Adherence to presurgical antibiotic protocols found to be low in Brazilian study

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Surgical procedure
UW Health / Flickr cc

In only 20.7% of surgeries, prescribers followed surgical antibiotic prophylaxis (SAP) protocols for procedures performed at a university hospital in Sao Paulo, Brazil, finds a study published yesterday in the American Journal of Infection Control.

University of Sao Paulo researchers assessed prescriber adherence to SAP protocols and contributing factors among surgeries performed by cardiologists, urologists, neurologists, and gastrointestinal specialists. They compared SAP prescriptions to hospital protocols on surgical indication and antibiotic choice, dosage, and duration.

"Surgical antibiotic prophylaxis (SAP) is an important preventive measure, aiming to minimize surgical site infections," the study authors wrote. "However, despite evidence-based guidelines, adherence to SAP protocols remains suboptimal in clinical practice."

Lower adherence for antibiotic choice, duration

Prescribers adhered to SAP protocols for only 20.7% of 1,864 surgeries. Lower adherence rates were observed for antibiotic choice and duration of prophylaxis, particularly for neurologic and urologic procedures. The researchers also said that prescribers used broad-spectrum antibiotics more than necessary.

Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment.

Risk factors for nonadherence were high preoperative blood glucose levels, prolonged hospitalization, and long surgeries. Surgical teams had significant influence over protocol adherence.

"Despite the relatively high adherence to antibiotic dosage, challenges persist in antibiotic choice and duration adjustment," the researchers concluded. "Poor glycemic control, prolonged surgery and surgical teams were variables associated with inappropriate practice."

Salmonella outbreak tied to raw milk products from often-implicated firm may have sickened 165

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Raw milk
onstik / iStock

A four-state Salmonella outbreak linked to raw (unpasteurized) milk products has infected at least 165 people—many of them children—from fall 2023 to June 2024, Food Safety News (FSN) reported today based on data it obtained from the California Division of Communicable Disease Control (CDCDC) and the California Department of Health.

The median age of patients is 7 years.

Raw Farm (formerly Organic Pastures) of Fresno, California, has been linked to the outbreak, with 93% of those sickened reporting that they consumed the company's products. Raw Farm recalled the implicated products in October 2023 but resumed sales a week later.

Long history of outbreaks tied to raw-milk maker

Raw Farm has been tied to a series of outbreaks or recalls related to Salmonella, Campylobacter and Shiga toxin–producing Escherichia coli bacteria, FSN noted. 

FSN noted that when Raw Milk operated under the name Organic Pastures, its milk and cream products were associated with eight outbreaks of E coli, Listeria, and Campylobacter from 2006 to 2016.

In May 2023, the California Department of Food and Agriculture recalled Raw Farm milk after routine sampling detected C jejuni, and in August of that year, it announced a statewide recall of Salmonella-contaminated cheddar cheese from the company. In February 2024, the CDC reported 11 E coli cases in five states, including five hospitalizations, linked to Raw Farm cheddar cheese.

FSN noted that when Raw Milk operated under the name Organic Pastures, its milk and cream products were associated with eight outbreaks of E coli, Listeria, and Campylobacter from 2006 to 2016.

While the most recent California public health report from the current outbreak was released in February, the latest outbreak case was recorded in June, according to FSN. The two reports obtained by FSN were partially redacted, the publication said.

"It is beyond me to comprehend why public health would remain mute in the face of at least 165 sick, 20 hospitalized, and 40 percent of the ill five years or younger—especially raw milk—a risky elixir," Bill Marler, JD, a Seattle food safety attorney and FSN publisher, said in the article.

Quick takes: Haemophilus influenzae spike in Europe, H5N1 in Cambodian poultry, hepatitis C self-test

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  • In an annual update on Haemophilus influenzae released today, the European Centre for Disease Prevention and Control (ECDC) reported that the invasive form of the bacterial disease rose sharply in 2022 compared to the previous 2 years, which coincided with the lifting of COVID-19 restrictions and measures. It said 3,967 confirmed cases of invasive H influenzae disease were reported in 2022, up from 1,694 in 2021 and 1,849 in 2020. Easing COVID measures likely came with microbe-causing diseases returning to circulation, suggesting a correlation between the two events, the ECDC said. Babies younger than 1 year old were most affected, followed by seniors. H influenzae type b (Hib) made up a slightly greater percentage of cases in 2022 compared to recent years. Infection can range from mild to severe, with meningitis and septicemia seen in invasive infections. In most countries, children receive the Hib vaccine before they are 6 months old and a booster dose when they are 1 year old.
  • Cambodia's agriculture ministry has reported a highly pathogenic H5N1 avian flu outbreak in village birds from the same location where two human cases were recently reported, according to a notification from the World Organization for Animal Health (WOAH). The virus killed 474 of 1,168 susceptible birds, and the remaining ones were culled to curb the spread of the virus. The outbreak began on July 5, and the H5N1 findings were confirmed on July 7. The location of the poultry outbreak and the patients is Preah Bat Choan Chum commune in Takeo province. The clade wasn't noted WOAH report, but an older clade is known to circulate in Cambodia and has been implicated in other recent human infections in the country.
  • The World Health Organization (WHO) today announced that it has prequalified the first self-test for hepatitis C, which it said will help expand diagnosis and treatment, thus speeding global efforts to eliminate the disease. The OraQuick HCV self-test, made by OraSure Technologies, is an extension of the OraQuick HCV rapid antibody test that the WHO prequalified in 2017. The agency recommended hepatitis C self-testing in 2021 to complement existing diagnostic testing. WHO prequalification paves the way for low- and middle-income countries to receive the products.

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