Stewardship intervention linked to reduced antibiotic use in pediatric long-term care

News brief

Young girl in hospital — Dragos Condrea / iStock

An antimicrobial stewardship intervention at a pediatric long-term care facility (LTCF) was associated with sustained reductions in ciprofloxacin and other antibiotic use without increasing negative outcomes, researchers reported today in Pediatrics.

While antimicrobial stewardship programs (ASPs) are now well-established in US hospitals, they haven't been widely implemented or studied in pediatric LTCFs, where the risk of bacterial infections is elevated by factors such as indwelling devices, ventilator dependence, and impaired mobility. The ASP implemented at Totally Kids Specialty Healthcare-Sun Valley in 2014 aimed to reduce prescribing of ciprofloxacin for tracheitis in children with tracheostomy tubes.

To assess the impact of the intervention, which involved multidisciplinary education of physicians, staff, and families, researchers from the University of California Los Angeles compared ciprofloxacin use, other antibiotic use, infections, and mortality during the 5 years prior to the intervention (2009 to 2013) and the 8 years after the intervention (2015 to 2022). A total of 199 patients, a majority of whom had tracheostomy tubes (96%) and were ventilator-dependent (58%), were included in the study.

Reductions in ciprofloxacin, overall antibiotic use

Ciprofloxacin use declined from 17 antibiotic days per 1000 facility patient days to 4 days, a 76% reduction from pre- to post-intervention, while non-ciprofloxacin antibiotic use fell by 69%. Antibiotic courses for tracheitis decreased 89%, from a baseline of 38 to 4 treatment courses per 6 months post-intervention. No increases in positive blood or urine cultures, hospitalizations, mortality, or need for hospital antibiotics was observed.

The study authors attribute the decline in ciprofloxacin use to physicians shifting their diagnosis of bacterial tracheitis to alternatives such as viral infections or asthma exacerbations. But the decline in non-ciprofloxacin antibiotic use was an unexpected bonus.

"These reductions in overall antibiotic use imply broader changes in diagnosis and prescribing patterns among our clinicians," they wrote. "Although our ASP was directed mainly at ciprofloxacin for tracheitis treatment and not other antibiotic use, we believe that clinicians applied ASP principles to febrile illnesses in general."

The authors add that the results may be generalizable to other pediatric LTCFs.

These reductions in overall antibiotic use imply broader changes in diagnosis and prescribing patterns among our clinicians.

China reports fatal H5N6 avian flu case

News brief

Lisa Schnirring

China has reported another H5N6 avian flu infection, which involves a 70-year-old woman who was sick in the middle of June and has died from her illness, Hong Kong's Centre for Health Protection (CHP) said today in a statement.

market chickens — *Adam Cohn / Flickr cc*

The woman is from Hefei, the capital of Anhui province in eastern China. Her symptoms began on June 17, following a visit to a live poultry market. She was hospitalized on June 19 and died on July 8.

Highly pathogenic H5N6 is known to circulate in China's poultry and in a few other Asian countries. However, only China and Laos have reported human cases, which are often severe or fatal.

China has now reported four H5N6 cases for 2024. It reported its last illness in June, which involved a man from Fujian province who also died from his infection. Since the first human infections were reported in 2014, China has now reported 92 cases.

Pandemic disbelief identified as key factor in vaccine hesitancy

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Stephanie Soucheray, MA

A new study among Hispanic people in the United States suggests that an initial disbelief in the COVID-19 pandemic contributed to vaccine hesitancy among that population, especially among parents making vaccine decisions for their children. The study is published in PLOS One.

Vaccine hesitancy is usually linked to safety concerns, but this study proposes that those concerns are not the total picture and that more research needs to be undertaken on Latino attitudes towards vaccination.

"The Hispanic/Latino/Latinx community makes up 19% of the United States population yet accounted for 24.5% of SARS-CoV-2 (COVID-19) cases, second highest only to non-Hispanic Whites," the authors said. "Although 84% of Latinx adults over 18 years had completed the primary series of COVID-19 vaccines by March 2023, this community has been impacted by systemic inequities that have resulted in disproportionate health outcomes."

The study was based on an online survey completed by 290 Latino parent and adolescent dyads from a Southwestern metropolitan area of the United States. The survey was given twice, initially between August 2020 and March 2021 and 1 year later.

Youth disbelief played role in parents' vaccines hesitancy

Among other questions, parents were asked to rate their agreement with the statement, "The COVID-19 pandemic is a conspiracy," and youth rated their agreement with the statement, "The COVID-19 pandemic is fake or not real."

Overall, there was high vaccine uptake in the sample, with 88% of parents and 80% of youth receiving at least one dose of the COVID-19 vaccine.

Most notable, however, was the role of youth pandemic disbelief (belief the pandemic was a conspiracy or not real) in vaccine hesitancy: In addition to youths' pandemic disbelief predicting their own vaccine hesitancy, the authors wrote, it also predicted their parents’ vaccine hesitancy.

Parents are often thought of as the key decision maker for children under the age of 18.

"Parents are often thought of as the key decision maker for children under the age of 18, and although the final decision may rest with them, our findings suggest that their child’s perspective, particularly around disbelief, may be part of this decision-making process," the authors concluded.

UK group to fund multidisciplinary research into antimicrobial resistance

News brief

Chris Dall, MA

UK Research and Innovation (UKRI) this week announced it has dedicated £4.8 million ($6.2 million US) to fund eight networks working on different aspects of antimicrobial resistance (AMR).

The networks will tackle AMR across an array of sectors and disciplines, including agriculture, food, human medicine, veterinary medicine, social sciences, and the environment. They include the AMR in Agrifood Systems Transdisciplinary Network, the Fungal One Health and Antimicrobial Resistance Network, the People AMR Network, and the Futures AMR Network.

"Tackling the creeping pandemic of antimicrobial resistance—increasing resistance to antibiotics—is a large, complex problem," Colin Miles, PhD, head of Strategy, Advanced Manufacturing, and Clean Growth at UKRI, said in a press release.

"Rather than taking single-discipline approaches, we need researchers from across disciplines to come together and look at all aspects of the problem—from human behaviour and how we grow crops and rear animals for consumption to how we manage the environment or use technology, clinical management strategies and challenging established cultural norms."

The eight networks are among a number of groups that UKRI is funding to investigate and better manage infectious disease threats, one of the five strategic themes identified by the group as an existential threat to humanity.