted a retrospective, controlled, interrupted time series analysis of antibiotic dispensing, hospital activity, and PCT testing in 105 hospitals. /NHS hospital trusts in England and Wales from Feb. 24 to Jul. 5, 2020.

In the primary analysis, there was a statistically significant decrease of -1.08 (95% confidence interval [CI], -1.81 to -0.36) defined daily doses (DDD) per admission per week per trust immediately after introduction of PCT testing in the ER/ICU. But this was followed by a statistically significant increase of 0.05 (95% CI, 0.02 to 0.08) DDD per admission per week per trust. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions. The PCT test was not associated with any change in antibiotic prescribing in the intensive care unit.

“We found that the initial impact of PCT testing was gradually lost over time,” the study authors write. “It should be noted that this is an absolute effect, not relative to other trusts/hospitals, and is likely related to sustainability, which is a challenge for any antibiotic management intervention.”

The authors add, however, that the initial impact of PCT testing represents an 18% reduction from the national median of 5.9 DDD per admission per week per trust, and that further research should be conducted to determine the impact at the patient level and its potential for clinical efficacy.
February 8 J Antimicrob Chemother abstract

Three cases of ceftriaxone-resistant gonorrhea reported in England

The UK Health Safety Agency (UKHSA) yesterday reported three new cases of gonorrhea resistant to ceftriaxone.

The newly diagnosed cases involve a woman in London in her 20s and a heterosexual couple from the Midlands in their 20s. There is currently no known link between the cases.

Ceftriaxone-resistant strains of gonorrhea are most common in the Asia-Pacific region, but have occasionally been identified in people who have traveled or moved to the UK from that region. On December 24, 2021, the UKHSA reported a case of ceftriaxone-resistant gonorrhea in a man who contracted the infection in London in November.

As of 2019, ceftriaxone has been the main antibiotic used to treat gonorrhea infections in the UK. Previous treatment guidelines recommended dual therapy with ceftriaxone and azithromycin, but azithromycin is no longer recommended due to high levels of resistance.

“After a few years with no cases of this hard-to-treat form of gonorrhea, we’ve now seen 4 cases in the past 2 months,” said Katy Sinka, PhD, who leads the sexually transmitted infections (STIs) section of the ‘UKHSA,’ said in a statement. “It’s too early to say if this will be the start of a longer-term trend, but we know that STIs are on the rise in general.”

UKHSA officials say they are awaiting follow-up tests in all three cases to see if treatment has been successful.
February 7 UKHSA Press release
December 24 UKHSA
Press release

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