Unneeded antibiotics for respiratory infections tied to harm, higher costs
A study of more than 3 million patients with bacterial and viral respiratory infections found that inappropriate antibiotic prescriptions were associated with increased risk of adverse events and higher healthcare costs, researchers reported today in Clinical Infectious Diseases.
The study, conducted by researchers with the Washington University School of Medicine in St. Louis and the Pew Charitable Trusts, used data from the MarketScan Commercial Database to analyze antibiotic exposure among adults aged 18 to 64 years who were diagnosed as having a bacterial or viral infection from April 2016 through September 2018.
They analyzed inappropriate versus appropriate prescriptions, focusing on the relationship between inappropriate antibiotics and adverse drug events and 30-day attributable expenditures. Inappropriate antibiotics were defined as non–guideline-recommended antibiotics for bacterial infections and any antibiotic for viral infections.
Among 3,294,598 eligible adults (median age, 43 years; 41% male), there were 1,656,960 bacterial respiratory infections and 1,637,638 viral respiratory infections. The proportion of adults with bacterial infections who received inappropriate antibiotics differed by infection, ranging from 43% (sinusitis) to 56% (pharyngitis), while inappropriate antibiotics for viral infections ranged from 7% (influenza) to 66% (bronchitis).
Analysis of different infections found that inappropriate antibiotics for pharyngitis were associated with an increased risk of Clostridioides difficile infection (hazard ratio [HR], 2.90; 95% confidence interval [CI], 1.31 to 6.40) and nausea/vomiting/abdominal pain (HR, 1.10; 95% CI, 1.03 to 1.08), while an increased of vulvovaginal candidiasis was linked to inappropriate antibiotics for viral upper respiratory infections (HR, 1.24; 95% CI, 1.14 to 1.34 ) and non-suppurative otitis media (ear infection; HR, 1.39; 95% CI, 1.09 to 1.77).
The mean 30-day total attributable expenditure for inappropriate antibiotics for bacterial infections ranged from $18 (sinusitis) to $67 (pharyngitis) and from –$53 (bronchitis) to $49 (influenza) for viral infections.
"These results support the need for increased outpatient antibiotic stewardship efforts to discourage antibiotic prescribing for viral infections, encourage appropriate selection of guideline-recommended antibiotics for bacterial infections, and reduce antibiotic-related harms and expenditures," the study authors concluded.
Nov 9 Clin Infect Dis abstract
Listeria outbreak tied to deli products sickens 16 in 6 states, 1 fatally
The Centers for Disease Control and Prevention (CDC) yesterday announced a Listeria monocytogenes outbreak linked to meat and cheese sold at delis that has so far sickened at least 16 people, one of them fatally, in 6 states.
So far, officials haven't identified a specific food source, which they said is difficult, given that Listeria spreads easily from food to surfaces in the deli environment and can persist in display cases and on equipment.
Interviews with 12 sick people revealed that 11 had eaten meat and cheese from delis. Of seven sick people in New York, five had bought meat or cheese from at least one location of NetCost Market, a grocery chain that sells international foods. However, the CDC said it doesn't think NetCost Market is the source of the outbreak, because some sick people did not shop there. "A contaminated food likely introduced the outbreak strain of Listeria into delis in multiple states," the CDC said.
In 2021, New York state and city officials found the outbreak strain in environmental and food samples from the same NetCost Market store in Brooklyn and in food from one of the stores on Staten Island. After deep cleaning and negative testing, Listeria was found again at the Brooklyn store in September 2022.
Illness onsets range from April 2021 to Sep 29, 2022. Affected states include New York (7), Maryland (3), Illinois (2), Massachusetts (2), California (1), and New Jersey (1). All of the sick people are adults, and of 13 people with ethnicity information, 11 are of Eastern European descent. Thirteen people were hospitalized, including a Maryland resident who died. One of the sick people was a pregnant woman who lost her baby.
The CDC has advised people at higher risk of Listeria illness—pregnant women, older people, and those with weakened immune systems—to avoid eating meat and cheese from deli counters unless it is heated to at least 165°F.
Nov 9 CDC outbreak notice
Avian flu outbreaks strike more poultry flocks in 8 states
Over the past few days, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has reported highly pathogenic avian influenza outbreaks in eight states, including three with outbreaks at commercial farms.
The new developments brought the number of birds lost in the current Eurasian H5N1 outbreaks within a stone's throw of the record 50.5 million-bird loss that producers sustained during avian influenza outbreaks in 2015. The latest outbreaks have now led to the loss of 50.3 million birds across 46 states, according to APHIS.
Pennsylvania has reported three outbreaks at turkey farms, all in Lehigh County, which together have more than 46,000 birds. Iowa reported its second recent outbreak at a layer farm in Wright County, which has more than 1 million birds. Iowa has been the hardest-hit state regarding poultry losses. In Wisconsin, the virus struck a gamebird farm in Jefferson County that houses 180,000 birds.
Seven states reported more outbreaks in backyard birds, including Iowa, Pennsylvania, Washington, Ohio, Virginia, Wyoming, and New York.
USDA APHIS avian influenza updates
In international developments, France's agriculture ministry raised its avian flu alert, which triggered a requirement that farmers must keep poultry indoors, according to Reuters.
The pace of outbreaks has risen over the past few months, with France experiencing its worst outbreaks leading to the culling of 22 million birds so far. The United Kingdom recently announced a similar requirement to protect poultry.
Nov 10 Reuters story