News Scan for Aug 03, 2016

Test for cutting antibiotic overuse
Patient sharing and CRE
Anthrax continues in Siberia

Rapid bacterial infection test reduces unnecessary antibiotic use

A new study in The Lancet shows that C-reactive protein (CRP) testing performed at the point of care safely reduced antibiotic use in patients with acute respiratory infections in Vietnam, without compromising patients' recovery.

In a randomized, controlled trial performed at primary care centers in northern Vietnam, researchers from the Oxford University Clinical Research Unit in Hanoi assigned more than 2,000 patients who had at least one symptom of an acute respiratory infection into one of two groups: One that received a point-of-care test for C-reactive protein (a biomarker for bacterial infection), and a control group that received routine care.

The primary end point of the study was the number of patients in the two groups receiving antibiotics within 2 weeks of enrollment. The expectation, based on studies performed in Europe, was that CRP testing would reduce antibiotic prescribing by 20%.

Overall, the researchers found that 541 of 908 patients in the CRP-guided group (64%) used an antibiotic within 14 days of follow-up, compared with 738 out of 947 patients in the control group (78%), with significant differences seen in both children and adults. This constituted an 18% reduction in antibiotic prescribing.

In both groups, clinical recovery rates were similar. Adverse events were rare, with no deaths and 14 hospitalizations.

The study is significant because it's the first to gauge the effects of CRP testing on antibiotic prescribing in a low- or middle-income country , the authors wrote. The findings indicate that the intervention—which has the potential to be scaled up with affordable and reliable CRP tests becoming more available—could be effective in countries with resource constraints.

"With this easy-to-use tool, primary healthcare providers can safely limit the unnecessary antibiotic use for viral respiratory infections," investigator Nguyen Van Kinh, MD, PhD, of the National Hospital for Tropical Disease in Hanoi said in a news release. "The study provides important evidence for simple solutions in antibiotic stewardship programmes."
Aug 2 Lancet Glob Health study
Aug 2 Oxford University news release


Patient sharing among hospitals might foster spread of CRE

A new study indicates that hospitals that are more likely to share patients with other hospitals have higher rates of carbapenem-resistant Enterobacteriaceae (CRE).

In the study, published in Clinical Infectious Diseases on Aug 1, researchers used a social network analysis of 185 Illinois hospitals in a statewide patient-sharing network to evaluate the influence of patient sharing on hospital-specific rates of CRE.

What they found was that hospitals that were more connected or central—ie, were more likely to share patients with other hospitals—had higher burdens of CRE, and that each additional hospital connection increased that burden. In rural counties, for example, each hospital connection was associated with a 6% increase in the CRE rate. In Chicago and other urban parts of the state, the associated increase was 3%.

In addition, sharing four or more patients with a long-term acute care hospital, where CRE infections are particularly problematic, was also linked to higher CRE rates.

Although the study does not prove that more interconnectedness causes higher CRE rates, the authors said the finding have immediate public health implications. "Our results provide an important way of identifying hospitals at highest risk of CRE exposure," the authors wrote.

An accompanying editorial adds that the study highlights the need for greater understanding of the role that hospital transfers play in infection control, and that the findings have "profound implications" for infectious disease surveillance efforts.
Aug 1 Clin Infect Dis abstract
Aug 1 Clin Infect Dis commentary


Reports: 90 now hospitalized for suspected anthrax in Siberia

Several news organizations reported yesterday that 90 people are now hospitalized in the Yamal-Nenets area of Siberia and a 12-year-old boy is dead from suspected anthrax infection. So far, 20 cases have been confirmed.

The New York Times reports the boy's death is the first from anthrax in 75 years. 

A very warm summer has melted a layer of permafrost in Yamal-Nenets, revealing carcasses of reindeer that may be releasing Bacillus anthracis, the bacterium that causes anthrax, into soil. B anthracis can infect and kill humans and animals. Authorities in Siberia say 2,300 reindeer have died from suspected anthrax infection this summer, while more than 3,000 have been vaccinated against anthrax as of Tuesday.

Humans contract anthrax when they touch infected animals, inhale spores, or eat contaminated foods. The 90 people hospitalized are nomadic reindeer herders, and authorities suspect they had close contact with sick or dead animals.  

Earlier this week Popular Science reported that the reindeer carcasses were likely from 1941, the last year a major anthrax outbreak occurred in that area of Siberia.
Aug 2 New York Times story

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