News Scan for Apr 22, 2019

News brief

Two new MERS cases recorded in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) today and over the weekend recorded two more cases of MERS-CoV for epidemiologic weeks 16 and 17.

On Apr 20 the MOH said an 83-year-old man from Taif was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) infection. The man's case is listed as "primary," and he had recent contact with camels.

Today a 56-year-old man from Medina was confirmed as being diagnosed as having MERS. It is not known if he had camel contact, but his illness is also listed as "primary," meaning it is unlikely he contracted the virus from another person.

The cases raise Saudi Arabia's MERS-CoV total for the year to 134 cases, including 57 linked to a large outbreak in Wadi ad-Dawasir.
Apr 20 MOH report
Apr 22 MOH report


WHO: Brazil confirms 75 yellow fever cases in current season

From July 2018 through March 2019, Brazil recorded 75 yellow fever cases, including 17 deaths, resulting in a case-fatality ratio of 23%. The numbers come from a new update published today by the World Health Organization (WHO).

Though Brazil is seeing yellow fever spread in regions with low population immunity, the 2018-19 seasonal numbers pale in comparison to the two distinct waves of yellow fever outbreaks seen in recent years. In 2016 and 2017 officials noted 778 human cases, including 262 deaths, and in 2017-18 officials confirmed 1,376 human cases, including 483 deaths.

According to the WHO, current cases have been confirmed in Sao Paulo (62), Parana (12), and Santa Catarina (1) states. Of these patients, 88% are men, the median age is 43 years, and 71% are rural workers.

These are the first cases recorded in Parana state, located in southeast Brazil, since 2015. The other cases recorded in the last 2 months were in Sao Paulo state. Sao Paulo and Parana states have also reported epizootic cases in the last month, the WHO said.

"The geographical distribution of human cases and epizootics from the current and previous two seasonal cycles suggests southward movement of the virus, which presents further risk to the states of Parana, Rio Grande do Sul, and Santa Catarina," the WHO said.
Apr 18
WHO update

Stewardship / Resistance Scan for Apr 22, 2019

News brief

Study: High variability in prescribing by Canadian family physicians

A new study by Canadian researchers has found substantial inter-physician variability in antibiotic prescribing that was not explained at all by differences in patients. The findings appeared in the Journal of Antimicrobial Chemotherapy.

To describe predictors of overall antibiotic prescribing and inter-physician variability among family physicians in Ontario, researchers from Public Health Toronto looked at prescribing rates over 5 years and evaluated the association of patient-, physician-, and clinic-level characteristics with those rates. Using electronic medical records and linked databases containing demographic information on patients and physicians, they evaluated nearly 4 million physician-patient encounters, with 322,129 unique patients cared for by 313 physicians at 41 primary care clinics.

Overall, physicians prescribed a median of 54 antibiotics per 1,000 encounters. Patients' age and sex were highly correlated with antibiotic prescriptions, particularly in girls aged 3 to 5 years, who were associated with the highest antibiotic prescribing rates compared with males 65 years of age and older (odds ratio [OR], 4.01; 95% confidence interval [CI], 3.89 to 4.13). The only significant physician-level predictor was a median daily patient volume of more than 20 patients, compared with more than 10 (adjusted OR, 1.28; 95% CI, 1.06 to 1.55).

The analysis also found, however, that patient-level covariates had little impact on the variability of physician prescribing. The median ORs with and without patient characteristics were 1.68 and 1.69, respectively, which was interpreted as meaning that the odds of receiving an antibiotic prescription in the same patient randomly encountering two different physicians varied by 1.7-fold, simply by seeing different physicians. In addition, except among children ages 0 to 11, physician identifiers explained more of the antibiotic prescribing than all patient characteristics, including comorbidities and healthcare use.

The authors of the study say the findings provide supporting evidence that antibiotic prescribing rates don't need to be adjusted for patient characteristics when used for peer comparison of family physicians working in similar practice settings.
Apr 19 J Antimicrob Chemother study


Review highlights factors linked with prescribing in primary, dental care

In another study in the Journal of Antimicrobial Chemotherapy, a team of British researchers reviewed published literature and identified 30 factors associated with the decision to prescribe antibiotics to adults with acute conditions in primary care and primary dental care.

For the two-part review, the researchers identified 689 publications across primary care and 432 across dental care for review. Of these, nine and seven studies, respectively, were included in the final review. They covered 46 countries, of which 12 were low- and middle-income countries (LMICs).

A total of 30 modifiable and non-modifiable factors associated with prescribing were identified across both the umbrella review of primary care studies and the systematic review of primary dental studies. Among the 30 factors identified, the most frequent were "patient/condition characteristics," "patient influence," and "treatment skills." The two factors that were unique to dental studies were "procedure possible," and "treatment skills." None of the factors identified related only to LMICs.

The authors of the study say the identification of these factors should assist the theory-informed design of new interventions—and fine-tuning of existing interventions—aimed at helping clinicians in primary care and dental care optimize antibiotic prescribing.
Apr 19 J Antimicrob Chemother study

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