Study shows increase in antibiotic use among cancer patients before death

News brief

Cancer patient talking to doctor — pondsaksit / iStock

A study of patients with advanced cancer found an increase in broad-spectrum antibiotic use in the last 3 months of life, South Korean researchers reported yesterday in JAMA Network Open.

For the nationwide cohort study, researchers used data from the South Korean National Health Insurance database to examine broad-spectrum antibiotic use among patients with advanced cancer who died from July 2002 through December 2021, calculating the proportion of patients who received antibiotics and the amount used. While patients with advanced cancer frequently receive antibiotics because of a heightened risk of bacterial infections, there's concern that excessive antibiotic use may compromise the quality of end-of-life care and promote the emergence of multidrug-resistant organisms.

The end-of-life trajectory was divided into five intervals: T1 (6 months to 3 months before death), T2 (3 months to 1 month before death), T3 (1 month to 2 weeks before death), T4 (2 weeks to 1 week before death), and T5 (final week before death).

Window for targeted stewardship interventions

Among the 515,366 decedents (mean age, 68.7 years; 64.7% male) included in the study, 288,151 (55.9%) received broad-spectrum antibiotics during the last 6 months of life. The proportion of patients receiving broad-spectrum antibiotics peaked during T2, with 144,920 (28.1%) patients receiving at least 1 dose, and declined to 68, 564 (13.3%) during T5. In contrast, total consumption peaked during T3, reaching 190.0 days of therapy per 1,000 patient-days. The patterns were consistent across antibiotic classes and cancer types.

During the last week of life, patients with leukemia had the highest exposure to broad-spectrum antibiotics compared with those with lung cancer (the reference group), both for prescription proportions (crude odds ratio, 1.50; 95% confidence interval [CI], 1.43 to 1.58) and total consumption (adjusted relative risk, 1.21; 95% CI, 1.19 to 1.23).

The study authors say the findings suggest that 3 months to 2 weeks before death could be a window for targeted stewardship interventions in advanced cancer patients.

"Our study may offer important insights for stewardship efforts targeting patients with advanced cancer in the end-of-life phase, suggesting a potential turning point when more deliberate prescribing decisions could be considered," they wrote.

US government signs $56 million deal for smallpox/mpox vaccine

News brief

Chris Dall, MA

Emergent BioSolutions announced yesterday that it has received a $56 million contract extension to supply the US government with doses of a combined smallpox/mpox vaccine.

The single-dose vaccine, ACAM2000, was first approved by the Food and Drug Administration (FDA) in 2007 for active immunization against smallpox in people considered to be at high risk of infection, then for active immunization against mpox in high-risk individuals in 2024. It's one of two FDA-approved smallpox and mpox vaccines, along with Bavarian Nordic's Jynneos vaccine.

Part of 10-year contract

The contract modification is under Emergent's existing 10-year contract with the Administration for Strategic Preparedness and Response (ASPR) at the Department of Health and Human Services. ASPR leads the nation's medical and public health preparedness and response efforts for disaster and other public health emergencies.

"Our new contract modification for ACAM2000 vaccine reflects the continued collaboration between Emergent and the U.S. government to prioritize preparedness support," Paul Williams, senior vice president and head of products business, global government, and public affairs at Emergent, said in a company press release.

The company says deliveries of ACAM2000 to the Strategic National Stockpile are expected to begin this month.

Kids with COVID had a 50% to 60% higher risk of depression, anxiety in 2021, researchers say

News brief

Mary Van Beusekom, MS

Anxious young woman sitting on floor — *Joice Kelly / Unsplash*

Relative to uninfected children, COVID-19 patients aged 8 to 17 years were at a 49% higher risk for new-onset depression or anxiety in 2021, rising to 59% in those with severe illness, according to a University of Utah study published this week in PLOS One.

The researchers mined the Utah All Payers Claims Database to explore the link between COVID-19 infection, illness severity, and risk of depression and anxiety among 154,565 school-aged youth who had private insurance or Medicaid coverage. The average participant age was 10.8 years in 2019, when the study period began, and 48% were girls.

Key contributors to mental illness among children include the pandemic's direct impacts on daily life, such as school closures, isolation from peers, and disrupted family routines, the authors noted.

"These challenges have likely had long-term consequences for the mental health and well-being of young people," they wrote. "Moreover, COVID-19 infection itself may play a significant role in the development of mental health disorders among children and adolescents."

Prioritizing youth mental well-being

Children infected with COVID-19 had a 49% higher probability of experiencing new-onset depression or anxiety. Compared with uninfected youth, those with moderate symptoms had a 40% higher likelihood of incident depression or anxiety, a risk that rose to 59% among those with severe disease.

As society continues to navigate the post-pandemic landscape, prioritizing the mental well-being of younger populations is critical for fostering resilience and ensuring that adequate resources are available to support their psychological recovery.

"At the onset of the pandemic, healthcare efforts primarily focused on treating the physical health symptoms from COVID-19 infection," the researchers wrote. "The novelty of the virus meant that the psychological impact of the illness took a lower priority compared to the discovery of its cure, leaving a gap in mental health care."

The findings, they said, underscore the need for targeted mental health interventions for infected children.

"As society continues to navigate the post-pandemic landscape, prioritizing the mental well-being of younger populations is critical for fostering resilience and ensuring that adequate resources are available to support their psychological recovery," the authors concluded.