News Scan for Mar 10, 2021

Antibiotic order sets in the ED
;
New pandemic flu vaccine virus recs

Study links antibiotic order sets to improved ED prescribing

Use of antibiotic order sets built into the electronic medical record for common infectious diagnoses in the emergency department (ED) was associated with improved antibiotic prescribing at an academic medical center, Emory University researchers reported yesterday in Infection Control & Hospital Epidemiology.

The order sets at Emory University Hospital were created for cystitis, pyelonephritis, pneumonia, chronic obstructive pulmonary disease, and cellulitis and included recommended antibiotics based on clinical practice guidelines and a recommendation for the first dose to be given in the ED, along with a pre-populated prescription for appropriate duration.

The order sets were deployed in March 2019, and a survey was sent in November 2019 to assess whether the sets were being used. The researchers also conducted a chart review from October to November 2019 to assess the impact on prescribing practices for patients presenting with one of the five diagnoses.

While 59.4% of survey respondents said they used the order sets, the chart review showed that in 104 qualifying patient encounters, order sets were used in only 22 (21%). But patients were more likely to receive the first antibiotic dose in the ED when the order sets were used than when they were not used (90.9% versus 71.2%), and were also more likely to receive an appropriate antibiotic (86.4% vs 33.8%) and to have an appropriate duration prescribed (68.2% vs 24.5%). The researchers did not detect a statistically significant difference in appropriate renal dosing between the two groups.

Almost all providers who used the order sets noted they were easy to use and saved time.

The authors say larger studies are needed to evaluate the impact of order sets on prescribing and patient outcomes.
Mar 9 Infect Control Hosp Epidemiol study

 

WHO advisors propose 2 new vaccine viruses for pandemic preparedness

A World Health Organization (WHO) advisory committee on flu vaccine strain selection recently recommended two more candidate vaccine viruses for pandemic preparedness, one targeting H5N8 and the other variant H1 (H1v).

The recommendation came as part of recent meetings to recommend strains to recommend for the Northern Hemisphere's 2021-22 flu season.

Based on analyses from genetic characterization and antigen testing, the experts proposed a candidate vaccine virus against a new H5N8 clade (2.3.4.4b) known as A/Astrakhan/3212/2020. The virus was found in human cases recently reported in Russia and is related to a clade reported in poultry and wild birds in Eurasia over the past several months. Previously, the WHO had only one H5N8 strain on its list of candidate vaccine viruses for pandemic preparedness.

The other new candidate vaccine virus proposed is a H1v from a new lineage, 1C.2.1, known as A/Netherlands/10370-1b/2020. The WHO said the new virus is related to a H1N1v infection in the Netherlands. In lab experiments, the virus from the patient was poorly recognized by vaccine viruses developed for similar strains.
WHO March zoonotic candidate vaccine virus recommendations

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