News Scan for Nov 13, 2020

Pharmacist-led stewardship
COVID-19 and antibiotic use
Polio in 3 countries
More H5N8 avian flu in poultry
US food outbreaks

Pharmacist-led stewardship linked to improved antibiotic prescribing

An antibiotic stewardship program (ASP) intervention led by ambulatory care pharmacists was associated with improvements in guideline-concordant antibiotic prescribing in a family medicine residency clinic, researchers reported today in Infection Control and Hospital Epidemiology.

The study, conducted at a single primary-care office in Grand Rapids, Michigan, compared antibiotic prescribing for three conditions—upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and other soft-tissue infections (SSTIs)—before and after the implementation of the ASP intervention, which included education, guideline dissemination, and weekly audit and feedback of medical residents led by ambulatory care pharmacists. Guideline concordance was determined based on the institution's outpatient ASP guidelines.

Overall, 1,397 antibiotic prescriptions were issued over the 12-month study period, and 525 antibiotic prescriptions were audited (90 pre-intervention and 435 post-intervention). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all three infection types post-intervention to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001).

Significant improvements were seen in guideline-concordant antibiotic selection (68.9% pre-intervention vs 80.2% post-intervention; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02).

The authors of the study say the findings add to the growing body of evidence showing the importance of establishing good antibiotic prescribing habits early in medical practice, and demonstrate the impact that ambulatory care pharmacists can have as antibiotic stewardship leaders.
Nov 13 Infect Control Hosp Epidemiol abstract


Few bacterial co-infections found in London COVID-19 hospital patients

A study conducted at two acute care hospitals in North West London found bacterial co-infections were infrequent in COVID-19 patients and did not have an impact on clinical outcomes, but practitioners almost universally prescribed empiric antibiotics, researchers reported today in the Journal of Antimicrobial Chemotherapy.

The retrospective observational cohort study included all adult non-pregnant patients admitted to the two hospitals from Mar 1 through Apr 30 and confirmed to have COVID-19 within 48 hours of admission. The researchers reviewed microbiologic specimens taken within 48 hours to assess their clinical significance, along with empiric antibiotic treatment, and compared demographic and clinical characteristics of patients who had and didn't have bacterial co-infections.

Of the 1,396 patients included in the study, 37 (2.7%) had clinically important bacterial co-infections within 48 hours of admission, 11 of which were respiratory tract infections. Thirty-six of the 37 patients with bacterial co-infections received empiric antibiotics at the time of admission, as did 98 of 100 randomly selected patients without co-infection.

There was no significant difference in age, gender, pre-existing illnesses, intensive care unit admission, or 30-day all-cause mortality between those with and without bacterial co-infection, but patients with bacterial co-infection had significantly higher white cell count, neutrophil count, and C-reactive protein levels.

"These results suggest that empirical antimicrobial treatment may not be necessary in patients presenting with high suspicion of COVID-19 infection, though the decision could be guided by high inflammatory markers," the authors wrote. "Furthermore, our findings suggest that presence of bacterial co-infection at the time of presentation does not affect the clinical outcome adversely."
Nov 13 J Antimicrob Chemother study


Three countries report more vaccine-derived polio cases

Three countries—Afghanistan, Chad, and Somalia—reported more polio cases this week, all of which involved circulating vaccine-derived poliovirus type 2 (cVDPV2), the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

Afghanistan reported 15 new cVDPV2 cases from seven provinces, and 8 of them were from Kandahar. The country has now reported 136 such cases for 2020.

In Africa, Chad reported 1 more case, which is from Logone Oriental province, lifting the country's total for the year to 80 from two different outbreaks. And Somalia reported 3 cases, 1 from Galbeed and 2 from Banadir, putting its total at 20 cVDPV2 cases, plus a coinfection that also involved type 3.
Nov 12 GPEI weekly update

In other polio developments, the World Health Organization (WHO) today announced the launch of a campaign to immunize 1.5 million young children in South Sudan against polio. So far this year, 15 vaccine-derived polio cases have been diagnosed in seven of the country's counties across five of its states.

The first round of the campaign will target children in seven states. The WHO added that less than 50% of the country's children are vaccinated against polio and other life-threatening diseases.
Nov 13 WHO African regional office statement


Five countries report more H5N8 avian flu poultry outbreaks

Five countries have reported more highly pathogenic H5N8 avian flu outbreaks in poultry, according to the latest notifications from the World Organization for Animal Health (OIE).

Russia, where the outbreaks began in late summer, reported five more outbreaks, all in backyard poultry in the country's southwest. Locations include Yugra region, Tartarstan, and Samara Oblast. The events began between Oct 25 and Nov 1, killing 299 of 175,634 susceptible birds. The survivors were slated for culling.

Elsewhere in Europe, the Netherlands reported one more H5N8 outbreak, which began Nov 9 at a poultry farm in Groningen province, killing 113 of 47,102 birds. All other poultry on the premises were destroyed. Meanwhile, German officials reported an outbreak involving H5N8 at a farm in Mecklenburg-Vorpommern state that housed layers, broilers, ducks, and geese. The event began on Nov 11 and killed 55 of 257 birds.

Outside of Europe, Israel reported the virus at a turkey farm in Hazafon. The outbreak started on Nov 3 and killed 500 of 28,000 birds, and authorities slaughtered the rest to curb the spread. And finally, Japan reported another H5N8 outbreak in Kagawa prefecture, which occurred at a broiler farm. It began on Nov 10 and killed 16 of 11,000 chickens, and stamping out was ordered for the rest of the flock.
Nov 13 OIE report on H5N8 in Russia
Nov 13 OIE report on H5N8 in the Netherlands
Nov 13 OIE report on H5N8 in Germany
Nov 12 OIE report on H5N8 in Israel
Nov 12 OIE report on H5N8 in Japan


In 2016, CDC investigated 174 food- and animal-derived outbreaks

In today's Mortality and Morbidity Weekly Report (MMWR), the Centers for Disease Control and Prevention (CDC) report that, in 2016, health officials investigated 174 outbreaks related to Salmonella (69.0%), Escherichia coli (E coli, 21.8%), and Listeria monocytogenes (Listeria, 9.2%), with sprouts and chicken being the leading culprits.

After investigation, only 50 events had sufficient evidence to be classified as multistate outbreaks. Thirty-nine (78% of those) were solved with at least a suspected food or animal source.

Across 118 total outbreaks that had the potential to be multistate outbreaks, there were 3,480 illnesses, 752 hospitalizations, 16 cases of hemolytic uremic syndrome, and 26 deaths.

Out of the 18 multistate foodborne disease outbreaks that had a confirmed source, the CDC issued 10 recalls, 2 market withdrawals and 1 Food Safety and Inspection Service (FSIS) health alert. Sprouts and chicken were the most commonly linked food and animal sources of outbreak-related illness, with 131 and 134 cases, respectively. Events tied to backyard chickens reached a new high, with 10 multistate outbreaks and 930 illnesses. Three outbreaks had novel food-pathogen pairs: flour and E coli, frozen vegetables and Listeria, and bagged salad and Listeria.

Of the total 230 possible multistate outbreaks that occurred in 2016, 87.0% were detected by PulseNet, 10.9% by state and local health departments, and 2.2% by the Food and Drug Administration and FSIS, which is part of the Department of Agriculture. The median duration of each investigation was 37 days.
Nov 13 MMWR report

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