UK study finds little change in rate of repeat antibiotic prescribing during COVID-19

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Doc giving a prescriptionAn analysis of nearly 3 years of patient data in the United Kingdom found no evidence of major changes in the level of inappropriate or repeat antibiotic prescribing in primary care after the start of the COVID-19 pandemic, UK researchers reported late last week in the Journal of Infection.

To identify whether repeat prescribing of antibiotics for specific infections changed after the start of the pandemic, a team led by researchers with the University of Manchester reviewed electronic heath record (EHR) data on 9.1 million patients who were prescribed antibiotics from January 1, 2019, through December 31, 2021. Research conducted prior to the pandemic has found that repeat prescribing, which involves the renewal of short-term antibiotic prescriptions for acute issues that exist beyond a single course of treatment, accounts for up to 30% of antibiotic prescriptions in UK primary care, and the UK's 5-year National Action Plan on Antimicrobial Resistance (AMR) has identified reducing repeat prescribing as one of its goals.

Of the 29.2 million antibiotic prescriptions recorded over the study period, 29.1% were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate prescription.

There was a sharp increase in repeat prescribing at the beginning of the pandemic among the infection-coded cohort, but it returned to normal by April 2021. For those with uncoded infections, repeat prescribing jumped significantly in February 2020 and remained high until November 2021. But no major changes in the rates of repeat antibiotic prescribing during COVID-19 were found among the entire cohort. 

There is a need for treatment guidelines to be developed around antibiotic failure.

The study authors say the findings suggest more work is needed to reduce repeat prescribing.

"There is a need for treatment guidelines to be developed around antibiotic failure and for clinicians to have information about the risks of a patient returning (i.e., treatment failure)," they wrote. "The lack of evidence of effectiveness of repeat antibiotic prescribing and developing signals of risks may indicate the need for targeting repeat prescribing as a priority for optimising antibiotic prescribing."

COVID-positive infants may have fewer urinary tract, bacterial infections

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UTI definition and pillsCompared with feverish infants who tested negative for COVID-19, a lower proportion of babies aged 8 to 60 days who tested positive had co-occurring urinary tract infections (UTIs), bacteremia without meningitis, and bacterial meningitis, according to a study published late last week in JAMA Network Open.

Bacteremia is the presence of bacteria in the bloodstream, and meningitis is inflammation of the membranes that protect the brain and spinal cord.

Led by a Yale School of Medicine researcher, the study was part of a quality-improvement project at 106 US and Canadian hospitals from November 1, 2020, to October 31, 2022. Participants were full-term and feverish but otherwise healthy infants without bronchiolitis (lung infection in infants and young children) who were tested for COVID-19.

Among 14,402 infants, 58.4% were 29 to 60 days old, 56.5% were boys, 26.1% tested positive for COVID-19, 39.8% were White, 25.0% were Hispanic, 13.3% were of another race, 12.5% were of unknown race, and 9.4% were Black.

Bacterial infections varied by age, inflammatory markers

Compared with infants who tested negative, a lower proportion of those who tested COVID-positive had UTI (0.8% vs 7.6%), bacteremia without meningitis (0.2% vs 2.1%), or bacterial meningitis (<0.1% vs 0.5%).

Among infants 29 to 60 days old diagnosed as having COVID-19, 0.4% had UTI, and less than 0.1% each had bacteremia or meningitis. Of SARS-CoV-2–positive infants, a lower proportion of those with normal levels of inflammatory markers (IMs) had bacteremia and/or bacterial meningitis than those with abnormal IMs (<0.1% vs 1.8%).

It is important to note that the prevalence of concomitant bacterial infection varied by age group.

"Although the prevalence of UTI and IBI [invasive bacterial infection] may be low enough for some clinicians to consider deferring further testing for bacterial infection in SARS-CoV-2–positive infants, depending on their risk tolerance and practice setting, it is important to note that the prevalence of concomitant bacterial infection varied by age group and whether IMs were normal or abnormal," the study authors wrote.

High uptake of second COVID vaccine dose seen among pharmacy users

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Close-up of needle inserted into vaccine vialA Walgreens study reveals that over 80% of patients received their second dose of Moderna COVID-19 vaccine on time, per recommendations from the US Centers for Disease Control and Prevention (CDC).

Walgreens was one of the largest participants in the Federal Retail Pharmacy Program (FRRP), which was started to rapidly distribute COVID-19 vaccines in 2021. The company operates 8,965 retail pharmacy locations in the United States, with approximately 78% of Americans living within 5 miles of a Walgreens pharmacy, the authors said.

The study was published in Vaccine and was based on data collected from 4,870,915 participants who received at least one dose of mRNA-1273 at Walgreens between December 18, 2020, and February 28, 2022. The participants were 57.0% White and 52.6% female and were, on average, 49.4 years old.

Among patients who received a first dose of mRNA-1273 at Walgreens, 84.9% (4,137,382) went on to receive a second dose, and of these, 96.0% received the second dose on time (3,970,906), defined as between 24 and 42 days after the first dose.

Factors related to second-dose uptake included being older, having to travel 10 miles or less to get the first dose, higher community-level health insurance coverage, and residing in areas with low social vulnerability.

"Patients identifying as Hispanic or Latino/Black or African American had reduced odds of receiving the second dose on-time as compared to White (not Hispanic/Latino) patients, suggesting that factors other than accessibility contributed to lower rates among these patients," the authors said. "Similar disparities have been reported in previous research, suggesting the need for further study into vaccination barriers and facilitators within these populations."

Similar disparities have been reported in previous research, suggesting the need for further study into vaccination barriers.

As of February 8, 2023, the CDC said that 92% of US adults had received at least one dose of COVID-19, vaccine, and 79% were fully vaccinated with a primary series.

CDC issues building ventilation guidance to guard against respiratory infections

News brief

The Centers for Disease Control and Prevention (CDC) last week published guidance for improving building ventilation to help protect people from respiratory infections, with a goal of at least five air changes each hour and an upgrade to MERV-13 filters.

Deploying multiple infection prevention and control strategies can optimize the overall effectiveness of ventilation interventions, the CDC said.

Basic strategies include maintaining heating, ventilation, and air conditioning (HVAC) systems as recommended by the manufacturer and updating the systems to meet current standards. Other key steps include regular filter changes and ensuring that filters fit properly.

The CDC also detailed several enhanced strategies, which include the air-change recommendation and upgrading to MERV-13 filters. Steps  also include keeping the fan on the "on" position rather than "auto" when people are in the building, adding fresh air, using appropriately sized air cleaners, installing ultraviolet air treatment systems, and using carbon dioxide monitors to track air quality.

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