A modeling study based on point-prevalence surveys from 99 countries highlights how hospital-associated drug-resistant infections (HARIs) contribute to the global burden of antimicrobial resistance (AMR), researchers reported yesterday in PLOS Medicine.

For the study, a team led by researchers with One Health Trust identified 474 point-prevalence surveys published from 2010 through 2020 on antibiotic resistance proportions for hospital-associated infections in 99 countries. They focused on resistance proportions for six high-priority pathogens: Escherichia coli, Klebsiella spp, Staphylococcus spp, Acinetobacter spp, Pseudomonas spp, and Enterobacter spp. The researchers coupled these findings with country-level estimates of hospitalization rates and durations plus statistical extrapolation based on common economic indicators to estimate the number HARIs per year by country and by country income group.

Highest burden in China

The global number of HARIs was estimated at 136 million per year (95% credible interval [CrI], 26 to 246 million), with the highest burden found in China (52 million; 95% CrI, 10 million to 95 million), Pakistan (10 million; 95% CrI, 2 million to 18 million), and India (9 million; 95% CrI, 3 million to 15 million). Among income groups, middle-income nations bore the highest burden of HARIs per year (119 million; 95% CrI, 23 million to 215 million). The high-income country with the most HARIs per year was the United States (3 million; 95% CI, 1 million to 5 million).

The researchers say that although the study was constrained by the limited number of point-prevalence surveys available, it nonetheless adds to the findings of the Global Research on Antimicrobial Resistance (GRAM) report, which estimated that 1.27 million deaths in 2019 were directly attributable to AMR and 4.95 million were associated with AMR, but GRAM researchers didn't distinguish between hospital-associated and community-associated infections.

"Our results complement these results from Murray and colleagues by describing a substantial burden of hospital-associated resistant infections alone that contribute to the death burden reported," they wrote. "As such, we have highlighted a setting in which drug-resistant disease should be investigated further."

A study conducted at three Veterans Administration (VA) hospitals found that telehealth-supported stewardship activities were associated with reduced antibiotic use in long-term care (LTC) units, researchers reported today in Infection Control & Hospital Epidemiology.

The telehealth-supported intervention, implemented at VA hospitals in Iowa, Georgia, and New York, involved thrice-weekly virtual meetings between an off-site infectious disease physician and the local stewardship pharmacists at each hospital to review patients on antibiotics in the acute-care and LTC units and provide real-time feedback on prescribing.

To evaluate the effectiveness of the intervention, VA researchers conducted an interrupted time series analysis, measuring antibiotic days of therapy (DOT) per 1,000 days present at all three sites before and after implementation.

Antibiotic days of therapy down 30% in LTCs

During the 1-year intervention period, the telehealth program reviewed 502 unique patients and made 681 recommendations to 24 providers, 77% of which were accepted. The most common recommendations were to stop antibiotics (28%) and change antibiotic duration (19%). After program initiation, antibiotic DOT immediately decreased by 26 DOT per 1,000 days present (a 30% decline) in the LTC units but did change in the acute-care units, which saw a 16% increase in antibiotic DOT. Thereafter DOT remained stable in both settings.

Overall, providers perceived the project as acceptable, and project activities were considered workload-appropriate for stewardship pharmacists at two of the three sites.

Wider implementation of telehealth-supported stewardship activities may achieve further reductions in antibiotic use.

The study authors attribute the immediate success in the LTC units to the fact that providers in the units worked every weekday and followed their patients longitudinally, while providers in the acute-care units frequently rotated, which may have been a barrier to building trust.

"Wider implementation of telehealth-supported stewardship activities may achieve further reductions in antibiotic use," they wrote.

Pfizer Hospital, which makes sterile injectable medications, this week warned customers about shortages and potential outages of certain Bicillin L-A (penicillin G benzathine injectable suspension) and Bicillin C-R (penicillin G benzathine and penicillin G procaine injectable suspension) prefilled syringes.

Penicillin G is on the Resilient Drug Supply Project's (RDSP's) list of 156 critical acute drugs and is on the American Society of Health-System Pharmacists (ASHP) and the Food and Drug Administration (FDA) drug shortage lists. In April, the AHSP posted a notice about penicillin G benzathine shortages, specifically 1-milliliter (mL), 2-mL, and 4-mL syringes of Bicillin L-A. The RDSP is part of the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News.

These presentations will not be available until further notice.

Pfizer said the supply interruptions are due to complex factors that include increased demand from a rise in syphilis infections and competitive shortages. It added that it has prioritized production of 2-mL and 4-mL syringes of Bicillin L-A.

The company said it expects Bicillin C-R supplies to be depleted in the third quarter of this year and the pediatric version of Bicillin L-A to be depleted by the second quarter. "These presentations will not be available until further notice," Pfizer said in its letter to customers.

Tests have confirmed chronic wasting disease (CWD) in a mule deer from a previously unaffected deer hunting area in Wyoming, the state's game and fish department said this week in a statement.

The disease was found in a targeted male mule deer near Rock Springs, located in the west central part of the state, in deer hunt area 131 in the Green River region. Wildlife managers euthanized the deer in late April.

The newly affected region includes part of the Sublette deer herd, in which CWD was detected in 2017. The Wyoming Game & Fish Department said it borders six other CWD-positive areas.

Officials urged hunters to avoid eating animals that show signs of illness or test positive for CWD.

Highly contagious and always fatal, CWD affects cervids such as deer, elk, moose, and caribou. It is a prion disease that is similar to bovine spongiform encephalopathy ("mad cow" disease). So far CWD hasn't been detected in humans.

Global flu activity continues to decline, driven by decreases in the Northern Hemisphere, though markers show increases in some Southern Hemisphere countries, the World Health Organization (WHO) said in its latest update, which roughly covers the last half of May.

Australia's flu activity rose further, with New Zealand's flulike illness and severe acute respiratory infection rates now above baselines. South Africa reported a sharp rise in flulike illness activity, along with the related pneumonia level above the seasonal threshold.

Some of South America's temperate countries, mainly Chile, are reporting increasing flu detections, mainly 2009 H1N1 but also influenza B. Paraguay and Uruguay also reported increased flu activity. In South America's tropical region, flu levels remained elevated.

Flu in most other world regions declined or remained stable, though levels of H1N1 activity increased in Cambodia, and South Korea reported a slight rise, mainly due to H3N2.

At national flu labs during the reporting period, 63.7% of respiratory specimens that tested positive for flu were influenza A, and of subtyped influenza A viruses, 78.9% were H1N1. All characterized influenza B viruses belonged to the Victoria lineage.