Swiss study finds catheter-associated UTIs are more frequently antibiotic resistant

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A study of urine cultures in Switzerland found that pathogens that cause catheter-associated urinary tract infections (CAUTIs) were more frequently resistant to antibiotics than non-CAUTI pathogens, researchers reported yesterday in Antimicrobial Stewardship & Healthcare Epidemiology.

For the study, a team of Swiss researchers analyzed all urine cultures from 2019 submitted to the Swiss Centre for Antibiotic Resistance. They conducted antimicrobial susceptibility tests and compared proportions of bacterial species and antibiotic-resistant isolates in CAUTIs, which are considered complicated UTIs and are generally treated with fluoroquinolone antibiotics, and non-CAUTI samples.

The aim of the study was to clarify whether urinary pathogens and antibiotic resistance vary depending on catheter association, which could help clinicians with empiric antibiotic therapy choices.

Among the 27,158 urine cultures that met the inclusion criteria, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Proteus mirabilis represented 70% and 85% of pathogens identified in CAUTI and non-CAUTI samples, respectively. The most relevant difference concerned P aeruginosa, which represented 10% of CAUTI pathogens versus 3.3% of non-CAUTIs. The overall resistance rate for the often empirically prescribed antibiotics ciprofloxacin, norfloxacin, and trimethoprim-sulfamethoxazole was between 13% and 31%.

Except for nitrofurantoin, E coli from CAUTI samples were more often resistant to all classes of antibiotics analyzed, including third-generation cephalosporins (used as a surrogate for extended-spectrum β-lactamase, or ESBL, production). Significantly higher resistance proportions in CAUTI samples versus non-CAUTI samples were observed for ciprofloxacin and norfloxacin in K pneumoniae, for norfloxacin in P mirabilis, and for cefepime and piperacillin-tazobactam in P aeruginosa.

Given the large sample size of isolates, the study authors say they believe their findings are representative of the current ecology of urinary pathogens in Switzerland.

"This finding emphasizes the need for urine sampling for culturing before initiating therapy for CAUTI and the importance of considering therapeutic alternatives," they concluded.

Tanzania declares Marburg virus outbreak

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Following the investigation of five undiagnosed deaths from a hemorrhagic illness, Tanzania's health minister today said tests have confirmed Marburg virus, a close relative of Ebola, according to Agence France-Presse (AFP).

Marburg virus particles
NIAID/Flickr cc

Ummy Mwalimu, Tanzania's health minister, said 3 patients are hospitalized, and 161 contacts are under monitoring.

An earlier media report said the initial illnesses were reported from two villages in Bukoba Rural District in the northwestern part of the country.

Like Ebola, Marburg virus spreads through contact with body fluids of infected people. It has a case-fatality rate as high as 88%, and so far there are no approved vaccines or specific treatments.

Equatorial Guinea virus similar to Sierra Leone bat virus

In January, Equatorial Guinea announced its first Marburg virus outbreak, which has so far resulted in 11 deaths and one confirmed case. There has been little new information about outbreak developments since then. The World Health Organization (WHO) regional office for Africa said in its latest weekly health emergencies update that no new cases have been reported and that genetic sequencing suggests the virus is most similar to one found in fruit bats in Sierra Leone.

Americans less active after emergence of COVID-19, study finds

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A Vanderbilt University study estimates that Americans took 719 fewer daily steps in the first year of the COVID-19 pandemic than they did before.

In the study, published yesterday in JAMA Network Open, researchers analyzed data from 5,443 All of Us (AOU) research participants with Fitbit tracking information for 10 days or more a month for at least 6 months before (January 2018 to January 2020) and after (June 2020 to December 2021) the pandemic began.

Participants also completed a survey on socioeconomic status, mental health, location, and deprivation index. Median age was 53 years, 71.7% were women, 86.0% were White, 9.3% were of other race, and 4.7% were Black.

Highest risk among poor, mentally ill

Median observed daily steps before the pandemic were 7,808, compared with 7,089 after (difference, 719 steps). A counterfactual model estimated that participants walked 575 fewer steps per day than the observed steps in 2021. The reduction was largely explained by younger age (β, −243 per 10-year decrease), residence in the Northeast (β vs other regions, −288), and higher deprivation index score (β, −477 per 0.1 increment).

Lower step counts in 2021 were also influenced by COVID-19 vaccination status (β for vaccinated vs unvaccinated, 48), depression (β, −36 per 1 score increment), and psychological stress (β, −13 per 1 score increment). There was no link between lower step counts and sex or chronic conditions such as obesity, diabetes, coronary artery disease, high blood pressure, or cancer.

"We found a statistically significant decline in daily step counts that persisted even after most COVID-19–related restrictions were relaxed, suggesting COVID-19 affected long-term behavioral choices," the authors wrote.

But they said it's unclear whether the reduction will be clinically meaningful over time. "Any meaningful difference is likely dependent on baseline activity, age, and other patient-level factors," they wrote. "Our prior work in the AOU cohort suggests that modestly lower step counts over a long period could have a substantial contribution to long-term disease risk," including the risk of cardiometabolic conditions and the potential to worsen health disparities associated with socioeconomic status and mental illness.

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