News Scan for Apr 14, 2021

News brief

ED stewardship intervention tied to reduced prescribing for viral infections

A pilot trial conducted at two emergency departments (EDs) found that audit and feedback with peer-to-peer comparisons reduced antibiotic prescribing for viral acute respiratory infections (ARIs) but not overall antibiotic use, researchers reported today in Open Forum Infectious Diseases.

The quasi-experimental study used an interrupted time-series design and a matched-pair non-equivalent control group to evaluate the impact of the pilot intervention, which consisted of an initial one-on-one educational meeting with each willing ED clinician and individual clinician feedback at baseline and via a quarterly email. The feedback to clinicians focused on the frequency of antibiotic prescribing for uncomplicated ARIs and for prescribing for all patient visits.

The researchers compared the total antimicrobial prescribing rate at two Veterans Affairs Medical Center EDs that implemented the intervention with two control EDs. An exploratory analysis measured antibiotic prescribing for uncomplicated ARIs and reviewed charts to assess guideline-concordant management for six common infections.

The study enrolled 27 of 31 eligible clinicians at the two EDs, who acknowledged the receipt of 33.3% of feedback emails. In the baseline and intervention periods, intervention sites had 28,016 and 23,164 patient visits, respectively, compared with 33,077 and 28,835 at the control EDs.

Analysis of the primary outcome during the intervention period showed a non-significant absolute reduction of 1% in the monthly total antibiotic prescribing rate at the intervention sites compared with the control sites (incidence rate ratio, 0.99; 95% confidence interval, 0.98 to 1.01).

The exploratory analysis, however, found that antibiotic prescribing for uncomplicated ARIs at the intervention sites declined from 68.6% to 42.4% between the baseline and intervention periods, and guideline-concordant management at the intervention sites improved from 52.1% to 72.5%. Those improvements were not seen at the control sites.

"Future stewardship studies on audit-and-feedback in EDs should incorporate additional strategies, such as local champions, to improve the adoption and sustainability of the intervention," the authors wrote. "Future studies could also evaluate the perceived acceptability of the feedback and optimal methods for delivering feedback, including for infections other than ARIs."
Apr 14 Open Forum Infect Dis abstract

Swiss biotech receives funding for novel antibiotic development

Swiss biotech company BioVersys today announced a financing deal with the European Investment Bank (EIB) for up to €20 million (US $23.9 million) to support development of novel antibiotics for multidrug-resistant infections.

The venture loan will facilitate development of two products in BioVersys' pipeline: BV100, which is being studied for treatment of ventilator-associated bacterial pneumonia caused by carbapenem-resistant Acinetobacter Baumannii, and BVL-GSK098, a small molecule being tested for multidrug-resistant tuberculosis infections. Both drugs are in phase 1 clinical trials.

"There have been no new classes of antibiotics on the market for decades," EIB Vice-President Thomas Ostros said in a BioVersys press release. "This comes at an enormous cost for people and our societies at large. If we do not manage to curb AMR [antimicrobial resistance], it will not only kill thousands of people every year, but it will also drive millions into poverty."

The loan is financed under the Infectious Diseases Finance Facility, set up as part of a European Union initiative aimed at securing Europe's global competitiveness.
Apr 14 BioVersys press release

Sexually transmitted diseases in US reached all-time high in 2019

In 2019, rates of sexually transmitted diseases (STDs) reached an all-time high in the United States after being on the rise for 6 consecutive years, according to the Centers of Disease Control and Prevention (CDC) yesterday.

"Less than 20 years ago, gonorrhea rates in the U.S. were at historic lows, syphilis was close to elimination, and advances in chlamydia diagnostics made it easier to detect infections," said Raul Romaguera, DMD, MPH, acting director for the CDC's Division of STD Prevention, in a media statement. "That progress has since unraveled, and our STD defenses are down. We must prioritize and focus our efforts to regain this lost ground and control the spread of STDs."

The data from the 2019 STD Surveillance Report found 2.5 million cases of chlamydia, gonorrhea, and syphilis, the three most commonly reported STDs in the country. Those cases represent an almost 30% increase in those reportable STDs from 2015 to 2019.

The rise hit young adults the hardest: Americans ages 15 to 24 years made up 61% of chlamydia cases and 42% of gonorrhea cases.

According to the CDC, the COVID-19 pandemic has only strained available resources and staff to assist with STD-related interventions and services. STD clinics closed for a time, practitioners focused on the pandemic, and far fewer people seeking non-emergent healthcare.

"STDs will not wait for the pandemic to end, so we must rise to the challenge now," Romaguera said. "These new data should create a sense of urgency and mobilize the resources needed, so that future reports can tell a different story."
Apr 13 CDC press release

PAHO calls for redoubled battle against Chagas disease

The Pan American Health Organization (PAHO) yesterday warned that 70% of people living with Chagas disease don't know they have it, and they urged health providers in the Americas to double down on their efforts to diagnose the disease. The call for stepped-up recognition of the disease came ahead of the annual World Chagas Disease observance today.

An estimated 6 to 8 million people in the Americas are infected with the Trypanosoma cruzi parasite, spread by "kissing bugs", though many are asymptomatic. Chronic infections can lead to potentially fatal cardiomyopathy. About 10,000 people die each year from complications of the disease, with 75 million at risk for contracting it, including 8,000 babies born to unknowingly infected mothers.

PAHO said lab tests to detect the disease, treatment of patients, and vector control efforts have been disrupted by the pandemic to varying degrees.

Luis Gerardo Castellanos, MD, PhD, MPH, who leads PAHO's neglected, tropical, and vectorborne disease unit, said in a PAHO statement, "raising awareness of Chagas disease is the first step in preventing, detecting, and treating it, and in breaking the chain of transmission." He added that the disease originated in rural settings among people living in precarious housing situations, but that human migrants have brought it to urban areas, leading to further spread.
Apr 13 PAHO statement

COVID-19 Scan for Apr 14, 2021

News brief

Study suggests airline passenger spacing will slow COVID-19 spread

Keeping middle seats vacant on air flights has the potential to cut transmission of virus particles by 57% when multiple passengers are infected and by 23% when a single passenger is infected, according to an aerosol dispersion study that included earlier data that modeled plane airflow.

Researchers from the National Institute for Occupational Safety and Health (NIOSH) and Kansas State University reported the findings today in a Morbidity and Mortality Weekly Report (MMWR) study.

During the pandemic, a number of airlines blocked off the middle seats to assist with social distancing during flights, alongside mandatory masking. However, as demand for flights has increased, some have started booking middle seats again.

For the study, the researchers conducted aerosol dispersion experiments in plane cabin environments—a five-row section of a Boeing 737 and an 11-row section of a mockup. Ventilation systems used airline equipment, but without the jet engine. Mannequins emitting passenger-like heat were placed in the seats, and researched introduced bacteriophage MS2 virus, used before as a surrogate for pathogenic viruses, to simulate aerosol dispersion. The airflow modeling data were collected during a KSU study in 2017 as part of pandemic flu research, which didn't include mask use.

The authors said the 23% to 57% reductions they found for vacant middle seats, when compared with full seating, is similar the 45% reduction found in an earlier computational fluid dynamics simulation. The group pointed out that their study addressed only exposure and not transmission and only assessed aerosols, not fomites or droplets.

The researchers concluded that distancing by keeping middle seats vacant—along with current use of masks--could help reduce exposure, though the extent isn't fully understood. They also note that their study could help guide more studies of transmission risk, including those that look at mask use, virus characteristics, and host characteristics, such as vaccination.
Apr 14 MMWR report

Suicides stagnate or decline in wealthier countries during pandemic

Suicide rates largely remained stagnant or even declined during the early pandemic months in high- and upper-middle-income countries, according to a report yesterday in The Lancet Psychiatry.

The researchers first looked at real-time suicide data from 21 countries (11 of which had whole-country data with the rest composed of area-specific spots) from April to Jul 31, 2020, and compared rates with previous data from 1 to 4 years ago. Significant decreases in expected suicide rates were found in 12 areas (8 countries), ranging from New South Wales, Australia (rate ratio [RR] 0.81; 95% confidence interval [CI], 0.72 to 0.91), to Ecuador (RR 0.74; 95% CI, 0.67 to 0.82).

Some suicide rate increases were seen, though, and 10 of 35 areas had an RR greater than 1, peaking at 1.78 (Botucatu, Brazil). Further analysis of data through Oct 31, 2020, showed largely the same findings, with a few differences: Three areas showed significant decreases (Victoria, Australia [RR, 0.89]; Thames Valley, England [0.82]; Mexico City [0.86]) and three showed significant increases (Vienna, 1.31; Japan, 1.05; and Puerto Rico, 1.29).

"Governments and services need to remain vigilant for a possible delayed increase in suicides as a result of the pandemic. Suicide can be a lagging indicator of psychosocial difficulties, influenced by medium-term and longer-term disruptions to civic life and the economy," write Stella Botchway, BM BCh, MPH, and Seena Fazel, BSc, MBChB, MD, in a commentary. For example, they point out that Japan's suicide rates declined in the early months of the pandemic and then increased by at least 10%.

The researchers write that further study is needed to look at how suicide rates are stratified across age-group, sex, and race, as well as how public health mitigations and economic support may have affected mental health. Additionally, they note that low- or lower-middle-income countries may have different results.
Apr 13 Lancet Psychiatry study
Apr 13 Lancet Psychiatry commentary

Half of MIS-C patients have neurologic symptoms, unpublished data show

Twenty-four of 46 patients with multisystem inflammatory syndrome in children (MIS-C) displayed neurologic symptoms affecting the central and periphery systems, according to research being presented virtually at the American Academy of Neurology's (AAN's) 73rd annual meeting Apr 17 to 22. Previous data indicate that most cases of MIS-C have been associated after asymptomatic or mild COVID-19 infections.

The researchers looked at 46 children with MIS-C admitted to the Great Ormond Street Hospital in London from Apr 4 to Sep 1, 2020 (median age, 10.2 years). At presentation, half had headaches, 14 had encephalopathy, 6 had voice abnormalities or hoarseness, 6 had hallucinations, and 5 had ataxia. Additional testing showed that 14 of 15 who had an electroencephalogram had an excess of slow activity, and 4 of 7 who underwent nerve conduction studies and an electromyography had myopathic and neuropathic changes, according to the study's abstract.

Those who had neurologic symptoms were more likely to need a ventilator and circulation-related drugs, but there were no differences seen across demographics, inflammatory markers, management, or short-term outcomes. The researchers also noted that neurologic symptoms were seen more frequently in more severe presentations of MIS-C.

"Children who develop this condition should definitely be evaluated for neurologic symptoms and longer- term cognitive outcomes," said author Omar Abdel-Mannan, MD, in an AAN press release. "More studies are needed involving more children and following children to see how this condition changes over time and if there are any longer-term neurocognitive effects."
Apr 13 AAN abstract
Apr 13 AAN press release