News Scan for Jul 15, 2014

Late-season H7N9 in bird markets
Hospice antibiotic prescribing

H7N9 found after poultry markets reopened in China in 2013

As many as 22% of poultry samples tested positive for H7N9 avian flu in live-poultry markets in a Chinese city after the markets reopened in the summer of 2013 following their closure over H7N9 cases, according to a study yesterday in the International Journal of Infectious Diseases.

Investigators tested 113 poultry samples taken from 13 markets in Huzhou City in August and September after the markets were reopened on Aug 2 and 3. The samples comprised 92 poultry feces samples, 20 swab samples from culling benches, and 1 sewage sample.

Overall, 17 (15%) of the samples tested positive for H7N9 by polymerase chain reaction. Four of the markets had positive samples, with prevalence ranging from 4% to 22%.

Phylogenetic analyses of the viruses showed that the market strains belonged to the same genotype as those detected in humans in the area. Four people in Huzhou contracted H7N9 avian flu from October 2013 to Jan 20, 2014, the authors noted.

The authors conclude, "We must strengthen routine surveillance of live poultry markets to effectively prevent a large-scale outbreak of the H7N9 virus."
Jul 14 Int J Infect Dis abstract


Study: 21% of hospice patients prescribed antibiotics

About one in five terminally ill patients are prescribed antibiotics despite little evidence that the drugs improve symptoms or quality of life, according to results of a study of hospice patients published in Antimicrobial Agents & Chemotherapy last week.

Researchers studied prescribing data on 845 patients discharged to hospice care from Oregon Health & Science University (OHSU) Hospital in 2010 through 2012. They found that 21.1% had a prescription for antibiotics upon discharge, among whom 71.8% had a documented infection when they were first admitted to the OHSU Hospital.

Independent risk factors for receiving an antibiotic prescription were documented infection on first admission (adjusted odds ratio [AOR], 7.00), discharge to home hospice (AOR, 2.86), and having a cancer diagnosis (AOR=2.19).

"The frequency and prevalence of antibiotic use in this patient population is a concern," said lead author Jon P. Furuno, PhD, an associate professor in the Oregon State University/OHSU College of Pharmacy, in an Oregon State University press release.

"Antibiotics themselves can have serious side effects that sometimes cause new problems, a factor that often isn't adequately considered. And in terminally ill people they may or may not work anyway."

The design of the study probably leads to it underestimating the significance of the problem, the researchers wrote in their conclusion.
Jul 7 Antimicrob Agent Chemother abstract
Jul 14 Oregon State University
press release

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