US study finds slight decrease in multidrug-resistant uropathogenic E coli

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E coli on petri dishAn analysis of patients with uncomplicated urinary tract infections (uUTIs) in a large US healthcare network found a slight decrease in multidrug-resistant uropathogenic Escherichia coli (UPEC), researchers reported today in Open Forum Infectious Diseases.

The study examined data on 174,185 patients belonging to Kaiser Permanente Southern California who were treated for one or more UPEC uUTIs from January 2016 through December 2021. Resistance data on UPEC, which causes 80% of all uUTIs and has become increasingly multidrug resistant over the past two decades, was evaluated over time by care setting (in-person versus virtual) to help clinicians make more informed and appropriate decisions around empiric antibiotic treatment of outpatient UTIs, particularly in the growing virtual-care setting.

A total of 233,974 UPEC isolates were tested for susceptibility. Overall, multidrug resistance decreased from 13% in 2016 to 12% in 2021 and was similar in virtual and in-person settings. The most common types of resistance in multidrug-resistant UPEC isolates were to penicillins overall (29%) and co-resistance to penicillins and trimethoprim-sulfamethoxazole (TMP-SMX) (12%). Multidrug resistance involving penicillins and TMP-SMX and one or more antibiotic class was less common (7%).

Resistance to 1, 2, 3, and 4 antibiotic classes was found in 19%, 17%, 8%, and 4% of isolates, respectively. While 1% were resistant to 5 or more antibiotic classes, 50% were resistant to none. Similar resistance patterns were observed over time, and by care setting.

Virtual healthcare may expand access to UTI care, without increased risk of multi-drug resistance.

The study authors say the similar resistance patterns in virtual and in-person settings suggest virtual visits may be a convenient, cost-effective option for UTI care.

"Virtual healthcare may expand access to UTI care, without increased risk of multi-drug resistance," they wrote. "Ongoing surveillance of local microbial prevalence and resistance patterns are needed to further guide appropriate prescribing for UTI empiric therapy."

Pre-infection COVID vaccination linked to lower odds of lingering symptoms

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COVID vaccine vial syringeA US study published yesterday in Nature Communications suggests that pre-infection COVID-19 vaccination was tied to a lower likelihood of persistent symptoms 45 days after infection.

Researchers from the National Institutes of Health's RECOVER study analyzed the electronic health records of patients at 11 sites who tested positive for COVID-19, covering about 1 year starting on August 1, 2021. Minimum follow-up was 164 days.

They studied two groups: 47,404 people (1.5% who received a clinical diagnosis of long COVID and 55.6% who had completed a primary vaccine series) and a model-based cohort of 198,514 people (1.7% were predicted to have long COVID, and 43.4% had received a primary vaccine series).

Results consistent in both cohorts

The researchers found protective associations of vaccination with long-COVID diagnosis in both clinic-based and model-based outcomes. A subanalysis didn't reveal robust evidence that the protective effect depends on the time from vaccination to COVID-19 infection.

"We found that vaccination was consistently associated with lower odds and rates of long COVID clinical diagnosis and high-confidence computationally derived diagnosis after adjusting for sex, demographics, and medical history," they wrote. "A major finding of our analysis is that the protective association remains consistent in results requiring a clinical diagnosis, and among those who contracted COVID-19 in a later period that includes Omicron infections."

We found that vaccination was consistently associated with lower odds and rates of long COVID.

Relative to younger people, older adults had higher odds of both vaccination and long-COVID diagnoses. "Failing to account for the substantial differences between individuals who were and were not vaccinated prior to COVID-19 could lead one to inaccurately conclude that vaccination is harmful," the authors wrote.

They said that contrary to intuition and previous study results, people vaccinated 25 or more weeks before infection had the lowest odds of a long-COVID diagnosis.

"We do not present this as evidence that the benefits of vaccination with respect to long COVID do not wane," the researchers wrote. "Caution should be used when interpreting conditional coefficients and investigating the time between vaccination and COVID-19 was not a primary focus in this study."

COVID-19 infection associated with type 1 diabetes in kids

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Finger prick for monitoring blood glucosA new study suggests that a diagnosis of COVID-19 in children is associated with an increased incidence of type 1 diabetes in 2020 and 2021 in Bavaria, Germany. The study was published yesterday in JAMA.

The findings were based on data collected from the Bavarian Association of Statutory Health Insurance Physicians (BASHIP), which processes claims data for all insured patients in Bavaria, Germany. The study included children born between 2010 and 2018 and observed through December 2021 in the BASHIP database.

Incidence rates of type 1 diabetes were compared in 2018-2019 to 2020-2021 and were analyzed in conjunction with documented COVID-19 diagnoses. The frequency of a first diagnosis of COVID-19 ranged from 0.18% in January to March 2020 to 4.79% in October to December 2021.

The incidence rate of type 1 diabetes was 29.9 (95% binomial confidence interval [CI,] 27.7 to 32.2; 705 cases) per 100,000 person-years between January 2020 and December 2021, compared to 19.5 (95% CI, 17.8 to 21.4; 460 cases) between January 2018 and December 2019 (P<.001).

The findings suggest that SARS-CoV-2 infection contributed to the observed increase in type 1 diabetes.

Diagnoses of type 1 diabetes increased following documented COVID-19 infection. The incidence rate of type 1 diabetes during the pandemic was 28.5 (95% CI, 26.3 to 30.9; 620 cases) per 100,000 person-years in the absence of a COVID-19 diagnosis made before or at the same time as a diabetes diagnosis. 

In comparison, the incidence rate of type 1 diabetes was 55.2 (95% CI, 37.1 to 81.5; 27 cases) per 100,000 person-years in the same 3 months as a COVID-19 diagnosis (P<.001 vs COVID-19 negative). Six to 15 months after COVID-19 diagnosis, the diabetes incidence rate was 50.7 (95% CI, 34.3 to 74.4; 28 cases).

"The findings suggest that SARS-CoV-2 infection contributed to the observed increase in type 1 diabetes incidence during the pandemic," the authors concluded. "Possible mechanisms include initiation of autoimmunity or acceleration of disease progression."

Investor group renews push for restaurant chains to curb antibiotics in meat supply

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Big Mac hamburger
Willis Lam / Flickr cc

In an effort to break a stall in progress fast-food chains have made on antibiotic policies, a global coalition of investors is calling on 12 North Americabased fast-food chains to take stock of their policies and set new targets that align with World Health Organization (WHO) efforts to address antimicrobial resistance (AMR) links to livestock production.

In a statement yesterday, the Farm Animal Investment Risk & Return (FAIRR) coalition, which includes investors that manage $70 trillion in assets, said the new push addresses the leading driver of the $100 trillion AMR threat to the global economy. FAIRR first began engaging fast food and casual dining companies in 2016, which resulted in acknowledgements that the companies needed to do more to limit antibiotic use in their supply chains.

Emma Berntman, PhD, who is leading FAIRR's new restaurant engagement, said that, despite positive movement in the past, progress has stalled. "Investor focus on the 'silent pandemic' of AMR is gaining momentum as the world emerges from the worst of the COVID-19 pandemic – with shareholder resolutions on the issue filed at Hormel Foods, Tyson Foods and McDonald’s already this year."

Investor focus on the 'silent pandemic' of AMR is gaining momentum.

For the new push, FAIRR is asking companies to detail factors such as exposure to the proteins they purchase, antibiotic categories for each protein type, how they track antibiotic quantities used in the supply chain, and how they ensures compliance with its policies.

The deadline for new signatories is July 3. Besides the request for responses, FAIRR will invite the companies to meet their approaches to antibiotic use in their supply chains. The group will also publish the first formal company assessments next spring.

The list of companies includes Bloomin' Brands, Brinker International, Darden Restaurants, Domino's Pizza, McDonald's, Papa Johns, Starbucks, Texas Roadhouse, The Cheesecake Factory, Wendy’s, Yum! Brands, and Restaurant Brands International.

Use of CRP testing reduced antibiotics for respiratory infections, trial finds

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A randomized controlled trial in Vietnam found that use of point-of-care C-reactive protein (CRP) testing reduced antibiotic prescribing in patients with non-severe acute respiratory infections, researchers reported yesterday in The Lancet Infectious Diseases.

In the cluster-randomized trial, conducted from June 2020 through May 2021, 48 community health centers in Vietnam were randomly allocated to provide point-of-care CRP testing plus routine care (the intervention group) or routine care only (the control group). Point-of-care testing for CRP, a biomarker for inflammation that is secreted by the liver in response to bacterial infection, has been found to reduce antibiotic prescribing for non-severe respiratory infections in high-income settings, but the authors note that most of those studies have been performed in a research-oriented context and not in a routine care setting.

The primary end point in the trial was the proportion of patients prescribed an antibiotic at first attendance for a suspected acute respiratory tract infection in the intention-to-treat population.

In the intention-to-treat analysis, 17,345 (93.1%) of 18,621 patients in the intervention group and 20,860 (98.2%) of 21,235 patients in the control group received an antibiotic at their initial visit (adjusted relative risk [aRR], 0.83; 95% confidence interval [CI], 0.66 to 0.93). But only 14% of patients underwent CRP testing in the per-protocol analysis. When the analysis was restricted to this population, larger reductions in prescribing were observed (aRR, 0.64; 95% CI, 0.60 to 0.70). Time to resolution of symptoms (hazard ratio, 0.70; 95% CI, 0.39 to 1.27) and frequency of hospitalization (nine in the intervention group vs 17 in the control group; aRR, 0.52; 95% CI, 0.23 to 1.17) did not differ between groups.

Further work investigating the potential for a more comprehensive antimicrobial stewardship intervention combining education and CRP testing in this population is needed.

The study authors say that while their findings support the case for use of CRP testing for acute respiratory infections in low- and middle-income countries, the low uptake suggests scale-up efforts need to consider and address barriers to implementation.

"Furthermore, given the small population effect achieved in the study, further work investigating the potential for a more comprehensive antimicrobial stewardship intervention combining education and CRP testing in this population is needed," they wrote.

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