Stewardship / Resistance Scan for Jun 25, 2020

News brief

Public-private partnership aims to boost AMR surveillance in Africa

Pfizer and Wellcome Trust yesterday announced a new partnership with the governments of Kenya, Malawi, Ghana, and Uganda to track antimicrobial resistance (AMR) in those countries.

The Surveillance Partnership to Improve Data for Action on Antimicrobial Resistance (SPIDAAR) is a multi-year, public-private collaboration that will provide governments and health officials in the four countries with comprehensive data on AMR patterns and the burden of drug-resistant infections on patients.

Planning for the SPIDAAR began in 2019 with teams identifying health facilities in the four countries. The next phase will initiate surveillance programs at the selected facilities. The program will include a separate, prospective real-world data study to assess AMR rates in each country and the clinical costs of hospital-acquired infections.

"Drug-resistant infections are a huge global health threat, undermining advances in medicine and reversing health progress in countries like Ghana, Kenya, Malawi, and Uganda over the last 20 years," Gemma Buckland Merrett, PhD, Wellcome's science lead for drug-resistant infections, said in a Pfizer press release. "Only through effective surveillance in hospitals and all healthcare settings can we gather the information essential to understand and track these dangerous infections, stop the spread, and protect patients."

Program data will be made available on Pfizer's Antimicrobial Testing Leadership and Surveillance (ATLAS) platform and Wellcome's AMR Register.
Jun 24 Pfizer press release

AMR stable, antibiotic use down in the Netherlands, new report finds

A report today from Dutch health officials indicates that AMR patterns in the Netherlands remained stable in 2019 and that primary care physicians and veterinarians are prescribing fewer antibiotics.

The NethMap 2020 report shows that for most antibiotics, there have been very few statistically significant and clinically relevant shifts in resistance levels since 2015, both in general practices (GPs) and hospitals in the Netherlands. Most notably, the percentage of highly resistant microorganisms (HRMOs) and multidrug-resistance in Enterobacteriaceae remained stable in both settings, at less than 5% in GPs and less than 10% in hospitals. Among specific pathogens, vancomycin-resistant Enterococcus prevalence (less than 1%) and methicillin-resistant Staphylococcus aureus prevalence (less than 2%) remained low.

"For now, the data on resistance look encouraging," the authors of the report wrote.

Total systemic antibiotic use in outpatients also fell slightly, dropping to 8.68 defined daily doses (DDD) per 1,000 inhabitant days. Inpatient use increased to 90.7 when expressed as DDD/100 patient-days but remained stable at 339.7 when expressed as DDD/100 admissions. In veterinary medicine, sales of antibiotics fell by 16.1% compared with 2018 and by 70% compared with the index year 2009.

AMR in the various animal husbandry sectors also remained stable or decreased slightly, with the percentage of extended-spectrum beta lactamase-producing bacteria declining in all sectors, most dramatically in broiler chickens and chicken meat.

"In recent years, extra measures have been taken in the Netherlands to combat antibiotic resistance," the authors said. "These measures extend beyond the healthcare system because resistant bacteria also occur in animals, in foodstuffs and in the environment. That is why a 'One Health' approach is used in the Netherlands."
Jun 25 NethMap 2020 report

News Scan for Jun 25, 2020

News brief

Chilblains unrelated to COVID-19 infection, 2 studies conclude

Chilblains—which in this pandemic have been referred to as "COVID toes"—are not a sign of COVID-19 infection but rather a result of sedentary lifestyles linked to community lockdown measures and a lack of warm footwear, two small studies published today in JAMA Dermatology have found.

In a study involving 31 patients with chilblains, 11 of them teenagers, from Apr 10 to 17 at a Brussels hospital, none tested positive for SARS-CoV-2, the virus that causes COVID-19, on reverse-transcription polymerase chain reaction (RT-PCR) or had antibodies against the virus on serologic testing.

Biopsies of 22 skin samples showed no evidence of the virus. Twenty of 31 patients (64%) reported mild symptoms characteristic of coronavirus, and 3 (10%) reported contact with a person who tested positive for COVID-19.

Nine of 31 patients (29%) had a history of chilblains, and 4 (13%) had Raynaud's syndrome. Twenty patients (64%) said they had been less physically active than normal while in lockdown, and most said they remained in socks or barefoot most of the day.

A separate study of 20 pediatric patients hospitalized in Spain from Apr 9 to 15 with acral lesions (on the hands and feet) had no clinical signs of COVID-19, tested negative on RT-PCR, and had no antibodies against the virus on serologic testing. Histologic testing revealed that the lesions were chilblains.

Nine of 20 patients (45%) had a history of Raynaud's syndrome or chilblains, and 15 (75%) said they walked barefoot around their house during quarantine. Only 2 lived in a home with heat. "Other studies with improved microbiologic tests or molecular techniques aimed at demonstrating the presence of SARS-CoV-2 in the skin may help to clarify this problem," the authors wrote.

Chilblains are a painful inflammatory response of small blood vessels in the hands and feet caused by repeated exposure to cold air. Raynaud's syndrome is a narrowing of the small arteries that supply blood to the skin in response to cold temperatures or stress, limiting blood flow and causing feelings of numbness and cold.
Jun 25 JAMA Dermatol chilblains study and acral lesions study

Study shows high all-cause death rates at nursing homes in pandemic

A Harvard University study has revealed significant clinical burden and high death rates at skilled nursing facilities (SNFs) in Cleveland, Detroit, and New York City during the COVID-19 pandemic.

According to a research letter published yesterday in JAMA, 3,853 residents of 189 SNFs died from any cause from March to May 2020, versus 1,765 during the same period in 2019.

In Cleveland facilities, a mean of 6.3 of 1,000 residents died each week in 2020, compared with 4.9 per 1,000 residents in 2019, but the difference was not statistically significant. In Detroit facilities, a mean of 7.9 per 1,000 residents died each week in 2020, versus 3.5 in 2019, while a mean of 13.8 per 1,000 residents died in 2020 in New York City, compared with 4.1 in 2019.

During the peak of the outbreak in Detroit skilled SNFs in April, 17.4 per 1,000 residents died, compared with 4.0 in the same week in 2019, while in New York City, those figures were 36.3 versus 3.7.

Weekly admissions and patient census fell from March to May 2020 compared with the same period in 2019 at facilities in all three cities (mean, 91 vs 105 in Cleveland, 103 vs 130 in Detroit, and 235 vs 284 in New York City).

"These results suggest that SNFs experienced substantial clinical challenges during the COVID-19 pandemic," the authors wrote. "Mortality increased quickly, raising concerns about the capacity of SNFs to respond to outbreaks. Compounding the challenge, decreased patient census may lead to reductions in revenue at a time when SNFs have the greatest need for additional resources to manage and prevent future outbreaks."
Jun 24 JAMA research letter

CDC notes sharp rise in Salmonella infections linked to backyard poultry

One person has died and more than 368 additional people have been infected with Salmonella from live backyard poultry, according to a Centers for Disease Control and Prevention (CDC) update yesterday.

The new infections bring the outbreak total to 465 infections in 42 states. The CDC first reported the outbreak on May 20.

Illness onset dates range from Jan 14 to Jun 1, with patients ranging in age from less than 1 year to 88 years, with a median age of 31, the CDC said. Eighty-six patients have required hospitalization, and one death has been reported in Oklahoma.

"In interviews with 226 ill people, 179 (79%) reported contact with chicks and ducklings," the CDC said. "People reported obtaining chicks and ducklings from several sources, including agricultural stores, websites, and hatcheries."

The CDC said people who tend to backyard flocks must be vigilant about hand hygiene and should supervise children around the animals. Children under the age of 5 shouldn't touch backyard poultry, as young children are more susceptible to Salmonella.
Jun 24 CDC update
May 20 CIDRAP News scan on initial notice