News Scan for Jan 25, 2021

News brief

French study finds high antibiotic use in COVID-19 patients

Antibiotics were widely prescribed to hospitalized COVID-19 patients at Dijon University Hospital in France during the first wave of the pandemic but did not have any impact on outcome, French researchers reported yesterday in the International Journal of Infectious Diseases.

To assess the potential usefulness of empiric antibiotic therapy in patients hospitalized with COVID-19, hospital researchers conducted a retrospective study of all patients hospitalized for a confirmed COVID-19 infection from Feb 27 through Apr 30, 2020. They collected clinical, biologic, treatment, and outcome data, then compared the characteristics and outcomes of patients treated with and without antibiotics using propensity score matching.

Of the 220 patients included in the study, 174 (78%) were treated with antibiotics, most frequently amoxicillin-clavulanic acid (95 patients, 55%) and third-generation cephalosporins with or without macrolides (25, 14% and 27, 16%, respectively). No bacterial co-infections were documented.

Univariate analysis found that patients treated with antibiotics were significantly older, frailer, and had more severe disease on admission, and an unfavorable event (death or transfer to the intensive care unit) was more frequent in patients with antibiotic therapy than those without (hazard ratio [HR], 2.94; 95% confidence interval [CI], 1.07 to 8.11). In the multivariate analysis, however, antibiotic therapy was not significantly associated with outcome (HR, 1.612; 95% CI, 0.562 to 4.629), and no significant association between antibiotic use and outcome was observed on the propensity score matching (HR, 1.238; 95% CI, 0.77 to 2.00).

The study is the latest to document high antibiotic use in COVID-19 patients in the early months of the pandemic. The authors say the findings indicate that antibiotics should not be prescribed systematically for COVID-19 unless there is strong suspicion or proof of bacterial co-infection.
Jan 24 Int J Infect Dis study


Poor sanitation promotes antibiotic resistance, study reveals

Poor sanitation may play a significant role in selecting for antibiotic-resistant bacteria among residents, according to a study conducted in one of Africa's largest slums.

In the 5-month longitudinal study, published late last week in Antimicrobial Resistance and Infection Control, researchers with Washington State University, Kenya Medical Research Institute, and the US Centers for Disease Control and Prevention (CDC) selected 200 households from two villages in Kibera, an informal settlement in Nairobi, Kenya, for biweekly interviews that included questions on water, sanitation, hygiene, and antibiotic use practices. They also collected stool, hand swab, and drinking water samples to analyze for the presence of antibiotic-resistant bacteria. Escherichia coli isolated from the samples were tested against nine antibiotics from seven classes.

The analysis of E coli isolates found that 87.4% of stool, 83% of hand swab, and 79.7% of water sample isolates were resistant to at least one antibiotic, and 80% of all presumptive E coli isolates were resistant to at least three antibiotics. Stool isolates were resistant to trimethoprim (81%), sulfamethoxazole (80%), ampicillin (68%), streptomycin (60%), and tetracycline (55%).

Interviews found that 97 households (48.5%) reported using an antibiotic in at least one visit over the study period, for a total of 144 antibiotic episodes and 190 doses. Children in the households had 5 times the number of antibiotic episodes reported by adults (96 vs 19).

Multivariable regression models indicated antibiotic use within the household was not a significant risk factor for resistance to any of the nine antibiotics tested in adults and was only associated with resistance to two antibiotics in children. Enrolled children eating soil from the household compound and the presence of a common hand-washing station were both associated with an increased load of antibiotic-resistant E coli at the household and individual levels.

The authors concluded that while the presence of resistant bacteria appeared to be more affected by poor sanitation and environmental contamination, antibiotic use in the community could still play a role in promoting antibiotic resistance.

"Kibera experiences sanitation challenges that promote disease transmission and demand for antibiotics within a highly dense population," they wrote. "Under these conditions it is likely that selection of antibiotic-resistant bacteria within the gut, their disposal and enrichment within the environment, and recurrent transmission to humans occurs continuously."
Jan 22 Antimicrob Resist Infect Control study


CWD detected in new Wyoming hunting area

Wyoming wildlife officials announced last week that chronic wasting disease (CWD) has been confirmed in a new deer hunting area, according to an announcement from the Wyoming Game and Fish Department.

The disease was found in a mule deer buck found dead east of Pinedale in deer hunt area 138. Pinedale is in west central Wyoming near the southwest slope of the Wind River Mountains.

The hunting area where the buck was found borders two areas where CWD was confirmed in the past, to the north in 2017 and to the northeast in 2015.

Wyoming officials said personnel tested more than 6,300 samples for CWD in 2020 as part of efforts to track CWD and gauge possible management options for deer and elk. It added that the CDC recommends that hunters avoid eating meat from animals that are obviously sick or test positive for CWD, a prion disease that is always fatal to the animals that infects, which are members of the deer family and include elk and moose.
Jan 20 Wyoming Game and Fish Department press release

COVID-19 Scan for Jan 25, 2021

News brief

NFL COVID-19 tracking yields lessons for fine-tuning control measures

An intensive COVID-19 prevention and surveillance system that the National Football League (NFL) put in place this season identified certain types of risky in-club transmission, which helped officials revise its high-risk contact definition and improve its protocols.

Representatives from the NFL and their colleagues, including Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy, publisher of CIDRAP News, detailed their findings today in Morbidity and Mortality Weekly Report (MMWR).

As part of the NFL's COVID-19 measures established last July, players and staff wore masks, physically distanced, were frequently tested, and wore proximity devices to assist with contact tracing. Through the end of November, 329 (2.9%) cases were found among about 11,400 players and staff.

Through early September, fewer than 10 cases were found per week, but during the last week of September and into October, there were 41 cases, 21 from inter-team transmission linked to a single club, which led to temporary closure of the facility. The increase mirrored the national increase in cases.

Contact tracing found several transmission instances that occurred during less than 15 minutes of exposure within 6 feet. Interviews found that short exposures included unmasked meetings in small rooms or while eating.

The NFL implemented several changes after the cluster of cases, which included shifting to a more intensive protocol—such as more frequent testing, avoiding higher-risk activities, and a focus on finding high-risk contacts—after someone tested positive. Some high-risk activities included ridesharing in personal vehicles and eating and drinking in close proximity.

Efforts helped decrease facility exposures, even though US COVID-19 transmission continued to rise over the same time span.

The authors wrote that COVID-19 prevention steps should be continually optimized based on available data, and even though the NFL's protocols were resource-intensive, strategies such as more clearly characterizing close contacts and crafting more intensive protocols could apply to other settings, such as essential workplaces, nursing homes, and schools.
Jan 25 MMWR report


Pending results support full-dose anticoagulants for some COVID patients

Full-dose blood thinners are both safe and reduce vital organ support for moderately ill hospitalized COVID-19 patients, according to a National Institutes of Health (NIH) press release late last week.

While the three international trials investigating this matter have not been published yet, the NIH says that interim data for more than 1,000 moderately ill patients who received full doses of blood thinners (anticoagulants) showed superior results compared with lower dose levels.

The results also inspired further study to see if the treatment can lower COVID-19 mortality rates.

The NIH is drawing its conclusions from the Randomized, Embedded, Multi-factorial Adaptive Platform Trial for Community-acquired Pneumonia (REMAP-CAP) Therapeutic Anticoagulation; Accelerating COVID-19 Therapeutic Intervention and Vaccines-4 (ACTIV 4) Antithrombotics Inpatient; and Antithrombotic Therapy to Ameliorate Complications of COVID-19 (ATTACC) trials. "Moderately ill" was defined as hospitalized patients who did not need intensive care unit (ICU) admission or organ support such as mechanical ventilation at the time of recruitment.

"The trial investigators are now working as fast as possible to make the full results of the study available so clinicians can make informed decisions about treating their COVID-19 patients," NIH said in the press release. "The trial results reported today complement the group's findings announced in December that routine use of full-dose anti-coagulation when started in the ICU in critically ill COVID-19 patients was not beneficial and may have been harmful in some patients."

Because of the promising results, all three trials have stopped enrollment. Mary Cushman, MD, ACTIV 4 trial investigator, told MedPage Today, "Based on the very stringent criteria used to stop the trial, I would change my practice. In other words, it is unlikely there would be a reversal of the finding."

ATTACC principal investigator Ryan Zarychanski, MD, tweeted, "This will define a new standard of care for patients with COVID-19 in hospital but not on life support."
Jan 22 NIH press release
Jan 22 MedPage Today


Young kids unlikely to increase COVID rates during lockdown, study finds

Children 1 through 10 years old were unlikely to have increased COVID infection rates in southwest Germany in late spring 2020 during stay-at-home orders, according to a study published late last week by JAMA Pediatrics.

The researchers found that having a parent who was seropositive for COVID antibodies and a child who wasn't was 4.3 times more likely than having a child who was seropositive and a parent who was seronegative (95% confidence interval [CI], 1.19 to 15.52). Besides indicating children's low role in transmission, the researchers say the results can directly affect decisions to reopen childcare and schools.

The data quantified SARS-CoV-2 RNA and antibody prevalence in 2,482 child-parent pairs in Baden Württemberg, Germany, which had the second-highest case ratios in the country at 337 per 100,000 people. The researchers found 1.8% of parents had COVID antibodies, compared with 0.6% of children (95% CI, 1.2% to 2.4% and 0.3% to 1.0%, respectively). Virus-neutralizing activity was detected in 94.3% of the 70 immunoglobulin G–positive serum samples.

Only 2 participants (0.04%), a child-parent pair, tested positive for SARS-CoV-2 RNA.

During the study's duration, from Apr 22 to May 15, 2020, the country had closed schools and non-emergency daycares, but the 23.4% of children who attended emergency daycares did not have significantly different COVID rates. Younger children appeared to have lower seropositivity rates, though: 0.8% in children 1 through 5 years versus 1.0% in children 6 through 10.

"This SARS-CoV-2 prevalence study, which appears to be the largest focusing on children, is instructive for how ad hoc mass testing provides the basis for rational political decision-making in a pandemic," the researchers write.
Jan 22 JAMA Pediatr study

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