News Scan for Aug 19, 2020

Stewardship for urinary infections
Onion Salmonella outbreak grows

Clinical support tool linked to better antibiotic prescribing for cystitis

The inclusion of a clinical decision support system (CDSS) and order set within the electronic medical record, in combination with the use of local urine antibiograms, was associated with improved antibiotic prescribing for acute cystitis at a veterans' health system in North Carolina, researchers reported today in Infection Control & Hospital Epidemiology.

In the quasi-experimental, interrupted time-series analysis, researchers from Duke University School of Medicine and the Durham Veterans' Affairs Health Care System analyzed treatment of outpatient urinary tract infections from April 2016 through October 2019.

The study period consisted of the pre-intervention phase, an intervention period when the CDSS highlighting nitrofurantoin and beta-lactams as preferred agents over fluoroquinolones for uncomplicated acute cystitis was integrated within the electronic medical record, and a post-intervention phase. The primary outcomes measured were changes in monthly proportions of antibiotic classes prescribed for cystitis.

Prior to the intervention, monthly fluoroquinolone prescriptions accounted for 45% of all outpatient prescriptions of cystitis. After the intervention, fluoroquinolone prescriptions accounted for a median of 32% of antibiotics prescribed monthly for cystitis. Conversely, prescriptions for beta-lactams increased from a monthly median of 14% in the pre-intervention phase to 24.5%. Nitrofurantoin and trimethoprim/sulfamethoxazole prescribing was unaltered by the intervention.

In the interrupted time series analysis, CDSS implementation resulted in a −20.7% level change (95% CI, −33.8% to −7.5%; P = .002) and −1.4% change in slope (95% CI, −3.0% to 0.2%; P = .09) in fluoroquinolone prescribing for cystitis, and a 28.5% level change (95% CI, 15.5% to 41.7%; P < .001) and 1.2% change in slope (95% CI, −0.3% to 2.8%; P = .13) in beta-lactam prescriptions.

"In summary, CDSS combined with local urine antibiograms, even without prescriber education or audit and feedback, can be an effective tool for antimicrobial stewardship," the authors concluded.
Aug 19 Infect Control Hosp Epidemiol abstract


Salmonella outbreak linked to onions grows by more than 200 cases

A multistate Salmonella Newport outbreak linked to onions grew in the past week, with 229 new cases, according to the Centers for Disease Control and Prevention (CDC). According to the CDC, officials have confirmed 869 cases in 47 states, including 116 hospitalizations. No deaths have been recorded.

Thomson International, Inc. of Bakersfield, California, is the likely source of potentially contaminated red onions, which were used in a variety of food products, according to a list of recalled produces from the Food and Drug Administration (FDA). In addition to onions, cheese dips, salsa, and pre-diced onions have all been recalled. The products have been sold at retailers throughout the country, including Aldi, Public Super Market, Walmart, and Kroger.

According to the CDC, illness-onset dates range from Jun 19 to Aug 4, and the median age of sick people is 40. The most-affected state is California, with 115 cases, followed by Utah (105), Oregon (94), Montana (63), and Washington state (50).

"Eighty-eight percent of people reported eating onions or dishes likely containing onions in the week before their illness started," the CDC said. "Of the 68 cases who were asked what types of onions they ate, 46 (68%) ate any white onions, 45 (66%) ate any red onions, and 33 (49%) ate any yellow onions in the week prior to illness. Most ill people ate more than one type of onion in the week before illness."
Aug 18 CDC update
Aug 19 FDA recall notice

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