Stewardship / Resistance Scan for Apr 08, 2021

News brief

Australian study links rapid flu tests to reduction in antibiotic prescribing

Antibiotics were initiated less frequently, and antivirals used more frequently, in patients diagnosed as having influenza using rapid polymerase chain reaction (RPCR) tests compared with standard multiplex PCR (MPCR) tests, Australian researchers reported yesterday in BMC Infectious Diseases.

In the retrospective cohort study, the researchers compared outcomes in patients with positive influenza RPCR and MPCR tests at Prince of Wales Hospital in Sydney during the 2017 flu season, examining test turnaround times, antibiotic initiation, oseltamivir initiation, and hospital length of stay (LOS) for both emergency department and inpatient hospital stay.

The RPCR test introduced by the New South Wales public health system in 2017 returns results within 4 hours, while standard MPCR test results are available from 1 to 4 days. Previous research has suggested the potential for reduced antibiotic therapy and increased antiviral use with RPCR tests, but the data are limited.

Of the 484 positive test results identified by the researchers, 362 were from standard MPCR tests and 122 were from RPCR tests. The median turnaround time for the RPCR tests was 2.6 hours, compared with 22.6 hours for the MPCR tests.

Commencement of antibiotics was less frequent in the RPCR than the MPCR cohorts (51% vs 67%; odds ratio [OR], 0.52; 95% confidence interval [CI], 0.34 to 0.79). Patients at high risk of complications from influenza who were tested with RPCR tests were more likely to be treated with oseltamivir than those tested with MPCR tests (76% vs 63%; OR, 1.81; 95% CI, 1.07 to 3.08). No significant difference between the two groups was observed for hospital or emergency department LOS.

"Taken together these data show a very positive impact on appropriate antimicrobial prescribing following introduction of a RPCR influenza test at our institution," the authors wrote.
Apr 7 BMC Infect Dis study

Latin American ICUs show benefit from comprehensive stewardship

A study involving 77 Latin American hospitals found that medical-surgical intensive care units (MS-ICUs) with more comprehensive antimicrobial stewardship programs (ASPs) used fewer antibiotics and had fewer multidrug-resistant infections, researchers reported today in Infection Control & Hospital Epidemiology.

The study, conducted over 2 years, included a network of hospitals from nine Latin American countries. During the 6-month preintervention period, ASP members at each hospital were trained through an online course. In the following 12 months, the hospitals implemented locally salient antimicrobial stewardship strategies, and monthly point-prevalence surveys were conducted to measure the appropriateness of antimicrobial prescribing, antimicrobial consumption, mortality, and incidence of multidrug-resistant organisms in healthcare-associated infections (MDRO-HAIs). Self-assessment surveys of the ASPs (using a 0 to 100 scale) were conducted at the beginning and end of the study.

The hospitals were stratified into three groups according to the global score of the final self-assessment (ie, the 25th percentile or lower, between the 25th and 75th percentile, and the 75th percentile or higher). Overall 76.6% of the ASPs showed significant improvement in their self-assessment scores, but only 26% reached the 75th percentile or higher in the final self-assessment, and 23.4% did not improve their scores.

The point-prevalence surveys showed that the MS-ICUs in the 75th versus 25th percentiles performed better on several indicators: antimicrobial consumption (143.4 vs 159.4 defined daily doses per 100 patient-days), adherence to clinical guidelines (92.5% vs 59.3%), validation of prescriptions by pharmacists (72.0% vs 58.0%), crude mortality (15.9% vs 17.7%), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient-days). Only Clostridioides difficile infection rates were higher in the MS-ICUs above the 75th percentile.

"Our findings confirm that ASPs are often only partially implemented in Latin American hospitals," the study authors wrote. "This issue represents a very important challenge because institutional support, interventions to optimizing antibiotic use, monitoring and reporting processes, as well as physician education, are necessary to implement an ASP effectively."
Apr 8 Infect Control Hosp Epidemiol study

News Scan for Apr 08, 2021

News brief

Report spotlights inequalities in COVID-related restrictions

COVID-related mobility restrictions such as stay-at-home orders had disproportionate burdens on women, minorities, and lower-income populations, according to a study yesterday in JAMA Network Open.

On average, 90,692.8 US adults answered a weekly survey from Apr 23 to Jul 21, 2020, reporting how they thought the COVID-19 pandemic affected their well-being. Mean mobility reduction was 24.8%, and every 10% reduction was associated with higher odds of unemployment (odds ratio [OR], 1.3), food insufficiency (OR, 1.1), mental health problems (OR, 1.04), and class cancellations with no alternative (OR, 1.1). The other two well-being metrics, inaccessibility to medical care and defaulting on the previous month's home mortgage/rent payment, were not linked with mobility reduction.

Individuals with low household incomes had the highest risk of all six adverse outcomes, ranging from a 1.3 OR for inaccessible medical care (95% confidence interval [CI], 1.3 to 1.4) to a 2.6 OR for defaulting on a monthly rent/home mortgage payment (95% CI, 2.4 to 2.8).

Compared with White people, Black people reported a higher risk of food insufficiency (OR, 1.3; 95% CI, 1.2 to 1.4), defaulting on a home mortgage/rent payment (OR, 2.0; 95% CI, 1.9 to 2.2), and having canceled classes (OR, 1.3; OR, 1.2 to 1.4). Hispanic respondents and women also showed higher risks when compared with non-Hispanic White people and men, respectively.

Comparing multiple demographic factors showed further insights. For example, Black participants with low income had the highest risks of adverse outcomes across all well-being categories compared with White men with high incomes (eg, rent/mortgage default, men and women, OR, 5.7 and 5.3, respectively). White women with low income had the highest risk of inaccessible medical care (OR, 1.8), while Black women with high incomes were also notably vulnerable (OR, 1.7).

"Blanket public health policies ignoring existing distributions of risk to well-being may be associated with increased race/ethnicity–based, sex-based, and income-based inequities," the researchers conclude.

Most respondents were White (62.8%), married (54.1%), and women (51.6%). Average age was 51.6 years.
Apr 7 JAMA Netw Open study

COVID-related school closures linked with learning loss

An 8-week national school closure in the Netherlands was associated with an equivalent loss in learning, with disproportionate losses in students from lower-educated families, according to a study published yesterday in the Proceedings of the National Academy of Science.

To assess the effects of remote learning during the COVID-19 pandemic, the researchers looked at national test results for spelling, reading, and math from 350,000 Dutch students ages 8 to 11. The national tests occurred before and after the lockdown (January to February plus June 2020), and the researchers included the previous 3 years' test results as a baseline.

During 2020, a learning loss of 3 percentage points, or 0.08 standard deviations, occurred, which the researchers calculated to be equivalent to a learning loss of 8 weeks. Children from families in the lowest-educated homes (8%) were disproportionately affected, with losses up to 60% larger; whereas, the students' sex, school grade, subject, or prior performance had no significant effect.

While the results could not help in determining how other factors affected student test results (eg, less emphasis on test-taking skills, stress associated with taking tests in person during COVID), the researchers compared the test results with a generic oral reading test meant to assess learning readiness. Prior to the pandemic, there was no significant difference between students' performances on both tests, but last year, there was a greater drop (-1.19 vs -3.16, respectively). This suggests the deficit in core subject test scores is due to a lack of knowledge, according to the researchers.

"The Netherlands is interesting as a 'best-case' scenario, with a short lockdown, equitable school funding, and world-leading rates of broadband access," the researchers conclude. "Despite favorable conditions, we find that students made little or no progress while learning from home."
Apr 7 Proc Natl Acad Sci study

CWD turns up on another Minnesota deer farm

Chronic wasting disease (CWD) has been detected on another Minnesota deer farm, which was under quarantine due to links to infections at a farm in another part of the state.

The deer that tested positive is a 3-year-old white-tailed doe housed at a farm in Beltrami County in northwestern Minnesota, according to the Minnesota Board of Animal Health (MBAH). The animal was part of a 77-animal herd that was quarantined in October 2020 owing to links to an earlier detection in Houston County, located in the southeastern part of the state.

Investigators found that the Beltrami County farmer had bought 11 animals from a deer farm in the state's Winona County, which had sold deer to the Houston County farm. Three of the 11 deer recently died, and samples were collected for two, including the doe that yielded the positive sample. A sample couldn't be taken from the third deer because of advanced decomposition. The carcasses were taken to the University of Minnesota for safe disposal.

The Minnesota Department of Natural Resources will conduct precautionary surveillance in the area around the Beltrami County farm to determine if wild deer are infected with CWD.

Linda Glaser, DVM, MBAH assistant director, said the detection is disheartening and that the board will work with the US Department of Agriculture to depopulate the herd. "Our investigation and tracing led us to find this positive animal. However, CWD continues to negatively impact Minnesota farmed cervid producers, and the tools we have to control this disease are so limited."
Apr 7 MBAH statement