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