News Scan for Dec 30, 2016

US flu picks up
Cutting antibiotics for pneumonia

CDC reports accelerated flu activity as year winds down

Influenza activity in the United States picked up its pace in the penultimate week of 2016, according to an update today from the Centers for Disease Control and Prevention (CDC).

For the week ending Dec 24, the proportion of outpatient visits for influenza-like illness (ILI) was 2.9%, which is up from 2.3% the previous week and above the national baseline of 2.2%. Nine regions reported ILI at or above their region-specific baseline levels, which is up from five the week before. Only the Northeast reported normal outpatient ILI levels.

Four states— Alabama, Arizona, Georgia, and Oklahoma—reported high ILI activity, up from one (Oklahoma) the week before. New York City and Puerto Rico also noted high ILI activity, while five states had moderate ILI activity.

In addition, Guam and eight states (California, New Hampshire, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, and Virginia) reported widespread flu activity. In the previous week only Puerto Rico reported geographically widespread flu; this week the territory did not report that variable. Seventeen states and the US Virgin Islands reported regional flu activity.

The hospitalization rate for lab-confirmed influenza was 3.1 per 100,000 population, the CDC said, up from 2.4 the prior week. The rate among those 65 and over was 12.7 per 100,000 population.

The percentage of respiratory specimens testing positive for flu rose from 7.1% the week before to 10.4% last week. Influenza A viruses outpaced influenza B viruses 87% to 13% for the week. Of the "A" strains subtyped last week, 98% were H3N2. For the season, H3N2 viruses are predominating over 2009 H1N1 viruses 95% to 5%.

The CDC also noted the low-pathogenic H7N2 avian flu infection reported a week ago by New York City health officials that involved a veterinarian. The CDC said in today's report, "This is the first influenza A (H7N2) virus infection in humans identified in the United States since 2003 and the first known human infection with an influenza A virus likely acquired through exposure to an ill cat. The patient was mildly ill, was not hospitalized, and has recovered completely. No human-to-human transmission has been identified."|
Dec 30 CDC FluView report
Dec 27 CIDRAP News item "Vet contracts H7N2 virus from cats in New York City"


Study: Milder ventilator-related pneumonia may require fewer antibiotics

Patients treated for suspected ventilator-associated pneumonia (VAP) but with minimal and stable ventilator settings appear to have similar outcomes when treated with very short antibiotic courses compared with longer courses, according to a study yesterday in Clinical Infectious Diseases.

In the study, researchers retrospectively identified all adult patients who had been put on mechanical ventilation at Brigham and Women's Hospital in Boston from January 2006 to December 2014, then narrowed down the population to all patients started on antibiotics for possible VAP who had minimal or stable ventilator settings for at least 3 days. Minimal and stable ventilator settings can be an indication of less severe pneumonia.

The researchers then compared the outcomes of patients prescribed 1 to 3 days of antibiotics versus those prescribed more than 3 days of antibiotics. Results were adjusted for patients' demographics, comorbidities, severity of illness, clinical signs of infections, and pathogens.

Overall, 1,290 patients were identified, with 259 prescribed 1 to 3 days of antibiotics and 1,301 prescribed more than 3 days of antibiotics. When the outcomes were adjusted for possible confounders, the researchers found no statistically significant differences between the two groups in hazard ratios for time to extubation (HR, 1.16 for short versus long course), ventilator death (HR, 0.82), time to hospital discharge (HR, 1.07), or hospital death (HR, 0.99). In all cases, the authors note, the point estimates for the outcomes favored the shorter-course patients.

"These observations suggest the possibility that patients with suspected VAP but minimal and stable ventilator settings can be adequately managed with very short courses of antibiotics," the authors write, adding that if the findings are confirmed in a randomized controlled trial, serial ventilator settings surveillance could be a simple way for clinicians to identify candidates for early antibiotic discontinuation.
Dec 29 Clin Infect Dis abstract

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