US analysis finds antibiotic prescribing common in kids hospitalized with COVID

News brief

Young girl with oxygen maskAn analysis of surveillance data found that US children commonly received antibiotics for severe COVID-19 during the first year of the pandemic, despite a low prevalence of bacterial infections, researchers reported today in Open Forum Infectious Diseases.

Using data from the Overcoming COVID-19 Public Health Surveillance Registry, which includes children with SARS-CoV-2 infection–related complications who were treated at more than 70 hospitals in 25 states, a team led by researchers with Boston Children's Hospital evaluated children and adolescents aged 19 and younger who were admitted to an intensive care or high acuity unit for COVID-19 from March to December 2020. The primary outcomes assessed were prescription of antibiotics and the presence of community-onset bacterial co-infection. The researchers also examined factors associated with antibiotic prescriptions and bacterial co-infections.

Of the 532 children who met criteria for inclusion in the study, 63.3% were prescribed empiric antibiotics (most commonly ceftriaxone, vancomycin, and cefepime) and almost half received multiple antibiotics (21.1% received two, 10.0% received three, and 18.4% received four or more). But only 7.1% had bacterial co-infection, and only 3.0% had a respiratory bacterial co-infection.

There may be a lower likelihood of bacterial coinfection with SARS-CoV-2 infection.

In multivariable analyses, empiric antibiotics were more likely to be prescribed for immunocompromised patients (adjusted relative risk [aRR], 1.34; 95% confidence interval [CI], 1.01 to 1.79), those requiring any respiratory support except mechanical ventilation (aRR, 1.41; 95% CI, 1.05 to 1.90), and those requiring invasive mechanical ventilation (aRR, 1.83; 95% CI, 1.36 to 2.47). The presence of a pulmonary comorbidity other than asthma was associated with bacterial co-infection (aRR, 2.31; 95% CI, 1.15 to 4.62).

The study authors note that the findings are similar to those in US adults with COVID-19 during the first year of the pandemic.

"Pediatric providers accustomed to caring for children hospitalized with other respiratory viruses should be aware that there may be a lower likelihood of bacterial coinfection with SARS-CoV-2 infection, even in children requiring pediatric intensive care," they wrote.

Even mildly ill COVID-19 patients report chest pain at 6 months, 1 year

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An unpublished study involving nearly 150,000 COVID-19 survivors who had mild infections in Salt Lake City suggests that many still had chest pain 6 months and 1 year later.

The research was presented yesterday at the American College of Cardiology's Scientific Conference in New Orleans.

Intermountain Health researchers compared three groups of 148,158 people each, including COVID-19 patients treated in an outpatient setting from March 2020 to December 2021, a control group of matched patients seen for other indications during the same period, and a historical control group seen from January 2018 to August 2019.

While the COVID-19 patients had significantly higher rates of chest pain than the other groups, they didn't have higher rates of other cardiovascular events.

We did find chest pains to be a persistent problem, which could be a sign of future cardiovascular complications.

"While we didn't see any significant rates of major events like heart attack or stroke in patients who had an initial mild initial infection, we did find chest pains to be a persistent problem, which could be a sign of future cardiovascular complications," principal investigator Heidi May, PhD, said in an Intermountain Healthcare news release. "It could be that lasting effects of infection on the cardiovascular system are hard to quantify in terms of diagnoses or other events in the short-term and won’t be realized until longer follow up."

European report finds a mixed bag on resistant bacteria in humans, food animals

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Beef cattleEuropean Food Safety Authority (EFSA) highlights some negative and positive antimicrobial resistance trends in indicator bacteria from humans and food-producing animals.

The summary report, which examines 2020-21 data from 27 European Union member states, 5 non-member states, and the United Kingdom, found that, in Salmonella bacteria isolated from humans and food-producing animals, resistance to ampicillin, sulfonamides, and tetracyclines remained at high levels, while high to extremely high levels of resistance to fluoroquinolones (ciprofloxacin) were observed in Campylobacter coli and C jejuni isolates.

Both pathogens are leading causes of foodborne illness in people. The report notes that the level of ciprofloxacin resistance in Campylobacter is now so high that the antibiotic can no longer be recommended for treating severe infections in people.

Antimicrobial resistance is one of the greatest threats we face worldwide.

Among the encouraging trends was a decline in the resistance of Salmonella to ampicillin and tetracyclines in humans in several countries from 2013 to 2021, along with very low levels of combined resistance to ciprofloxacin and cefotaxime in Salmonella from humans and almost all animal and derived-meat categories. In addition, multidrug-resistance levels were generally low for C jejuni isolated from humans and animals.

Assessment of indicator bacteria for the production of extended-spectrum beta-lactamase (ESBL) and AmpC beta-lactamase enzymes—which confer resistance to multiple antibiotic classes—found that the proportion was very low in Salmonella recovered from humans and animals, and that statistically significant decreasing trends are evident in the prevalence of ESBL-producing Escherichia coli in chickens, chicken meat, and pork products in 17 EU member states. Resistance of E coli to carbapenems remains rare in food-producing animals and humans.

"Antimicrobial resistance is one of the greatest threats we face worldwide, affecting humans, animals, and the environment," ECDC and EFSA chief scientists Mike Catchpole, PhD, and Carlos Das Neves, DVM, PhD, said in a press release. "Working together remains key to tackling this complex problem."

Study: Screening newly admitted patients for C difficile colonization has little value

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A multicenter study conducted in the Netherlands found that screening patients for Clostridioides difficile colonization (CDC) was not useful for preventing C difficile infection (CDI), Dutch researchers reported late last week in Clinical Microbiology and Infection.

In the study, newly admitted patients in the medical and surgical wards at 4 Dutch hospitals were screened by stool culture daily for the presence of CDC, which can progress to symptomatic CDI in some patients if their microbiota is disturbed, and followed 1 one year. Even if colonized patients don't develop an infection, they do shed C difficile spores that could become a source of infection for other patients. The aim of the study was to determine the prevalence of CDC in the hospitals and investigate the value of a CDC screening program for preventing colonized patients from progressing to CDI or transmitting C difficile to other patients.

CDC was present in 108 of 2,211 admissions (4.9%), while colonization with a toxigenic strain (tCDC) was present in 68 of 2,211 admissions (3.1%). Among the 108 colonized patients, 44 different PCR ribotypes (RTs) were found, but the "hypervirulent" RT027 was not detected. Of the 49 colonized patients and 145 control patients enrolled in a case-control study, none developed CDI within a month of admission or during 1-year follow up.

Implementing screening was difficult and burdensome.

Core genome multilocus sequence typing (MLST) identified six clusters with genetically related isolates from tCDC and CDI patients, but in these clusters only one possible transmission event from a tCDC to a CDI patient was identified by epidemiologic data.

"Implementing screening was difficult and burdensome, while those tCDC patients that were detected did not have a high risk of progressing to CDI themselves and were not identified as an important direct source for incident hospitalized CDI cases," the study authors wrote. "Therefore, we think that we should focus on decreasing CDI susceptibility (e.g. by antimicrobial stewardship programs) and complying with general infection prevention measures to prevent spread from C. difficile and other nosocomial pathogens."

Florida reports fatal Naegleria fowleri case

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Naegleria fowleri amoebae
CDC / Govinda S. Visvesvara

The Florida Department of Health (Florida Health) recently reported a Naegleria fowleri case in a resident of Charlotte County, located in the southwestern part of the state, just north of Fort Myers.

The man died from his infection, according to media reports that cited health officials. Florida health first reported the case on Feb 23 and said the patient may have contracted the waterborne amoebic disease from sinus rinse practices using tap water. It said the illnesses are rare and are linked to contaminated water entering the body from the nose, not from drinking affected tap water.

In a Mar 2 update, Florida Health said its Charlotte County office, the Florida Department of Environmental Protection, and other partners are conducting an investigation and response efforts.

N fowleri is an amoeba that can cause a brain infection called primary amebic encephalitis. Infections are often fatal. The United States averages from 0 to 5 cases each year and has recorded 31 cases between 2012 and 2021. Of those, 2 patients contracted the parasite after rinsing their sinuses using contaminated tap water.

Most infections have been linked to swimming in southern states, but infections can also occur when people use contaminated tap water to irrigate their noses or sinuses, according to the US Centers for Disease Prevention and Control. N fowleri can grow in pipes, hot water heaters, and water systems, including treated public water systems.

Health officials urge people to use distilled or sterile water for sinus cleansing or to boil tap water for at least 1 minute, then cool it, before using it for that purpose.

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