News Scan for May 14, 2020

News brief

Study shows rising use of second-, third-line antibiotics in Indian hospitals

Use of second- and third-line antibiotics and fixed-dose combinations (FDCs) of antibiotics increased over a 10-year period at two Indian hospitals, a team of Swedish researchers reported yesterday in BMC Infectious Diseases.

In the study, researchers from Karolinska Insitutet looked at antibiotic prescribing practices at a teaching hospital and a non-teaching hospital in Madhya Pradesh, a large state in central India. The hospitals were selected because they were representative of most healthcare facilities in low- and middle-income countries, where the infectious disease burden is often high and antibiotic resistance is a common cause of mortality in patients with infectious disease.

Antibiotic prescription data were analyzed using the World Health Organization (WHO) classification system, which categorizes antibiotics under the Access, Watch, and Reserve labels based on the risk of antibiotic resistance. Access antibiotics are first-choice antibiotics that should be widely available, while Watch antibiotics are drugs that should be used only for specific indications, and Reserve antibiotics should be used only when other antibiotics don't work. FDCs, which are not recommended because they have been shown to drive resistance, consist of at least two antibiotics, often from different classes.

The researchers analyzed prescribing data on a total of 3,766 patients with infections—2,504 in the non-teaching hospital and 1,262 in the teaching hospital—and 92% and 98%, respectively, received antibiotics. Sixty-one percent of total prescriptions in the teaching hospital and 40% in the non-teaching hospital were for the Access category of antibiotics, while Watch category antibiotics comprised 29% and 40% of total prescriptions in the teaching and non-teaching hospital, respectively. Prescribing of FDCs of antibiotics was significantly higher in the non-teaching hospital (18%) than in the teaching hospital (8%, P < 0.05).

From 2008 through 2017, prescribing of all categories of antibiotics and FDCs increased significantly in the non-teaching hospital. Although overall antibiotic prescribing at the teaching hospital did not change significantly, prescribing of Watch and Reserve antibiotics increased, as did FDCs. Total antibiotic prescribing among patients with pneumonia, peritonitis, and cellulitis increased in both hospitals.

The authors say the establishment of antibiotic stewardship programs based in the WHO classification system, along with the implementation of routine diagnostics, could improve antibiotic prescribing.
May 13 BMC Infect Dis study

Board game helps improve AMR knowledge, Saudi study find

The results of a study conducted in Saudi Arabia suggest that the use of a board game can significantly increase knowledge of antimicrobial resistance (AMR), with better retention than a conventional lecture, researchers reported yesterday in BMC Public Health.

Using a single-blinded parallel-group randomized controlled design, researchers from the College of Dentistry at Umm-Al Qura University randomized 93 volunteers into two groups. Participants in the study group received information about AMR by playing a board game involving dice and flash cards with questions and information. The control group received the same information but by a conventional lecture. Participants filled out questionnaires to test their knowledge at three different time points: (T1) before the intervention, (T2) immediately after the intervention, and (T3) 1 month after the intervention for follow-up to evaluate their retention of the information.

The results showed significant improvements (P < 0.05) in knowledge scores for T2 and T3 in comparison to the T1 baseline scores in both groups. The knowledge scores also relapsed significantly from T2 to T3 in both groups, but the reduction of total knowledge scores from T2 to T3 was significantly greater in the control group than in the study group (P = 0.002), and the improvements in total knowledge scores from T1 to T3 were significantly higher in the study group than in the control group (P < 0.001). The overall mean knowledge score at T3 was also higher in the study group than the control group.

"Gamification using board games seems to be a promising tool for promotional efforts to improve public health knowledge about AMR in relation to dental treatment, as well as other oral health care topics," the authors wrote. "A board game is easy and affordable for use in middle and low socioeconomic communities, and this game provided good levels of retention of information about AMR. Nevertheless, further studies are needed to generalize this study's results."
May 13 BMC Public Health study

COVID-19 Scan for May 14, 2020

News brief

COVID-19 can infect dogs and cats, spread among cats, studies find

Two of 15 dogs who shared homes with humans infected with COVID-19 in Hong Kong were also infected, according to a study published today in Nature, and a separate study details experimental infections of cats.

In the first study, RNA from SARS-CoV-2, the virus that causes COVID-19, was detected in a 17-year-old male Pomeranian on five swabs collected over 13 days and twice in a 2-year-old male German shepherd; virus was isolated from nasal and oral swabs from that dog.

Both dogs, who remained asymptomatic, had developed antibodies to the disease, and the genetic sequences of their viruses were identical to those of their infected owners. "The evidence suggests that these are instances of human-to-animal transmission of SARS-CoV-2," the authors said. "It is unclear whether infected dogs can transmit the virus to other animals or back to humans."

The researchers also noted that the virus that causes SARS (severe acute respiratory syndrome) was also detected in domestic cats and a dog during the 2003 global outbreak of that disease, which was also caused by a novel coronavirus.
May 14 Nature abstract

In the second study, researchers in the United States and Japan have found that cats can easily become infected with COVID-19 and spread the disease to other cats, according to a letter published yesterday in the New England Journal of Medicine.

The authors inoculated three cats with SARS-CoV-2 isolated from a human patient. Within 3 days, the virus was detected in nasal swabs from all three cats.

The day after inoculation, the scientists placed a non-infected cat in the cages of each infected cat. Within 6 days, all six cats were shedding the virus, as detected in nasal, but not rectal, swabs. The cats continued to shed the virus for as long as 6 days. But the cats never showed symptoms.

The researchers said that people with COVID-19 symptoms should avoid contact with cats and that cat owners should keep their pets indoors.

"If they are quarantined in their house and are worried about passing COVID-19 to children and spouses, they should also worry about giving it to their animals," Peter Halfmann, PhD, a coauthor and professor at the University of Wisconsin at Madison, said in a press release.
May 13 N Engl J Med letter and press release

Study shows a fourth of COVID-19 YouTube videos misinform

A study today in BMJ Global Health found that 27.5% of screened YouTube videos contained misinformation about the novel coronavirus and the disease it causes, COVID-19.

To perform the study, researchers conducted a YouTube search on Mar 21 of English-language videos using the keywords "coronavirus" and "COVID-19," and the top 75 viewed videos from each search were analyzed.

Sixty-nine of the screened videos were included in a content analysis, 19 (27.5%) of which contained inaccurate statements about the virus, including racial conspiracy theories, or misinformation about vaccine development. Those 19 videos got more than 62 million views worldwide; of the 19 non-factual videos, 6 were from entertainment news (32%), 5 were from network news (26%), 5 were from internet news (26%) and 3 were from consumer videos (13%), the authors said. Videos by healthcare professionals and government agencies did not contain inaccuracies.

"As the current COVID-19 pandemic worsens, public health agencies must better use YouTube to deliver timely and accurate information and to minimise the spread of misinformation," the authors concluded. "This may play a significant role in successfully managing the COVID-19 pandemic."
May 14 BMJ Glob Health study

Health groups seek more transparency on remdesivir distribution

The Infectious Diseases Society of America (IDSA) and the HIV Medicine Association (HIVMA) today requested a meeting with White House Coronavirus Task Force coordinator Deborah Birx, MD, to discuss continuing concerns about how the antiviral drug remdesivir is being distributed.

The request comes a week after the groups called on Vice President Mike Pence and other members of the Trump administration to be more transparent about how and where the drug, which showed the ability to reduce recovery time in COVID-19 patients in an as-yet unpublished National Institute of Allergy and Infectious Diseases (NIAID) trial, is being distributed to US hospitals. Following that letter, the Department of Health and Human Services announced that doses of remdesivir were being delivered to health departments in six states (Connecticut, New Jersey, Illinois, Iowa, Maryland, and Michigan).

In the letter to Birx, who is now overseeing distribution of the drug, IDSA President Thomas File, MD, MSc, and HIVMA Chair Judith Feinberg, MD, FIDSA, said they supported the strategy to distribute remedesivir through state health departments, but are concerned about regional availability and patient surges across state lines.

They want to meet with Birx to discuss what data is being used to determine how to distribute the drug, what guidance is being given to states as they receive their allotments, how the administration plans to ensure that the drug is reaching populations disproportionately impacted by COVID-19, and whether the drug is being allocated in adequate amounts to safety-net hospitals.

"We are writing because we and many of our members are concerned about continuing uncertainties about how remdesivir will be distributed which are substantially hampering our ability to care for patients with COVID-19," File and Feinberg wrote.

They also asked that data from the NIAID trial be made publicly available so that hospitals can prioritize which patients will receive limited supplies of remdesivir.

The Food and Drug Administration granted an Emergency Use Authorization for remdesivir on May 1. Drug maker Gilead Sciences has committed to supply 607,000 vials of the drug to the United States over the next 6 weeks.
May 14 IDSA/HIVMA letter