News Scan for Jun 12, 2013

More berry-linked hepatitis A cases
Antibiotic stewardship in peds practices

Multistate berry-linked hepatitis A outbreak grows to 99 cases

Twelve new cases have been reported in the past 2 days in an outbreak of acute hepatitis A linked to an organic frozen berry mix, bringing the total to 99, the US Centers for Disease Control and Prevention (CDC) said today.

Based on information from 73 of the patients, 38 (52%) have been hospitalized, 47 (64%) are female, and 63 (86%) reported eating Townsend Farms Organic Anti-Oxidant Blend frozen berry and pomegranate mix.

All case-patients reported buying the mix from Costco, but the product was also sold at Harris Teeter stores, with no cases linked to those outlets so far. Patients range from 2 to 87 years old and are from eight southwestern states.

Analysis of samples from two states suggests the hepatitis A outbreak strain is genotype 1B, which is rarely seen in the Americas but circulates in North Africa and the Middle East.

The CDC first reported the outbreak on May 31, and Townsend Farms, of Fairview, Ore., recalled lots of the berry blend on Jun 3.
Jun 12 CDC update


Antibiotic program dropped levels in peds practices

An antibiotic stewardship intervention in pediatric outpatient clinics almost halved prescribing of broad-spectrum antibiotics for acute illnesses and decreased by 75% the use of off-guideline antibiotics for kids with pneumonia, researchers reported today.

The study, in the Journal of the American Medical Association (JAMA), included 162 clinicians at 25 pediatric primary care practices in Pennsylvania and New Jersey and monitored prescribing patterns from electronic health records 20 months before the intervention and 12 months afterward.

The intervention was a 1-hour clinician education session followed by 1 year of personalized, quarterly audit and feedback on prescribing for bacterial and viral acute respiratory tract infections. The control group knew they were part of the study, but did not receive the interventions.

Broad-spectrum prescribing fell from 26.8% to 14.3% in the intervention group, compared with a drop from 28.2% to 22.6% in controls. Off-guideline antibiotic prescribing for pneumonia decreased from 15.7% to 4.2% in the intervention group and from 17.1% to 16.3% in the controls.

In an editorial in the same issue, Jonathan Finkelstein, MD, MPH, a pediatrician at Boston Children's Hospital and Harvard Medical School, wrote that the authors may have underestimated the effect of the intervention, because they did not include data on antibiotics in kids with otitis media, which also may have decreased.
Jun 12 JAMA abstract
Jun 12 JAMA editorial extract

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