In a clinical cohort study, only 31.9% of high-risk adult COVID-19 outpatients were prescribed an antiviral drug, which the researchers said underscores the need to identify and reduce treatment barriers.

A team led by scientists from the California genomics firm Helix analyzed electronic health records from two healthcare systems in Minnesota and Nevada to determine prescribing patterns of nirmatrelvir-ritonavir (Paxlovid), molnupiravir, and remdesivir among 3,247 high-risk COVID-19 patients from April 2022 to June 2023.

The findings were published yesterday in Clinical Infectious Diseases.

Prescribing rose slightly in 2023

In total, 31.9% of patients were prescribed a COVID-19 antiviral, the most common of which was Paxlovid (87.6%), followed by molnupiravir (11.9%) and remdesivir (0.5%). The vast majority of patients were given their prescription on either the day they tested positive (30.3%) or the day after (56.3%).

The prescribing rate rose slightly over time, from 28.0% in 2022 to 34.6% in 2023. The proportion of patients with underlying conditions prescribed an antiviral was 32.2% to 42.6%. The percentage of patients with Charlson Comorbidity Index (CCI) scores of 1, 2, 3-4, and greater than 5 was 26.2% to 45.5%.

There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits.

Antiviral prescribing rates were similar for adults aged 65 and older (39.6%), including those with chronic lung disease (39.8%) or a weakened immune system (43.0%). Of the 1,732 patients (53.3%) with symptoms, prescribing was not meaningfully different overall (35.4% vs 27.9%) among asymptomatic patients or those 65 and older (42.6%).

Ages 50 to 64 years and 65 and older (vs 18 to 49); asthma, diabetes, obesity; and CCI values of 1, 2, or 3-4 (vs 0) were significantly tied to a higher likelihood of prescription. Conversely, unvaccinated status (vs vaccinated 0 to 5 months earlier) and having an emergency department or laboratory-only (vs outpatient) visit or chronic kidney disease were significantly linked to lower chances of prescription.

"There is a need to identify and address treatment barriers and raise awareness and understanding among providers and patients around oral antiviral eligibility, prescribing considerations, and proven benefits," the authors wrote.

New Jersey meat processor Fratelli Beretta USA has recalled about 11,000 pounds of its Busseto Food brand ready-to-eat charcuterie products after the Minnesota Department of Agriculture detected Salmonella in a product sample.

In a recall notice, the US Department of Agriculture (USDA) Food Safety Inspection Service (FSIS) said it is working with the Centers for Disease Control and Prevention and state health partners to investigate a multistate Salmonella outbreak. The positive sample that Minnesota officials found came from an unopened product sample as part of an illness investigation.

More cases likely

On January 2, the Minnesota Department of Health (MDH) said one Minnesotan got sick in December after eating a Busseto brand charcuterie sample bought at Sam's Club. The patient wasn't hospitalized. The MDH said that, since many patients infected with Salmonella don't seek medical care, the number of affected people is likely to be higher.

The FSIS recall notice said the sampler pack was produced on October 30, 2023, and was sold as a twin-pack containing two 9-ounce trays containing prosciutto, sweet sopressata, and dry coppa with the lot code L075330300 and best-if-used-by date of April 27, 2024.

Products subject to the recall were shipped to Sam's Club distribution centers in eight states: Georgia, Illinois, Indiana, Minnesota, North Carolina, Ohio, Oklahoma, and Texas. The FSIS said it is concerned that the products may still be in customer's refrigerators. It urged people not to consume them and to throw the products away or return them to the place of purchase.

The city of Dourados in Brazil's Mato Grosso del Sul state yesterday became the country's first to launch a mass dengue vaccination campaign.

In a prefecture statement today, officials said 537 doses were given on the first day of the campaign, which was developed by the municipal health department in a partnership with Takeda, which produces the Qdenga vaccine.

Targeting 150,000 people between ages 4 and 59 years old, the dengue vaccine will be administered in two doses, 3 months apart.

Prefecture health secretary Waldno Lucena, MD, said, "Dourados has been an example for the entire country, vaccination strengthens individual defenses and also contributes to building a collective barrier against the spread of dengue."

Newly approved vaccine

Brazilian drug regulators approved the Takeda vaccine in March 2023. The live attenuated vaccine, given subcutaneously, is built on a serotype 2 backbone and targets all four dengue serotypes.

The Americas region experienced record dengue activity in 2023, with Brazil the hardest-hit country, with more than 2.9 million cases. The World Health Organization last month noted a marked rise in dengue activity over the past two decades and warned that multiple factors could fuel further rises, including vector distribution changes, climate change, El Nino weather pattern consequences, and fragile healthcare systems.

Most US hospitals now meet the antibiotic stewardship standards set by the Centers for Disease Control and Prevention (CDC), according to a paper published today in Open Forum Infectious Diseases.

Using data from the National Healthcare Safety Network Annual Hospital Survey, CDC researchers found that 95% of US acute care hospitals reported using all seven of the CDC's Core Elements of Hospital Antibiotic Stewardship Programs (ASPs), up from just 41% in 2014. Across all survey years, uptake has been highest in large and teaching hospitals and lowest in small, critical access, and non-teaching hospitals.

The CDC has been monitoring uptake of the core elements—hospital leadership commitment, accountability, pharmacy/stewardship expertise, action, tracking, reporting, and education—since they were published in 2014. The CDC's objective was to help hospitals develop ASPs by outlining the structural and procedural components associated with successful programs.

While only 10% of hospitals reported uptake of all six Priority Elements, which highlight a subset of ASP implementation approaches considered highly effective by experts, 46% of hospitals reported uptake of four or five of those elements. In addition, 91% of hospitals reported monitoring antibiotic resistance patterns at least annually, and 74% said they tracked antibiotic use at least quarterly.

The CDC noted that hospitals have also made progress on uptake of recommended best practices, with 76% reporting implementation of prospective audit and feedback and 64% reporting that their ASP was co-led by a physician and pharmacist in 2021 (up from 23% in 2015). From 2014 to 2020, the percentage of ASPs that had a formal statement of support from hospital leadership rose from 53% to 97%.

Unclear impact on antibiotic use

Despite the signs of progress, the authors of the paper note that there has not yet been convincing evidence at the national level that increased implementation of the core elements has improved antibiotic use (AU) in US hospitals.

"The data in this report demonstrate that US hospitals have built a strong foundation for antibiotic stewardship," they wrote. "Our goal must now be to translate that infrastructure into even more effective interventions to improve AU."