Trial supports broad-spectrum antibiotic prevention for pancreatic surgery

News brief

The results of a randomized clinical trial support the use of piperacillin-tazobactam for reducing surgical-site infections (SSIs) following pancreatoduodenectomy, researchers reported today in JAMA.

In the pragmatic, open-label, multicenter phase 3 trial, 778 patients undergoing open pancreatoduodenectomy—a procedure to remove cancerous tumors from the head of the pancreas—were randomly assigned to receive piperacillin-tazobactam as perioperative antibiotic prophylaxis (prevention) or cefoxitin (the standard care). The primary outcome was development of postoperative SSI within 30 days. Secondary end points included 30-day mortality, development of clinically postoperative pancreatic fistula, and sepsis.

Among the 778 participants (378 in the piperacillin-tazobactam group, 400 in the cefoxitin group), the median age was 67.3, and 58.6% were men. The trial was stopped at the second interim analysis, which found that patients who received piperacillin-tazobactam had significantly fewer SSIs than those who received cefoxitin (19.8% vs 32%; absolute difference, –13.0%; 95% confidence interval [CI], –19.1% to –6.9%).

Participants treated with piperacillin-tazobactam also had lower rates of postoperative sepsis (4.2% vs 7.5%; absolute difference, −3.3%; 95% CI, −6.6% to 0.0%) and clinically relevant postoperative pancreatic fistula (12.7% vs 19.0%; absolute difference, −6.3%; 95% CI, −11.4% to −1.2%). Mortality rates at 30 days were 1.3% among participants treated with piperacillin-tazobactam and 2.5% among those receiving cefoxitin (absolute difference, −1.2%; 95% CI, −3.1% to 0.7%).

The trial investigators say the results are significant because SSIs are the most common driver of postoperative morbidity after pancreatoduodenectomy, which has remained high despite advances in surgical care.

"The effect of piperacillin-tazobactam observed in the trial was evident on stratified analyses of multiple subgroups, providing support for making broad-spectrum antibiotic prophylaxis standard care in all patients undergoing pancreatoduodenectomy," they wrote.

They added, however, that the results apply to pancreatoduodenectomy only and do not imply that broad-spectrum antibiotic prophylaxis should be used in other major operations.

CDC finalizes COVID vaccine changes, paving way for extra bivalent doses for vulnerable groups

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The Centers for Disease Control and Prevention (CDC) yesterday finalized a plan to simplify COVID-19 mRNA vaccine recommendations, which allows seniors and adults with weakened immune systems to receive a second dose of bivalent vaccine.

The announcement came just after its Advisory Committee on Immunization (ACIP) met to discuss the changes. The group did not vote but was supportive of the changes.

CDC's recommendation updates follow changes that came from the Food and Drug Administration (FDA) earlier this week, which removed the authorization for the monovalent versions of the mRNA vaccines and cleared second bivalent boosters for use in seniors and immunocompromised people.

Aside from simplifying vaccine administration and recommendations, the changes are also designed boost immunity in vulnerable groups until fall, when federal officials are expected to make another vaccine push ahead of the respiratory virus season. The FDA's vaccine advisors will meet in June to assess if changes are needed to the vaccines to cover emerging SARS-CoV-2 subvariants.

At yesterday's ACIP meeting, CDC officials acknowledged that recommendations for children ages 4 to 6 are still relatively complex and vary by vaccine and number of doses previously received. They also said they'd release more resources to help navigate vaccination and added that they will host a clinicians outreach and communication activity (COCA) call on the policy updates on May 11.

A third of US households used government-supplied at-home COVID tests

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A Morbidity and Mortality Weekly Report study published today finds that one third of US households used free at-home COVID-19 diagnostic tests from the program and suggests that, without the kits, one in four adults who used a test would likely otherwise have gone untested.

A team led by Emory University researchers analyzed data from a national probability survey to estimate awareness, acceptability, and use of the program in April and May 2022. The White House launched the program in January 2022 to enable all US households to order free, at-home rapid antigen tests delivered through the US Postal Service.

Program likely boosted testing, health equity

More than 70 million test kits were shipped by May 2022. The vast majority of households (93.8%) indicated they were aware of the COVID-19 test program, and more than half (59.9%) had ordered kits. In 32.1% of households, a household or non-household member had used at least one government test.

A total of 27.8% of households had ordered kits but had not yet used them. A total of 38.3% of those who tested for COVID-19 used a kit, and 22.2% of users reported testing positive at least once during the study period.

National programs to address availability and accessibility of critical health services in a pandemic response have substantial health value.

Among test users, 95.5% rated their experience as acceptable, and 23.6% said they probably wouldn't have tested if they didn't have the free tests. Rates of use were 42.1%, 41.5%, 34.8%, and 53.7% for Black, Hispanic, White, and other racial groups, respectively.

Use rates of other at-home COVID-19 tests were 11.8%, 44.4%, 45.8%, and 43.8% among Black, Hispanic, White, and other racial groups, respectively. Black adults were 72% less likely than other racial groups to use other at-home tests (adjusted relative risk, 0.28).

"Provision of tests through this well-publicized program likely improved use of COVID-19 home testing and health equity in the United States, particularly among Black persons," the authors wrote. "National programs to address availability and accessibility of critical health services in a pandemic response have substantial health value."

US prison population dropped early in pandemic, but not for Black inmates

News brief

A new analysis of US prison populations shows that the early months of the COVID-19 pandemic saw a drop in inmates, but the percentage of incarcerated Black people rose. The study was published yesterday in Nature.

The analysis showed that, by the middle of 2020, US prison population had fallen by 200,000 people from pre-pandemic levels. Between March of 2020 and July of 2021, the population had reduced by 17% overall. Researchers said this was due to courts shutting down across the nation, and early prisoner-release programs put into effect because of the novel coronavirus.

The reduction, however, was seen almost exclusively among White prisoners: In March 2020, Black prisoners made up 38.9% of the nation's prison population. But from March to November 2020, the percentage of incarcerated Black people increased by almost a full percentage point (0.9%). That increase undid a 7-year trend of falling incarceration numbers of Black Americans.

"The trend we observe at the national level is reproduced exactly among states with the highest Black and Latino populations, and persists in some form in nearly every other state," the authors said. "We estimate that nearly 15,000 fewer Black people would have been incarcerated in January 2021 if the racial disparities we observe were not present."

The authors said the pandemic revealed racial dynamics that had long been at play in prison-sentencing trends.

"The pandemic acted like a stress test for the criminal legal system, and that stress test revealed these disparities," said study author Brandon Ogbunu, PhD, of Yale University, in a Santa Fe Institute press release.

The trend we observe at the national level is reproduced exactly among states with the highest Black and Latino populations, and persists in some form in nearly every other state.

New online resource aims to assist antibiotic stewardship efforts

News brief

Denver Health and the Pew Charitable Trusts this week announced the launch of a new resource to help healthcare facilities across the country support antibiotic stewardship efforts.

The Outpatient Automated Stewardship Information System (OASIS) is an open-source statistical code that can harness data from electronic health records (EHRs) to assess antibiotic prescribing and provide individualized audit and feedback reports to medical providers on their antibiotic prescribing patterns. Developed and launched at Denver Health with the support of Pew, OASIS has the ability to assess antibiotic prescribing for acute respiratory conditions, acute otitis media (ear infection), and conditions that do not require antibiotics.

"Experts agree that tracking and reporting antibiotic prescribing is crucial to helping health care systems evaluate prescribing practices, ensure the appropriate use of these critical therapies, and slow the emergence of deadly antibiotic-resistant pathogens," David Hyun, MD, and Rachel Zetts, MPH, of Pew's antibiotic resistance project, wrote in a post on the Pew website. "OASIS will help address some of the long-standing barriers to these types of stewardship efforts, helping to protect individual patients and public health."

OASIS is free to download and doesn't require additional software or EHR upgrades.

Quick takes: Perceptions on childhood vaccines and low uptake in Africa, African mRNA vaccine hub

News brief
  • Public perceptions of childhood vaccinations declined during the pandemic in 52 of 55 countries covered in UNICEF's latest report on the status of the world's children. Belief in the importance of vaccines for kids dropped more than a third in South Korea, Papua New Guinea, Ghana, Senegal, and Japan, according to data from The Vaccine Confidence Project included in the report. China, India, and Mexico were the only countries where attitudes about the importance of vaccines held steady or improved. UNICEF said overall support remains strong, but several factors may be fueling vaccine hesitancy, including misinformation and political polarization.
  • In Africa, COVID-related interruptions have derailed progress with routine childhood vaccination, and an estimated 33 million children need to be vaccinated between 2023 and 2025 to meet global goals for reducing vaccine-preventable diseases, the World Health Organization (WHO) African regional office said today. In a "Big Catch-Up" campaign that begins next week, the WHO and its partners are targeting 10 priority African countries that have the highest numbers of zero-dose children.
  • The WHO today announced the launch of a new mRNA vaccine technology hub at Afrigen, a vaccine company in Cape Town, South Africa. The hub is part of ongoing efforts to boost equitable access to vaccines against COVID and future health threats. The company is currently scaling up a COVID vaccine candidate called AfriVac 2121 for use in phase 1 and 2 clinical trials.

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