Antimicrobial Use and the Emergence of Antimicrobial Resistance withStreptococcus pneumoniaein the United States

Otitis media is the leading indication for outpatient antimicrobial use in the United States. Overdiagnosis of and unnecessary prescribing for this condition has contributed to the spread of antimicrobial resistance. A critical step in reducing unnecessary prescribing is to identify the subset of patients who are unlikely to benefit from antibiotics. Conscientiously distinguishing acute otitis media (AOM) from otitis media with effusion (OME), and deferring antibiotics for OME will accomplish this goal, and will avoid up to 8 million unnecessary courses of antibiotics annually. Criteria for defining these conditions are presented, as well as the evidence supporting deferring antibiotic treatment. Discussions of shortened courses of antibiotics for AOM and restricted indications for antimicrobial prophylaxis are also presented.

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Dedicated time for antimicrobial stewardship—How much and why? Lessons learned from South Korea

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1235 ◽

2020 ◽

Vol 41 (12) ◽

pp. 1436-1437

Author(s):

Payal K. Patel ◽

Arjun Srinivasan

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

South Korea ◽

Antimicrobial Stewardship ◽

Large Scale ◽

The United States ◽

Lessons Learned ◽

Joint Commission ◽

Antimicrobial Use ◽

Institutional Level

AbstractAntimicrobial resistance is a global and pressing problem that requires large-scale, federal coordination of efforts and tailored local interventions and surveillance. Given the urgency of the threat, many countries now have national policies to reduce inappropriate antimicrobial use. However, few countries have followed this with resources at the institutional level to support the implementation of practices to achieve this goal. In the United States, accreditation bodies such as Centers for Medicare and Medicaid Services and The Joint Commission have added antimicrobial stewardship standards to encourage uptake of antimicrobial stewardship programs (ASPs).

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408. Impact of the COVID-19 Pandemic on Antimicrobial Use and Resistance in the United States and the Dominican Republic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab466.609 ◽

2021 ◽

Vol 8 (Supplement_1) ◽

pp. S305-S306

Author(s):

Alfredo J Mena Lora ◽

Rita Alexandra Rojas-Fermin ◽

Stephanie L Echeverria ◽

Katia Castro ◽

Anel E Guzman ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

Dominican Republic ◽

The United States ◽

Antimicrobial Use ◽

E Coli ◽

The Us ◽

Tract Infections ◽

The Impact

Abstract Background The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. Lower respiratory tract infections (LRTIs) caused by COVID-19 has led to an increase in hospitalizations. Disease severity and concerns for bacterial co-infections can increase antimicrobial pressure. Our aim is to define and compare the impact of COVID-19 on antimicrobial use (AU) and antimicrobial resistance (AMR) in the Dominican Republic (DR) and the United States (US). Methods We performed a retrospective review of AU and antimicrobial susceptibility patterns from 2019-20 at a hospital in the US (H-US) and the DR (H-DR). Our sites are community teaching hospitals with 151 beds in H-US and 295 beds in H-DR. After AU was tabulated, percent changes between 2019-20 were calculated. Resistance patterns for extended-spectrum beta-lactamase producing (ESBL) E coli, ESBL Klebsiella pneumoniae (ESBL-Kp), carbapenem resistant Pseudomonas aeruginosa (CR-PSAR) and Klebsiella pneumoniae (CR-Kp) were tabulated and percent changes between 2019-20 were calculated. Results AU increased by 10% in H-US and 25% in H-DR, with carbapenem use increasing by 268% and 144% respectively. Ceftriaxone use increased by 30% in H-US and 33% in H-DR. Azithromycin increased 54% in H-US and 338% in the H-DR. Resistance increased from 10% to 28% for ESBL-Kp and from 10% to 12% for ESBL E coli at H-US. CR-PSAR decreased from 20% to 12%, while cefepime and piperacillin resistance increased from 5% to 20% and 3% to 16% respectively (Figure 1). At H-DR, ESBL-Kp resistance decreased from 68% to 64% and increased from 58% to 59% for ESBL E coli. CR-PSAR and cefepime resistance increased from 5% to 19% and from 9% to 29% respectively (Figure 2). Figure 1. Antimicrobial resistance (%) for select organisms at H-US in 2019 and 2020 Figure 2. Antimicrobial resistance (%) for select organisms at H-DR in 2019 and 2020 Conclusion COVID-19 had a major impact on antimicrobial consumption and resistance in the US and DR. A greater impact was seen on ESBL rates in the US whilst a greater impact on carbapenem resistance was seen in the DR. The rise in carbapenem use in H-US reflected a rise in ESBL rates. In the DR, ESBL producing organisms were common prior to COVID-19 and carbapenem use was more widespread. The impact of the COVID-19 pandemic on AU may accelerate AMR worldwide. The scale up of antimicrobial stewardship across the globe is urgently needed to curb AMR. Disclosures All Authors: No reported disclosures

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Need for Annual Surveillance of Antimicrobial Resistance in Streptococcus pneumoniae in the United States: 2-Year Longitudinal Analysis

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.45.4.1037-1042.2001 ◽

2001 ◽

Vol 45 (4) ◽

pp. 1037-1042 ◽

Cited By ~ 94

Author(s):

Daniel F. Sahm ◽

James A. Karlowsky ◽

Laurie J. Kelly ◽

Ian A. Critchley ◽

Mark E. Jones ◽

...

Keyword(s):

United States ◽

Streptococcus Pneumoniae ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

The United States ◽

Multidrug Resistant ◽

Fluoroquinolone Resistance ◽

Resistance Patterns ◽

Changing Patterns ◽

Resistance To Penicillin

ABSTRACT Although changing patterns in antimicrobial resistance inStreptococcus pneumoniae have prompted several surveillance initiatives in recent years, the frequency with which these studies are needed has not been addressed. To approach this issue, the extent to which resistance patterns change over a 1-year period was examined. In this study we analyzed S. pneumoniaeantimicrobial susceptibility results produced in our laboratory with isolates obtained over 2 consecutive years (1997–1998 and 1998–1999) from the same 96 institutions distributed throughout the United States. Comparison of results revealed increases in resistant percentages for all antimicrobial agents studied except vancomycin. For four of the agents tested (penicillin, cefuroxime, trimethoprim-sulfamethoxazole, and levofloxacin), the increases were statistically significant (P < 0.05). Resistance to the fluoroquinolone remained low in both years (0.1 and 0.6%, respectively); in contrast, resistance to macrolides was consistently greater than 20%, and resistance to trimethoprim-sulfamethoxazole increased from 13.3 to 27.3%. Multidrug resistance, concurrent resistance to three or more antimicrobials of different chemical classes, also increased significantly between years, from 5.9 to 11%. The most prevalent phenotype was resistance to penicillin, azithromycin (representative macrolide), and trimethoprim-sulfamethoxazole. Multidrug-resistant phenotypes that included fluoroquinolone resistance were uncommon; however, two phenotypes that included fluoroquinolone resistance not found in 1997–1998 were encountered in 1998–1999. This longitudinal surveillance study of resistance inS. pneumoniae revealed that significant changes do occur in just a single year and supports the need for surveillance at least on an annual basis, if not continuously.

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Molecular Analysis ofEscherichia colifrom Retail Meats (2002–2004) from the United States National Antimicrobial Resistance Monitoring System

Clinical Infectious Diseases ◽

10.1086/599830 ◽

2009 ◽

Vol 49 (2) ◽

pp. 195-201 ◽

Cited By ~ 35

Author(s):

James R. Johnson ◽

James S. McCabe ◽

David G. White ◽

Brian Johnston ◽

Michael A. Kuskowski ◽

...

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Monitoring System ◽

Molecular Analysis ◽

The United States ◽

Resistance Monitoring ◽

Retail Meats

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Emergence of high rates of antimicrobial resistance among viridans group streptococci in the United States.

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.40.4.891 ◽

1996 ◽

Vol 40 (4) ◽

pp. 891-894 ◽

Cited By ~ 184

Author(s):

G V Doern ◽

M J Ferraro ◽

A B Brueggemann ◽

K L Ruoff

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Blood Culture ◽

Rank Order ◽

The United States ◽

Medical Centers ◽

Streptococcus Milleri ◽

Intermediate Resistance ◽

High Level ◽

Viridans Group Streptococci

Three hundred fifty-two blood culture isolates of viridans group streptococci obtained from 43 U.S. medical centers during 1993 and 1994 were characterized. Included were 48 isolates of "Streptococcus milleri," 219 S. mitis isolates, 29 S. salivarius isolates, and 56 S. sanguis isolates. High-level penicillin resistance (MIC, > or = 4.0 micrograms/ml) was noted among 13.4% of the strains; for 42.9% of the strains, penicillin MICs were 0.25 to 2.0 micrograms/ml (i.e., intermediate resistance). In general, amoxicillin was slightly more active than penicillin. The rank order of activity for five cephalosporins versus viridans group streptococci was cefpodoxime = ceftriaxone > cefprozil = cefuroxime > cephalexin. The percentages of isolates resistant (MIC, > or = 2 micrograms/ml) to these agents were 15, 17, 18, 20, and 96, respectively. The rates of resistance to erythromycin, tetracycline, and trimethoprim-sulfamethoxazole were 12 to 38%. Resistance to either chloramphenicol or ofloxacin was uncommon (i.e., < 1%). In general, among the four species, S. mitis was the most resistant and "S. milleri" was the most susceptible.

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Where have all the susceptible gonococci gone? A historical review of changes in MIC distribution over the past 75 years

10.21203/rs.2.13785/v2 ◽

2019 ◽

Author(s):

Chris Kenyon ◽

Jolein Laumen ◽

Dorien Van Den Bossche ◽

Christophe Van Dijck

Keyword(s):

United States ◽

South Africa ◽

Antimicrobial Resistance ◽

Historical Analysis ◽

Historical Review ◽

The United States ◽

Antimicrobial Consumption ◽

The Past ◽

The United Kingdom ◽

Loss Of Susceptibility

Abstract Background Does the emergence of antimicrobial resistance in Neisseria gonorrhoeae include the erasure of highly susceptible strains or does it merely involve a stretching of the MIC distribution? If it was the former this would be important to know as it would increase the probability that the loss of susceptibility is irreversible.Methods We conducted a historical analysis based on a literature review of changes of N. gonorrhoeae MIC distribution over the past 75 years for 3 antimicrobials (benzylpenicillin, ceftriaxone and azithromycin) in five countries (Denmark, Japan, South Africa, the United Kingdom and the United States).Results Changes in MIC distribution were most marked for benzylpenicillin and showed evidence of a right shifting of MIC distribution that was associated with a reduction/elimination of susceptible strains in all countries. In the case of ceftriaxone and azithromycin, where only more recent data was available, right shifting was also found in all countries but the extent of right shifting varied and the evidence for the elimination of susceptible strains was more mixed.Conclusions The finding of right shifting of MIC distribution combined with reduction/elimination of susceptible strains is concerning since it suggests that this shifting may not be reversible. Since excess antimicrobial consumption is likely to be responsible for this right shifting, this insight provides additional impetus to promote antimicrobial stewardship.

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Association between intensity of STI screening and development of antimicrobial resistance in N. gonorrhoeae in 12 cities in the USA: An ecological study

F1000Research ◽

10.12688/f1000research.15569.3 ◽

2018 ◽

Vol 7 ◽

pp. 1237

Author(s):

Chris R. Kenyon

Keyword(s):

United States ◽

Antimicrobial Resistance ◽

Ecological Study ◽

Geometric Mean ◽

The United States ◽

Transmitted Infection ◽

Sexually Transmitted ◽

Antimicrobial Sensitivity ◽

The Usa ◽

Sex With Men

In this study, we assessed if there was a city-level association between sexually transmitted infection (STI) screening intensity in men who have sex with men and antimicrobial sensitivity in Neisseria gonorrhoeae in the United States, 2007 to 2013. We found positive associations between STI screening intensity and increases in minimum inhibitory concentrations for cefixime and azithromycin, but not ceftriaxone when using change in city geometric mean N. gonorrhoeae MIC between 2005 and 2013.

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