Remdesivir, steroids tied to better COVID hospital outcomes

News brief

The antiviral drug remdesivir and corticosteroids were linked to better outcomes in COVID-19 patients admitted directly to a hospital ward in the Netherlands, suggests a real-world study published today in Open Forum Infectious Diseases.

The nationwide study, led by University of Amsterdam researchers, involved 5,643 COVID-19 patients admitted to 11 hospitals during four pandemic waves, from Feb 27, 2020, to Dec 31, 2021. Patients received remdesivir, corticosteroids, the antimalarial drug hydroxychloroquine, immune-suppressing interleukin-6 (IL-6) antagonists, or combinations thereof; intensive care unit (ICU) patients didn't receive remdesivir.

Over the four waves, overall median age fell from 67 to 64 years, and in-hospital death rates dropped from 21% to 15%. Of the 5,187 patients admitted directly to a ward, median age was 66 years, 59% were men, 13% were later admitted to an ICU, and 17% died in the hospital. Median age in the 456 patients admitted directly to an ICU was 65 years, 75% were men, 26% died in the ICU, and 33% died during admission.

Among patients admitted directly to a ward, remdesivir was linked to a higher rate of hospital release within 29 days (hazard ratio [HR], 1.16), and corticosteroids were tied to a lower likelihood of in-hospital death (HR, 0.81) and death by 12 weeks (HR, 0.84). Hydroxychloroquine was associated with an increased risk of death (HR, 1.54), and the results of IL-6 antagonists were inconclusive.

In patients admitted directly to an ICU, hydroxychloroquine, corticosteroids, and IL-6 antagonists weren't tied to a lower risk of death or hospital release alive.

The authors cautioned that changes in the predominant circulating SARS-CoV-2 variants, patient COVID-19 vaccination status, and use of noninvasive ventilation and high-flow nasal oxygen therapy during the study likely influenced the study outcomes and treatment effects.

"Given the ongoing evolution of the SARS-CoV-2 virus with novel clinically significant mutants appearing at a steady state during changing patient's characteristics over time, it is essential to continuously re-evaluate the real-world effectiveness of newly introduced drugs to treat COVID19," they wrote.

UK surveillance report shows declines in resistant infections, antibiotic use

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The latest surveillance report from the United Kingdom's Health Security Agency (HSA) shows that the overall burden of antimicrobial resistance (AMR) in England is declining, but the trend varies by pathogens, regions, and demographic groups.

Data from the ninth annual English Surveillance Programme for Antimicrobial Use and Resistance (ESPAUR) report shows that the burden of AMR declined by 4.2% from 2017 to 2021, mainly driven by a reduction in the incidence of Escherichia coli bloodstream infections (BSIs). The rate of resistant BSIs was highest in London and lowest in the East Midlands.

In addition, the total number of drug-resistant infections in England fell by 9.1% from 2018 to 2021. Although some of that decline could be the result of COVID-19 restrictions, the authors of the report note that it puts the country on target to meet its National Action Plan (NAP) goal of a 10% reduction in antibiotic-resistant infections from the 2018 baseline by 2025.

But the report also notes that severe antibiotic-resistant infections rose by 2.2% in 2021 compared with 2020, and that drug resistance appears to have a greater impact on ethnic minorities and socially deprived groups. Nearly 33% of BSIs in people in the Asian or British Asian ethnic group were caused by a resistant organism in 2021, compared with 20.9% of White people. And people in the most deprived 10% of the country had higher notification rates for carbapenemase-producing gram-negative bacteria than did those in the least deprived 10%.

"Understanding the impact of ethnicity, deprivation, regional divergence, along with potential confounders, remains an important area of investigation," the HSA wrote in a blog post.

Antibiotic consumption data, meanwhile, shows that antibiotic use in England fell by 0.5% from 2020 to 2021, and by 15.1% from 2017 to 2021—a decline that exceeds the goals of the NAP but is also likely linked to reduced use of healthcare services during the pandemic.

"Unless we continue to use antibiotics appropriately and continue to drive down infections overall, the trend may not be sustained," the HSA said.

Dutch study finds no evidence of monkeypox transmission before May 2022

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In a preprint study, Dutch researchers report finding no evidence of widespread human monkeypox virus (hMPXV) transmission in Dutch sexual networks of men who have sex with men (MSM) before May 2022. The study, which is not yet peer-reviewed, is published on medRxiv.

Researchers performed a retrospective study of 401 anorectal and ulcer samples from visitors of sexual health clinics in Rotterdam and Amsterdam dating back to Feb 14, 2022. Swabs are routinely taken when testing for gonorrhea or chlamydia. Samples are kept for an average of 4 to 6 months.

The earliest monkeypox cases identified in the study sample were from the first week of May 2022, the same week the United Kingdom, Spain, and Portugal identified initial cases.

"These findings suggest that the introduction of MPXV in Dutch sexual networks of MSM started somewhere at the end of April 2022. This coincides with the earliest symptom onset of hMPXV cases in the UK on April 21," the authors concluded. Widespread undetected transmission before the first week of May is unlikely.

Today, the global monkeypox total is 80,611 cases, 53 of them fatal, from 110 countries. Approximately 20,000 cases have been reported in Europe. The Netherlands has reported more than 1,200 cases, with a crude notification rate of 70.7 per million population, making it one of the top 5 European countries most affected during the global outbreak.

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