News Scan for Jun 30, 2020

News brief

Survey explores trust, self-interest, and teen pandemic practices

A study of 770 teens' attitudes conducted in the 7 days after the United States declared a national emergency amid the COVID-19 pandemic found that 69% weren't practicing physical distancing but 89% were following the news, and 88% were disinfecting daily.  

In the study, published yesterday in JAMA Pediatrics, researchers from Montana State University in Bozeman used social media to recruit adolescents 13 to 18 years old from Mar 20 to 22 to participate in the anonymous 31-question survey.

They found that beliefs about pandemic severity, social responsibility values, social trust, and self-interest were differentially linked to news monitoring, physical distancing, disinfecting behaviors, and hoarding of products in short supply. Disinfecting was defined as using hand sanitizer, washing hands, cleaning phones, and using disinfecting wipes.

Of 770 participants, 152 (20%) reported hoarding. Those who perceived the pandemic to be more severe were more likely to practice physical distancing, disinfection, and news monitoring but also more hoarding.

Teens who valued social responsibility were most likely to engage in disinfection and news monitoring and less likely to hoard, while those with greater self-interest were less likely to practice physical distancing and more likely to hoard. Those who demonstrated greater social trust were less likely than others to hoard.

Mean participant age was 16.3 years, and 575 of 770 (75%) were girls. The sample primarily included students in the 10th through 12th grade, with only 14% being 9th graders and 4% college students. Of 770 respondents, 558 (73%) were white, followed by Hispanic/Latino (117 [15%]), black (43 [6%]), Asian American/Pacific Islander (78 [10%]), American Indian/Alaska native (24 [3%]), and other race (23 [3%]).

The authors concluded that emphasizing the severity of the pandemic and social implications of related behaviors may help reinforce desired behaviors in teens. "Findings from this study stress the importance of increasing adolescents’ social responsibility values and decreasing self-interest values as a preventive measure for future pandemics and public health concerns," they wrote.
Jun 29 JAMA Pediatr study

Some cloth, cone-style masks impede some respiratory droplets, study finds

While no face mask available to the general public is 100% effective at containing expelled droplets that could contain respiratory pathogens such as COVID-19 viruses, well-fitted and two-layered homemade cloth masks and off-the-shelf cone-style masks were more effective than loosely folded and bandana-style masks in a study published today in Physics of Fluids.

Researchers from Florida Atlantic University's Department of Ocean and Mechanical Engineering in Dania Beach experimented with different types of materials and designs to determine which best suppressed the flow of respiratory droplets from mannequin heads that simulated coughs and sneezes.

Using a recreational fog/smoke machine, a mixture of distilled water and glycerin, and an off-the-shelf laser to visualize the droplets, they determined that loosely folded and bandana-style face coverings stopped little or no droplet jets.

And while homemade masks with two layers of quilting fabric and off-the-shelf cone-style masks leaked respiratory droplets through and around the mask, they reduced the numbers of large respiratory droplets ejected significantly. Without masks, the mannequins ejected respiratory fluids much farther than the 6 feet recommended in physical distancing guidelines.

The researchers observed that a higher thread count alone was not enough to guarantee better blockage of respiratory droplets; in fact, the bandana-style covering, which had the highest thread count of all the cloth masks tested, was the least effective.

The authors noted that the simulated coughs and sneezes in the study were simplified, whereas human coughs and sneezes are much more complex and dynamic, and warned that masks saturated with respiratory droplets may degrade their filtration capacity. They said they will further study the complex interaction of droplet evaporation, ambient airflow, and properties of ejected droplets that influence droplet behavior to better understand their dynamics.

Lead author Siddhartha Verma, PhD, said in a news release from the American Institute of Physics (AIP), which publishes the journal, that it's important to understand that face masks are not 100% effective in blocking respiratory pathogens. "This is why it is imperative that we use a combination of social distancing, face coverings, hand-washing and other recommendations from health care officials until an effective vaccine is released," he said.
Jun 30 Phys Fluids study
Jun 30 AIP news release


DRC's Equateur province outbreak total rises to 30

Two more Ebola cases have been confirmed in an outbreak in the Democratic Republic of Congo (DRC) Equateur province outbreak in the northwestern part of the country, raising the total to 30, the World Health Organization (WHO) African regional office said today on Twitter. No new deaths were reported, keeping the total at 13.

In its weekly update on outbreaks and health emergencies yesterday, the WHO's African regional office had more details about the outbreak and noted that five confirmed patients are still in the community, a factor that raises the risk of further spread. The report covers cases reported through Jun 28 and does not include the two most recent cases. However, it noted that the 28th case, reported on Jun 27 from Bikoro health zone, is the wife of a recently confirmed case and had not been listed as a contact or vaccinated.

The latest confirmed case-patient is receiving care at the Ebola treatment center in Bikoro. One patient suspected of having Ebola escaped in Wangata, and the confirmed patients still in the community are in Bikoro, Bolomba, Mbandanka, and Wangata. Since Jun 5, 6,336 people have been vaccinated in eight of nine vaccination rings.

The WHO said the situation in the Equateur province Ebola outbreak, the DRC's 11th, continues to evolve, with continued incidences in confirmed cases in the community and contacts lost to follow-up; however, all parts of the response are activated in the affected areas.
Jun 30 WHO African regional office tweet
Jun 29 WHO African regional office weekly report


FDA: 91 products recalled due to Cyclospora outbreak in US

The Food and Drug Administration (FDA) reported yesterday that 91 products distributed to stores in 30 states and the District of Columbia are under recall because of an ongoing Cyclospora outbreak that has sickened more than 200 people. Some of those people have reported eating bagged garden salads from large grocery chains.

The recall was voluntarily initiated by Fresh Express, and will affect 91 branded and private label salad products produced at the company's Streamwood, Illinois, facility that contain iceberg lettuce, red cabbage, and/or carrot ingredients. Fresh Express recalled the products because of a possible health risk from Cyclospora, the company said.

"The Fresh Express recall includes only those salads that are clearly marked with the letter Z at the beginning of the Product Code, which is located in the upper right-hand corner of the front of the package," the recall announcement stated.

The recalled products were distributed to stores from Jun 6 to Jun 26. No other Fresh Express products are included in the recall.
Jun 29 FDA

Stewardship / Resistance Scan for Jun 30, 2020

News brief

CARB-X to fund its first CRISPR-based phage project

CARB-X announced an award today of up to $1.82 million to French biotechnology company Eligo Bioscience to develop CRISPR- and bacteriophage-based therapeutics to prevent multidrug-resistant infections in transplant patients.

Eligo's EB004 project takes bacteriophages, which are viruses that selectively infect and kill bacteria, and designs them to inject synthetic DNA into targeted bacterial populations—extended-spectrum beta-lactamase-producing and carbapenem-resistant Escherichia coli and Klebsiella pneumoniae—in a patient's digestive tract. The DNA is designed to circumvent bacterial defense systems and enable the expression of a CRISPR-Cas system that creates double strand DNA breaks only in the antibiotic resistance genes carried by the targeted bacteria, selectively killing the bacteria carrying these genes and leaving those that don't carry antibiotic-resistance genes alone.

The idea behind the project is to eliminate these multidrug-resistant pathogens from a transplant patient's microbiome before the procedure to prevent the onset of life-threatening post-operative infections, without disrupting any beneficial bacteria.

"Eligo is developing a new class of targeted biotherapeutics to selectively eliminate certain multidrug-resistant bacteria by combining the specificity of CRISPR and the ability of bacteriophages to deliver DNA into bacteria," CARB-X chief of research and development Erin Duffy, PhD, said in a press release. "This innovative approach, if successful, offers additional benefits in that it can prevent multi-drug-resistant infections while not harming bacteria in the microbiome."

This is the first CRISPR-based phage project funded by CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator). Eligo could receive up to $7.05 million in funding if certain project milestones are met.
Jun 30 CARB-X press release


Antimicrobial stewardship helps Saudi hospitals cut antibiotic use, expenses

Implementation of antimicrobial stewardship programs at four private hospitals in Saudi Arabia resulted in reduced antibiotic use and expenditures and lowered incidence of healthcare-associated infections, Saudi researchers reported yesterday in Antimicrobial Resistance and Infection Control.

In a pre-post quasi-experimental study, the researchers aimed to measure the impact of the antibiotic stewardship program implemented at four Al Habib Medical Group hospitals by comparing the 1-year baseline period prior to implementation (2015) with 4 years of post-implementation data (2016 through 2019). Patients were included on the pre- and post-implementation arms if they were on any of 10 selected broad-spectrum antibiotics (imipenem/cilastatin, piperacillin/tazobactam, colistin, tigecycline, cefepime, meropenem, ciprofloxacin, moxifloxacin, teicoplanin, and linezolid).

A total of 409,403 subjects were included in the study, with 79,369 in the pre-implementation period and 330,034 in the post-implementation arm. Average consumption of the targeted antibiotics, in defined daily doses (DDDs), was lower from 2016 through 2019 than in the pre-implementation period (233 vs 320 DDDs per 1,000 patient-days, P = 0.689), and antibiotic expenditures decreased by 28.45% in the first years of the program and remained relatively stable in subsequent years, with an estimated overall cumulative cost savings estimated at US $1,676,514.

Rates of healthcare-associated infections also fell, with incidence of Clostridioides difficile declining by 86.17%, ventilator-associated pneumonia falling by 75%, and central line-associated bloodstream infections falling by 94.12%.

The authors of the study note that many indirect expenses are also expected to decrease proportionally, including those associated with antibiotic resistance, antibiotic side effects, hospital-acquired infections, and increased length of hospital stay and readmission.
Jun 29 Antimicrob Resist Infect Control study


Rapid ID, susceptibility test aids stewardship, study finds

Implementation of a rapid identification (ID) and antimicrobial susceptibility test (AST) combined with pharmacy-driven antimicrobial stewardship in patients with gram-negative bacteremia and candidemia was associated with decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and fewer days in the hospital, researchers reported yesterday in Antimicrobial Agents and Chemotherapy.

In a pre-post quasi-experimental study conducted at a 288-bed community hospital in Maryland, researchers investigated the impact of the Accelerate Pheno system and Accelerate PhenoTest BC kit (AXDX), which can produce ID results in 2 hours and AST results in an additional 5 hours, on antimicrobial stewardship and clinical outcomes when compared with rapid genotypic testing.

The study included 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) with positive blood cultures with gram-negative rods or candida species. The primary endpoints were time to first antibiotic intervention, time to targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 hours, and 30-day readmission rates.

The final analysis included 84 patients in the pre-implementation group and 89 in the post-AXDX group. The results showed that time to first antibiotic intervention was significantly shorter in the post-AXDX group compared with the pre-AXDX group (8 vs 26.3 hours, P = .003), as was the median time to targeted therapy (9 vs 14.4 hours, P = .03). In addition, hospital LOS was shorter in the post-AXDX group compared with the pre-AXDX patients (6 vs 8 days, P = .002), and the antibiotic intensity score was lower (12 vs 16, P = .0002). Both groups had a comparable 14-day mortality (0% vs 3.6%, P = .11).

"Our results demonstrate that in a resource-limited community hospital setting, fast ID and AST via AXDX can be used in conjunction with clinical pharmacy services to positively impact patient care," the authors of the study wrote.
Jun 29 Antimicrob Agents Chemother abstract

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