Non-restrictive stewardship intervention tied to less fluoroquinolone use

A non-restrictive antibiotic stewardship intervention was associated with reduced fluoroquinolone prescribing at two community hospitals in Los Angeles, researchers reported yesterday in Open Forum Infectious Diseases.

Based on high fluoroquinolone resistance among common organisms, the association of fluoroquinolones with Clostridioides difficile infection, and documented adverse drug reactions, members of the pharmacy and infectious prevention departments at the two non-academic community hospitals developed strategies to curb excessive use of levofloxacin (LVX), one of the most commonly used antibiotics in the United States.

Because of some of the disadvantages of restrictive policies like pre-authorization, they focused on non-restrictive strategies such as education, monitoring and reporting fluoroquinolone susceptibility trends to physician groups, daily prospective audit and feedback, and implementation of beta-lactam-based institutional guidelines for empiric therapy.

To assess the effectiveness of the interventions, which were implemented in January 2017, researchers collected antibiotic use data from August 2015 through January 2021. Both hospitals showed significant downward trends in LVX prescribing over the study period, and the decrease in LVX use was sustained. At the same time, both hospitals saw an increase in use of ceftriaxone (CRO), which institutional guidelines recommended in place of levofloxacin because of higher susceptibility rates against Enterobacterales. Researchers also observed a positive correlation between reduced LVX days of therapy and reduced Pseudomonas aeruginosa non-susceptibility.

"We speculate the decrease in LVX may result in less adverse drug reactions, along with a higher likelihood of achieving active empiric antimicrobial therapy due in part to CRO's superior susceptibility rates among the Enterobacterales organisms, coupled with a demonstrated improvement in LVX susceptibility among inpatient P. aeruginosa isolates," the study authors wrote. "This was accomplished by targeting prescribing behaviors and the provision of provider feedback and education, which may have less of a negative connotation compared to restrictive approaches."
Aug 1 Open Forum Infect Dis abstract

US Lyme disease diagnoses increased dramatically in past 15 years

A report today from FAIR Health reveals that, from 2007 to 2021, Lyme diagnoses rose 357% in rural regions of the United States and 65% in urban areas, according to private insurance claims.

In the past 5 years, from 2016 to 2021, insurance claims increased 60% in rural areas and 19% in urban areas. 

FAIR Health is an independent organization with a database of more than 36 billion privately billed healthcare claims. The percentage of claims for Lyme disease rose steeply in rural areas in June and July of each year, but from November to April, urban areas saw a higher percentage.

In 2017, New Jersey, Connecticut, North Carolina, Rhode Island and Vermont had the highest rates of insurance claims for Lyme disease. Five years later, the states were New Jersey, Vermont, Rhode Island, Maine, and Connecticut.

"Lyme disease remains a growing public health concern. FAIR Health will continue to use its repository of claims data to provide actionable and relevant insights to healthcare stakeholders seeking to better understand the ongoing rise of Lyme disease cases," said FAIR Health President Robin Gelburd in a press release.
Aug 2 FAIR Health press release
Aug 2 FAIR Health infographic

Florida reports second local dengue case

The Florida Department of Health on Jul 29 reported the state's second locally transmitted dengue case, also involving a resident of Miami-Dade County.

In the middle of July, health officials issued a mosquito-borne illness advisory after the first local dengue case was detected.

Spread by Aedes mosquitoes, local cases aren't uncommon in south Florida. For example, in 2020 the state reported 71 locally acquired cases to the US Centers for Disease Control and Prevention.

Florida's health department urges people to take preventive steps, such as draining standing water, using insect repellent, and wearing protective clothing. Officials also reminded people about the symptoms, which can include fever, headache, eye pain, and musculoskeletal pain.
Jul 29 Florida Health statement
Jul 20 CIDRAP News scan

H5N1 avian flu strikes more poultry in Oregon, turns up in Norwegian foxes

As sporadic highly pathogenic avian flu detections continue over the summer, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported one more outbreak in a poultry flock, which affected a backyard facility in Coos County.

Coos County is in the southwestern part of the state, and the backyard facility had 20 birds. Many of the most recent poultry outbreaks have occurred in western states; however, Florida recently reported its first outbreak in poultry.

So far this year H5N1 outbreaks in poultry have led to the loss of 40.1 million birds across 38 states.
USDA APHIS poultry outbreak page

In other H5N1 developments, Norway recently reported H5N1 for the first time in mammals, according to a government veterinary statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. The virus was found in two fox pups found sick in Stad municipality on the country's southwestern coast.

Over the past year, H5N1 has been found in several mammal species in Europe and North America, raising concerns about the zoonotic potential of the virus. So far, only two human infections have been found. Both were mild and involved people who had extensive contact with birds.
Jul 31 AFD post