Study shows global decline in antimicrobial use during COVID pandemic was short-lived

News brief

An analysis of global antimicrobial sales data suggests the decline in outpatient antimicrobial consumption (AMC) during the first two years of the COVID-19 pandemic was transient and likely linked to non-pharmaceutical interventions (NPIs), such as lockdowns, Japanese researchers reported last week in Clinical Microbiology and Infection.

Using the IQVIA MIDAS database, researchers from Japan's National Center for Global Health and Medicine examined monthly antimicrobial sales for 69 countries, comparing the change rate of AMC for 2020 over 2019, 2021 over 2020, and 2022 over 2021. While several studies have documented global decreases in AMC in 2020 and 2021, the persistence of the downward trend is unknown at the global level. But the study authors note that research by the US Centers for Disease Control and Prevention has shown a significant rebound in US AMC in 2022.

"If this reversal were in fact a global trend, it would mean that the success of AMR [antimicrobial resistance] control efforts is in part due to the COVID-19 pandemic, which in turn means that we must continue, as before, to focus on AMR countermeasures," they wrote.

Change in healthcare-seeking behavior

Of the 68 countries that had one or more changepoints in AMC after 2020, 61 experienced a decrease after the pandemic started in 2020, and 53 of 61 showed a reverse increasing trend in 2022. An interrupted time series analysis of G7 countries showed a decreasing trend in AMC after those countries implemented movement restrictions, and an increasing trend after restrictions were lifted.

The authors say the decreasing trend in antimicrobial use following implementation of movement restrictions was likely the result of fewer medical consultations and an indirect decrease in unnecessary antimicrobial use among the general population.

"In other words, this global decrease was not due to COVID-19 itself but was a consequence of the change in the healthcare-seeking behaviour of the general population, in addition to the reduced prevalence of infectious diseases caused by NPIs which include not only movement restrictions but also school closures, face covering recommendations and so forth," they wrote.

Nevada reports its first avian flu detection in dairy cattle as virus hits Iowa layer farm

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Lisa Schnirring

The Nevada Department of Agriculture on December 6 reported the state's first avian flu detection in dairy cattle, which involved a herd in Nye County, located northwest of Las Vegas.

Since H5N1 was first detected in US dairy cows in March, the virus has now infected herds in 16 states.

Though Nye County borders California, the area isn't adjacent to the Central Valley epicenter of California's ongoing outbreaks in dairy cattle.

According to the Nevada Dairy Farmers and Dairy Council of Nevada, a trade group, that state has just over 20 dairy farms, which range from 500 to more than 32,000 cows. Nationally, Nevada ranks 32nd in milk production.

More poultry outbreaks in 3 states

In poultry developments, the Iowa Department of Agriculture and Land Stewardship on December 6 reported its first outbreak since June, which involves a commercial layer farm in Sioux County in the northwestern corner of the state. Iowa is the nation's top egg-producing state, according to the Iowa Egg Council.

Also, the US Department of Agriculture (USDA) Animal and Health Inspection Service (APHIS) confirmed two more poultry outbreaks in separate states. One involves a commercial farm in California's Stanislaus County that has 44,000 birds and the other a backyard flock in Colorado's Pitkin County.

Survey of Pakistani pediatricians finds limited education, training in antibiotic stewardship

News brief

Chris Dall, MA

A survey of pediatricians in Pakistan found insufficient knowledge of antibiotic use and antimicrobial resistance (AMR), researchers reported today in JAC-Antimicrobial Resistance.

The web-based survey was sent to 480 pediatricians from public and private sector hospitals in Pakistan, and 383 responded. Most respondents were male (87.7%), aged 35 years or younger (55.4%), working in tertiary hospitals (68.4%), and conducting 51 to 100 child consultations every day (45%).

Most pediatricians knew that antibiotics were not useful in treating viral infections (96.6%) and could cause secondary infections by destroying the body's normal flora (83.3%), but only 15% reported obtaining training on antibiotic usage and AMR, only 25.3% stated they were aware of antimicrobial stewardship, and only 7.6% confirmed a functioning antimicrobial stewardship program in their institutions. In addition, while 95% perceived AMR as a serious concern in Pakistan and 85.1% believed it is a significant problem in their hospital, only 27.4% believed antibiotics were being overprescribed in their hospital. Pediatricians with fewer years of medical experience had significantly lower knowledge scores regarding antibiotics and AMR, compared with those with more experience.

Barriers to stewardship

Most respondents said they were prepared to initiate antimicrobial stewardship programs, but perceived barriers included patients' non-adherence to prescribed medication and a lack of online learning sources, treatment guidelines, and support from hospital administration.

...only 15% reported obtaining training on antibiotic usage and AMR, only 25.3% stated they were aware of antimicrobial stewardship, and only 7.6% confirmed a functioning antimicrobial stewardship program in their institutions.

The study authors say the findings are concerning given the documented high rates of antibiotic prescribing among newborns and children in Pakistan. Previous studies have found prescribing rates of up to 99% in pediatric intensive care units and neonatal medical wards, and 91% in pediatric medical wards.

"These rates demonstrate appreciable differences in reality between knowledge scores regarding antibiotics and AMR and paediatricians’ actual prescribing practices," they wrote. "This discrepancy may arise from the fact that only a limited number of participating paediatricians received education on AMR and antimicrobial stewardship programmes as part of their undergraduate and postgraduate curriculum, and had received any training on these aspects in the last year."

The authors say the issue should be prioritized in Pakistan's National Action Plan on AMR.

Most COVID vaccine–hesitant Dutch adults later changed their mind, report suggests

News brief

Mary Van Beusekom, MS

Of more than 12,000 adults in the Netherlands who were reluctant or unwilling to be vaccinated against COVID-19 when vaccines were first rolled out, 86% and 34% were either vaccinated or said they would be, according to a study in BMC Public Health.

An Utrecht University-led research team analyzed data from a study by the Dutch National Institute for Public Health and the Environment, conducted from April 2020 to September 2022 to track behavior and perceptions during the pandemic.

Healthcare provider offering vaccine — *Prostock.Studio/iStock*

That study recruited a non–nationally representative cohort from existing panels or through social media and surveyed them multiple times over 19 months. Most participants were women (74%), highly educated (53%), and healthy (77%).

Analyses were stratified into two phases: the active campaign phase early in vaccine availability and the residual phase, when everyone was eligible.

Vaccine beliefs not static

Among 12,512 participants who were initially hesitant (8,658) or unwilling (3,854) to receive a COVID-19 vaccine, 86% and 34% said they either were vaccinated or intended to be.

Finding that, for a novel vaccine, vaccination preferences are not static and switches in vaccination preferences are associated with individual, social, and contextual factors, has implications for research and practice.

In phase 1, relative to adults aged 70 years and older, those aged 40 to 54 had 24% lower odds of switching to vaccination in phase 1 (adjusted hazard ratio [aHR], 0.76). Those with a medical condition had a 10% higher chance of switching than healthy participants (aHR, 1.10). But in phase 2, relative to participants aged 70 years and older, those aged 40 to 54 were 44% more likely to get vaccinated (aHR, 1.44).

Participants in both phases were more likely to change their minds if they believed the vaccines were effective (phase 1 aHR, 1.76; phase 2 aHR, 1.65), thought vaccination was the norm (phase 1 aHR, 1.30; phase 2 aHR, 1.19), or became eligible during stricter lockdowns (phase 1 aHR, 1.26; phase 2 aHR, 1.09).

"Finding that, for a novel vaccine, vaccination preferences are not static and switches in vaccination preferences are associated with individual, social, and contextual factors, has implications for research and practice," the authors wrote.