News Scan for Dec 20, 2021

News brief

COVID ICU patients with acute kidney injury at higher risk for death

A small observational study presented over the weekend at the online Euroanaesthesia conference suggests that, of COVID-19 patients admitted to the intensive care unit (ICU), those with acute kidney injury (AKI) are more likely to die in the hospital than those with a history of kidney disease.

According to a press release from study sponsor, The European Society of Anaesthesiology and Intensive care (ESAIC), the study also showed that dialysis doesn't appreciably increase the chances of survival.

Austrian researchers retrospectively studied all 129 patients hospitalized with COVID-19 at two ICUs in Vienna from Sep 1, 2020, to Feb 15, 2021. Median patient age was 66.5 years, and two-thirds were men.

Thirty-three patients had a history of kidney disease, 26 were previously healthy kidney patients who developed AKI 5 days after ICU admission, and 70 patients had normal kidney function before and during their ICU stay. Thirty-two patients required dialysis.

Among the 33 patients with pre-existing kidney disease, 55% survived their ICU stay, compared with 46% of those diagnosed as having AKI and 83% of the patients who maintained normal kidney function.

The two groups of patients with impaired kidney dysfunction had significantly lower odds of survival than average, for a higher risk of death than those with normal kidney function. The findings suggest that neither early initiation of dialysis nor the number of days on dialysis had much survival benefit, the authors said.

Lead author Katharina Oberneder, MD, of Sigmund Freud University, said the results indicate that kidney dysfunction is a key risk factor for death related to COVID-19 in ICU patients. "Ultimately, what is most important is focusing on the early diagnosis of acute kidney dysfunction and how we can use these results to improve the care of critically ill COVID-19 patients," she said.
Dec 17 ESAIC press release

H5N1 avian flu found in Estonian fox and water birds in France, Hong Kong

Three jurisdictions reported highly pathogenic H5N1 avian flu in populations other than poultry, including a fox, zoo birds, and wild birds, according to the latest notifications from the World Organisation for Animal Health (OIE).

Estonia reported high-pathogenic H5N1 in a dead wild red fox found in Hiiu province on Hiiumaa island off the country's western Baltic coast. Results were confirmed on Nov 24. The report said the animal probably contracted the virus from other wild species.

Elsewhere in Europe, France reported H5N1 in pink-backed pelicans at a zoo in Occitanie province in the country's southwest. The zoo keeps birds in both aviaries and in open-air settings, including on a pond, which is close to a wetland. The event began on Dec 14 and killed 3 of 65 susceptible birds.

In Asia, Hong Kong reported H5N1 in a black-faced spoonbill found dead on Dec 16 at a wetland park in Yuen Long as part of ongoing surveillance. No detections were found on nearby poultry farms.
Dec 17 OIE report on H5N1 in Estonian fox
Dec 18 OIE report on H5N1 at French zoo
Dec 20 OIE report on H5N1 in Hong Kong

Stewardship / Resistance Scan for Dec 20, 2021

News brief

Stewardship steps tied to reduced antibiotics, C diff at community hospital

Implementation of a multifaceted antimicrobial stewardship program (ASP) in a large community hospital in New Jersey was associated with significant, sustained reductions in unnecessary antibiotic use, Clostridioides difficile infection (CDI) rates, and antimicrobial acquisition costs, researchers reported late last week in Infection Control & Hospital Epidemiology.

In early 2013, the 413-bed acute care non-teaching hospital implemented two processes to address overuse of broad-spectrum intravenous antibiotics: reduction in the computerized antibiotic ordering duration from 14 days to 7 days, and a pharmacist-driven ASP that had authority to discontinue unnecessary antibiotic use. In addition, the hospital changed its CDI testing protocol in 2016 to reduce unnecessary testing.

Comparison of the baseline period (October 2012 to March 2013) to the period following implementation of the ASP showed that average antibiotic days of therapy (DOT) fell by more than 10% initially, and over the study period fell from 860 per 1,000 patient-days to 400 to 500 per 1,000 patient-days in 2021. Reductions were consistent among all antibiotic classes. No concordant rise in complications, such as increased intensive care unit admissions or 30-day sepsis readmission rates, were observed.

The hospital's CDI rate fell by more than 90%, with the most significant reduction occurring after the test protocol was changed, and antibiotic acquisition costs declined by more than 50%. The analysis also found that Pseudomonas aeruginosa susceptibilities to piperacillin and imipenem increased by statistically significant levels.

The study authors note that the findings are significant because most literature on ASPs has been published from large academic medical centers, where physicians are employed by the health system, and very little research has been published on ASPs in non-academic settings that use private practice infectious diseases physicians. They say the results indicate that antibiotic prescribing can be improved even in settings where many physicians are in private practice.

"Safely averting the administration of thousands of doses of unnecessary and potentially harmful therapeutics exemplifies high-value care," they wrote. "We believe that these results could potentially serve as a benchmark for appropriate utilization, particularly in community hospitals."
Dec 17 Infect Control Hosp Epidemiol abstract

New C diff drug substantially reduces recurrence in phase 3 trial

Summit Therapeutics, of Cambridge, Massachusetts, announced promising results today from a phase 3 trial of its investigational precision CDI drug, ridinilazole.

The results of the phase 3 Ri-CoDiFy trial, which included 759 patients at hospitals in the United States and several other countries, showed that patients treated with ridinilazole experienced substantially less recurrence of CDI compared with patients treated with vancomycin. That finding resulted in a higher sustained clinical response (SCR) for ridinilazole than for vancomycin, but the drug did not meet the study's primary end point for superiority. SCR is defined as clinical response of the treated episode of CDI and no recurrence of infection 30 days after the end of treatment.

The company says the results, which have not yet been peer-reviewed or published, were particularly promising in patients considered high-risk.

While vancomycin is the standard of care for CDI, treatment with broad-spectrum antibiotics, which eliminate both good and bad gut bacteria, can put patients at risk of recurring infections. A phase 2 study of ridinilazole showed that the drug specifically targets C difficile, sparing commensal bacteria.

"Although Ri-CoDIFy did not meet the primary endpoint for the design of this study, we did see a meaningful reduction in recurrence in the ridinilazole arm, which we believe is tied to the precision properties of ridinilazole and its associated relative sparing of the gut microbiome," Fong Clow, DSc, head of biometrics at Summit, said in a company press release. "We believe this is a viable measurement of the effect of this drug and has biological significance as to the potential value of the drug."
Dec 20 Summit Therapeutics press release