News Scan for Jun 02, 2020

News brief

COVID-19 takes heavy toll on new doctors' mental health, study finds

First-year medical residents in Shanghai—500 miles away from the Chinese COVID-19 epicenter of Wuhan—had a steep decline in mood, increased depression and anxiety, and twice the level of fear of workplace violence in the first month of the pandemic, according to a research letter published yesterday in JAMA Network Open.

The study involved 385 medical residents beginning work at 12 hospitals in August 2019 who tracked their mood each day on a smartphone app and answered questionnaires about their mental health and whether they had experienced, seen, or feared physical violence or verbal abuse at work. The questionnaires were given 2 weeks before residency and at 3 and 6 months.

Daily mood scores decreased significantly between 3 months (before the pandemic) and 6 months (at the pandemic peak), while scores for depression, anxiety, and fear of or observations of patient or patient family violence rose significantly.

The results contrasted sharply with the scores of residents who participated in the same study the previous year and had stable scores over the same period. Previous research had shown that first-year residencies are associated with large increases in depressive symptoms.

In a press release, coauthor Elena Frank, PhD, of the University of Michigan at Ann Arbor, said that infectious disease outbreaks can fray healthcare workers' physical and psychological health.

"It's easy to forget that they face many of the same additional stresses as the rest of us—concerns about elderly or at-risk family, loss of childcare—while simultaneously managing an increased clinical workload, and all while placing themselves and their families at greater risk of infection," she said.

The authors concluded that hospitals should ensure that doctors receive adequate support and access to mental health services.
Jun 1 JAMA Netw Open research letter
Jun 1 University of Michigan press release


Wuhan data show less than 1% of recovered COVID-19 patients suffered relapse

Editor's Note: This item was edited on Jun 3 with the correct percent of patients who suffered a relapse: 0.78%, not 7.7%.

A study today in the International Journal of Infectious Diseases showed that, of 1,673 recovered COVID-19 patients from two fever clinics in Wuhan, China, 13 experienced a relapse of mild disease within 20 days of symptom resolution from initial infections.

To conduct the study, 1,673 cured patients—defined as having negative test results, clear chest scans, and resolution of symptoms—were followed up two to six times between Mar 1 and Mar 20. Relapses were confirmed with positive test results and chest imaging. All 13 (0.78%) of patients who relapsed also had respiratory symptoms, but none required admittance to the intensive care unit. All relapsed patients also had high levels of C-reactive protein.

"Only 7.7% patients experienced recurrence during isolation and observation, and all presented with mild symptoms. No nosocomial transmission was found in this process," the authors wrote.

Serologic tests for immunoglobulin G (IgG) antibody was negative in 10 of the relapsed cases, IgM antibody was positive in 3 cases, and both IgG and IgM were positive in 3, the authors wrote. In patients who did not experience relapse, IgG antibody was negative in 1,543 cases (92.9%). However, IgM antibody was positive in 1,170 cases (70.9%), and both IgG and IgM were positive in 178 patients (10.7%).
Jun 2 Int J Infect Dis study

Stewardship / Resistance Scan for Jun 02, 2020

News brief

Cefiderocol gets FDA approval for use in nosocomial pneumonia

Drug maker Shionogi & Co. of Osaka, Japan, announced yesterday that the US Food and Drug Administration (FDA) has accepted the company's supplemental New Drug Application (sNDA) and granted Priority Review designation for the use of cefiderocol to treat adults with nosocomial pneumonia.

Cefiderocol, sold under the brand name Fetroja, is a cephalosporin antibiotic with a novel mechanism of penetrating the tough outer membrane of gram-negative bacteria and the ability to overcome resistance mechanisms used by gram-negative pathogens to evade antibiotics. It was approved by the FDA for treatment of complicated urinary tract infections caused by gram-negative pathogens on Nov 12, 2019.

According to a company press release, the sNDA is based on results from a phase 3 study that showed cefiderocol met the primary endpoint of non-inferiority compared with high-dose extended-infusion meropenem in treatment of patients with healthcare-acquired and ventilator-associated pneumonia caused by gram-negative pathogens.

The results showed that 14 days after initiation of treatment, all-cause mortality in the modified intention-to-treat population was 12.4% for cefiderocol (18 of 145 patients) and 11.6% for meropenem (17/146).

The company said cefiderocol also met key secondary endpoints of clinical and microbiologic outcomes at test-of-cure and demonstrated no unexpected safety signals.

"We are committed to working with the FDA in order to bring Fetroja to more patients fighting these challenging and life-threatening Gram-negative infections as quickly as possible," said Akira Kato, PhD, president and CEO at Shionogi Inc., the company's US-based subsidiary.
Jun 1 Shionogi press release


Discharge stewardship linked to better antibiotic prescribing, study finds

Expanding an antimicrobial stewardship program (ASP) to ensure that hospital patients are discharged with appropriate therapy was associated with improvements in appropriate antibiotic prescribing and fewer days of antibiotic therapy at an Ohio hospital, researchers reported today in Infection Control & Hospital Epidemiology.

The study assessed the percentage of patients discharged on appropriate therapy before and after implementation of the discharge stewardship intervention, in which the discharge ASP pharmacist at Northeast Ohio Medical University reviewed patient medical records and anti-infective regimens and provided recommendations on antibiotic therapy to the medical team, if appropriate.

Other outcomes included antimicrobial days of therapy (DOT) and the percentage of readmissions of healthcare visits for treatment failure within 30 days. A total of 122 patients were included in the study, with 61 each in the pre-intervention and post-intervention groups.

Analysis of the two groups found that the percentage of appropriate therapy on discharge was 47.5% before the ASP expansion compared with 85.2% afterward (relative risk [RR], 0.28; 95% confidence interval [CI], 0.147 to 0.538; P < .001). In the post-intervention phase, 48 recommendations were made across 40 patients upon discharge, with an 81% acceptance rate. Recommendations included change in duration (44%), followed by discontinuation (17%), change in dose (14.5%), and change in drug (10%).

The average duration of therapy was 7.8 days in the post-intervention group, compared with 8.9 days in pre-intervention group (P = 0.079). Antimicrobial DOTs were also lower after the intervention than before (555 days vs 626.5 days, respectively). The total 30-day readmission rate was 19.7% in the pre-intervention group versus 11.5% in the post-intervention group (RR, 0.583; 95% CI, 0.246 to 1.38; P = 0.212), a difference not considered statistically significant. 

"This project demonstrated that the expansion of an ASP significantly improved the rate of appropriate discharge anti-infective prescribing," the authors of the study write. "A larger patient population is necessary to fully describe the effect on readmissions, adverse events, and treatment failure. Time spent on ASP will also be useful to determine the real-world feasibility of expanding to a larger population."
Jun 2 Infect Control Hosp Epidemiol abstract

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