Stewardship / Resistance Scan for Jan 29, 2019

News brief

Pooled data show pharmacists' input helpful in stewardship programs

A meta-analysis of 15 studies published yesterday in the Journal of Antimicrobial Chemotherapy concluded that antimicrobial stewardship programs (ASPs) involving pharmacists are effective in decreasing antibiotic prescribing and increasing guideline-adherent antibiotic prescribing by general practitioners (GPs).

For the study, Australian experts searched multiple databases for studies published up to February 2018 that met their inclusion criteria and included 15 studies that involved 18 randomized and non-randomized trials of ASPs involving pharmacists as interventionists to GPs.

Overall, researchers noted a 14% reduction in the antibiotic prescribing rate (APR) (odds ratio [OR], 0.86) and a doubling in the antibiotic prescribing adherence rate (APAR) (OR, 1.96) at 6 months median intervention follow-up. High-quality randomized trials showed an 8% decrease in APR and a 2.6-times increase in APAR. When pharmacists and GPs teamed up, ASPs were tied to a 7% lower APR and an increased APAR (OR, 1.72). Interventions involving pharmacist–infectious disease professional teams also decreased the APR (OR, 0.81) and increased the APAR (OR, 2.36).

The meta-analysis authors also noted that GP education plus prescribing feedback and group meetings were effective in both outcomes, whereas GP education, academic detailing, and workshop training were effective in APAR outcome. They add, "However, substantial heterogeneity was demonstrated."
Jan 28 J Antimicrob Chemother study

Study: No antibiotic benefits for hospital asthma exacerbation

Editor's note: On Jan 19, 2021, this study was retracted at the request of the authors and replaced with a corrected version, following a letter to the editor of JAMA Internal Medicine suggesting that the original study might be subject to immortal time bias. Please see the links below for the new findings, which differ from those of the original study.

Antibiotic therapy for patients hospitalized for asthma exacerbation isn't associated with better outcomes and shouldn't be routinely used in adults for that purpose, a research team based at the University of Massachusetts Medical School reported yesterday in JAMA Internal Medicine.

Though professional groups discourage empiric use of antibiotics for treating asthma exacerbation, use of the drugs is still high in the United States and other countries, they note. To see if adding them improves outcomes in hospitalized patients who also received corticosteroids, they looked at outcomes in a cohort of 19,811 patients hospitalized with asthma at 542 US acute care hospitals from January 2015 through December 2016 who received corticosteroids. Of the group, 8,788 (44%) got antibiotics in their first 2 days of hospitalization.

Compared with those who didn't get antibiotics, the group who got the drugs had significantly longer hospital stays, higher hospitalization costs, similar treatment failure rates, and higher risk of antibiotic-related diarrhea.

The team wrote that asthma exacerbation is an important cause of hospitalization and that decreasing inappropriate antibiotic use in that population fits well with the US Centers for Disease Control and Prevention's national strategy for combating antibiotic-resistant bacteria. They also emphasized that the short-term antibiotic treatment lacks effectiveness evidence and may be harmful and that more research is needed on strategies to curb antibiotic use in patients hospitalized for asthma exacerbation.
Jan 19, 2021, JAMA Intern Med notice of retraction and replacement
Jan 19, 2021, JAMA Intern Med comment and response
Jan 19, 2021, JAMA Intern Med editorial
Jan 19, 2021, JAMA Intern Med updated study

News Scan for Jan 29, 2019

News brief

Oman and Saudi Arabia report new MERS cases

Two Middle East countries reported new MERS-CoV cases today, including four in Oman and one in Saudi Arabia, according to separate health ministry announcements.

Oman's health ministry didn't have many details about the cases, but said the they are receiving care at a reference hospital, according to a statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The ministry said the new MERS-CoV (Middle East respiratory syndrome coronavirus) cases raise Oman's total since 2013 to 18. The country reported its last case in March of 2018.

Meanwhile, Saudi Arabia's health ministr,y in its epidemiological week 5 report, noted one more case, which involves a 38-year-old man from the city of Wadi Aldwasir in the south-central part of the country. The man is hospitalized, and an investigation found that he had contact with camels before he got sick.
Jan 29 AFD post
Jan 29 Saudi MOH report

Meta-analysis finds good accuracy for rapid tests for flu, other viruses

A meta-analysis of studies on rapid molecular tests for flu, respiratory syncytial virus (RSV), and other respiratory viruses found that they provide accurate results, but results on their clinical impact are conflicting, researchers from the Netherlands reported yesterday in Clinical Infectious Diseases.

They reviewed 63 separate reports from 56 studies that evaluated, as compared to conventional molecular tests, 13 commercial molecular rapid test products. Pooled sensitivity was 90.9% (95% confidence interval [CI], 88.7%-93.1%) and pooled specificity was 96.1% (95% CI, 94.2%-97.9%) for detecting either flu (29), RSV (1), flu virus and RSV (19), and a viral panel that included flu and RSV (14).

The 15 clinical impact studies varied widely by size and quality, leading to results that were inconclusive. However, the team found high-quality evidence that rapid testing might decrease the length of hospital stay and may increase the use of oseltamivir in patients who test positive for flu.

The group didn't observe any effect on antibiotic prescriptions, duration of antibiotic therapy, use of in-hospital isolation measurements, or the number of hospital admissions.

"We therefore suggest to consider implementation of rapid molecular tests within hospital settings and recommend performance of high-quality randomized studies," researchers concluded.
Jan 28 Clin Infect Dis abstract

Avian flu outbreaks strike birds in Nigeria, South Africa, Russia

In the latest highly pathogenic avian influenza outbreak developments, Nigeria and South Africa reported more H5N8 outbreaks on farms and Russia reported another H5 outbreak, this time involving a turkey farm, according to separate notifications from the World Organization for Animal Health (OIE).

Nigeria's outbreak, its second of the year involving H5N8, began on Jan 10 and affected a farm housing 13-week-old pullet in Bauchi state, located in the central part of the country. The virus killed 8 of 2,000 birds, and the surviving ones were culled as part of the outbreak response.

Meanwhile, South Africa reported five H5N8 outbreaks at ostrich farms in Western Cape Province that began between August and November of 2018. Taken together, the virus killed 133 of 6,533 susceptible birds at different locations, one of which was the city of Cape Town. The surviving birds were slated for stamping out.

Elsewhere, Russia's agriculture ministry reported another in a small but steady stream of H5 outbreaks affecting poultry in the west of the country. The latest event started on Jan 21 at a turkey farm in Rostov province, killing 51 of 16,177 birds. The rest were culled to curb the spread of the virus.
Jan 28 OIE report on H5N8 in Nigeria
Jan 28 OIE report on H5N8 in South Africa
Jan 28 OIE report on H5 in Russia

CDC calls Listeria outbreak tied to pork rolls over

The Centers for Disease Control and Prevention (CDC) today called an end to its investigation of a Listeria outbreak tied to Vietnamese pork patty rolls that hospitalized four people in as many states. The agency did not add any cases to the outbreak total since federal officials first announced it on Nov 21, 2018.

Officials in Louisiana, Michigan, Tennessee, and Texas reported cases. The date of first symptoms ranged from Jul 1, 2017, to Oct 24, 2018. Patients were women from 35 to 84 years old.

"As of January 29, 2019, this outbreak appears to be over," the CDC said. On Nov 20, the 165368 C. Corporation of Houston, doing business as Long Phung Food Products, recalled ready-to-eat pork products after the Listeria cases were announced. The bacterium is one of the more lethal to cause foodborne disease.
Jan 29 CDC update

Takeda's new dengue vaccine shows promise in late-stage trial

Today Japanese drug maker Takeda announced promising results of late-stage clinical trials of TAK-003, the company's new dengue vaccine.

According to Reuters, the vaccine performed well in the phase 3 TIDES trial, which assessed the safety and efficacy of the vaccine in 20,000 children in Asia and Latin America.

Takeda officials said blood samples taken before the trial began established whether children had been previously exposed to dengue, a step missed by Sanofi Pasteur when they were testing Dengvaxia, their dengue vaccine. Only after it had been approved for use, Dengvaxia was found to enhance dengue infections in children who were dengue-naive at the time of vaccination.

Takeda has not released details on how the vaccine performed, but told Reuters there were no significant safety concerns, and they would follow up with trial participants for 3 years. The company said it will be publishing full results from the trial in peer-reviewed journals.

TAK-003 is administered in two doses, given 3 months apart. The vaccine is based on a weakened dengue 2 virus, with genes from dengue 1, 3, and 4.
Jan 29 Reuters story
Jan 29 Takeda press release