News Scan for Jan 24, 2022

News brief

Study: Mental health visits increased for physicians during pandemic

A new Canadian study shows visits for mental health and substance abuse problems by physicians increased 27% during the first year of the COVID-19 pandemic. The study is published in JAMA Network Open.

The study was based on mental health and substance use outpatient records of 34,055 practicing physicians in Ontario, Canada. The number of visits per 1,000 physicians increased by 27% during the first year of the pandemic, and the absolute proportion of physicians with one or more mental health and substance use visits increased to 13.4% during the first year of the pandemic, compared with 12.3% in the prior year.

The relative increase was significantly greater in physicians without a mental health and substance use history (adjusted incident rate ratio, 1.72; 95% confidence interval, 1.60 to 1.85) than in physicians with a mental health and substance use history, the authors wrote.

Outpatient visits for mental health concerns rose significantly in the first 5 months pf the pandemic, 28.3% of all visits, and dropped to 27% during the next 7 months.

Men and women physicians, physicians in urban and rural settings, and physicians of all ages all saw similar increases in visits. Interestingly, there was no significant differences in mental health needs between physicians seeing COVID-19 patients directly in the emergency room or hospital, and those who did not.

"We did notice that this group of physicians, which included individuals in critical care, emergency medicine and internal medicine, already had lower rates of mental health visits pre-pandemic," said co-senior author Manish Sood, MD, in an Ottawa Hospital news release. "This could mean they have greater resilience, more reluctance to seek care, or have work schedules that are a barrier to seeking care."

"The overall findings of increased mental health care use among the physician population is an important contribution, reiterating the looming mental health crises among health care workers in the wake of the pandemic," said Bernard Chang, MD, PhD in a JAMA Network Open commentary on the study.

Sood added in the release, "It's important to note that our study only looked at the first year of the pandemic, and the situation has changed since, particularly with the omicron variant now putting incredible pressure on the healthcare system."
Jan 21 JAMA Netw Open study
Jan 21 JAMA Netw Open commentary

H5N1 avian flu sparks poultry outbreaks in Burkina Faso and Moldovia

Two countries—Burkina Faso and Moldovia—reported new highly pathogenic H5N1 avian flu events in poultry, according to the latest notifications from the World Organisation for Animal Health (OIE).

Burkina Faso is the latest in a small number of African countries to report a recurrence of H5N1 in poultry. The country reported its last outbreak of the virus in November 2015.

The new outbreak occurred at a layer farm in the Centre region, beginning on Dec 15 and killing 117,842 of 150,000 susceptible birds. Officials said the poultry deaths occurred suddenly, and the virus spread at an unprecedented speed. They added that poultry markets and end-of-year celebrations may have worsened the outbreak situation. The remaining chickens were culled to curb the spread of the virus.

In Europe, animal health officials in Moldovia said H5N1 struck backyard birds in an event beginning on Jan 1 in Telenesti district, in the north central part of the country. The virus killed 623 of 2,800 birds at the location. The outbreak is Moldovia's first involving the H5N1 strain.
Jan 21 OIE report on H5N1 in Burkina Faso
Jan 24 OIE report on H5N1 in Moldovia

Stewardship / Resistance Scan for Jan 24, 2022

News brief

Study highlights non-guideline adherent antibiotic treatment for C diff

A review of Clostridioides difficile infection (CDI) treatments at 10 community hospitals found that only 50% of treatment regimens were adherent to guidelines regarding use of fidaxomicin, researchers reported today in Infection Control & Hospital Epidemiology.

The review looked at all adult non-hospice patients with confirmed CDI who received fidaxomicin at 10 community hospitals within the University of Pittsburgh Medical Center (UPMC) system from May 2018 through August 2019. Based on updated CDI treatment guidelines from Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America, UPMC in April 2018 broadened fidaxomicin use but did not recommend it for initial treatment of CDI.

The aim of the study was to better understand fidaxomicin use following introduction of the updated UPMC guidelines, which were communicated to pharmacy directors and local antimicrobial stewardship programs at all UPMC hospitals.

Average fidaxomicin use remained low but increased by 30% pre-updated guidelines to post-updated guidelines. Of the 104 fidaxomicin regimens prescribed, 52 were non-adherent to UPMC guidelines. The main reasons for non-adherence included use for fulminant CDI (36 prescriptions) and concurrent use with other CDI treatment (29), neither of which were recommended at the time by the UPMC guidelines. Infectious disease (ID) physicians accounted for 25 (48%) of the 52 non-adherent regimens.

The study authors say the findings highlight the importance of including ID consultants in antimicrobial stewardship programs.

"Although release of new or updated clinical guidelines provides opportunities to advance patient care, dissemination of this information is often slow," they write. "Antimicrobial stewardship programs play a critical role in dissemination and should ensure that all providers, including ID staff, exercise appropriate stewardship in their prescribing practices."
Jan 24 Infect Control Hosp Epidemiol abstract

Urgent care study finds decline in antibiotic prescribing during COVID-19

An analysis of antibiotic prescribing at two academic urgent care clinics found a sustained decline in antibiotic prescribing during the COVID-19 pandemic, despite a transition to telemedicine, researchers reported late last week in Open Forum Infectious Diseases.

In the study, researchers from Stanford University School of Medicine compared the proportion of clinic and telemedicine visits at two academic urgent care clinics during which antibiotics were prescribed before (December to January 2019) and during (January to December 2020) the pandemic. They extracted diagnoses and antibiotic data from the electronic medical record and assigned each encounter a disease category and an antibiotic prescribing tier based on whether antibiotics were almost always (tier 1), sometimes (tier 2), or almost never (tier 3) indicated.

A total of 69,842 encounters were analyzed, with 33,591 occurring before and 36,251 during COVID-19. Telemedicine visits rapidly increased in March 2020 and became the dominant visit modality thereafter. The pre-COVID-19 antibiotic prescribing rate was 17%, compared with 11% during COVID-19. The antibiotic prescribing rate was 9% in telemedicine and 15% in clinic visits during COVID-19. The overall decline in antibiotic prescribing was driven primarily by encounters for a respiratory diagnosis and was not observed in encounters for gastrointestinal, genitourinary, skin, or other infections.

Among respiratory encounters, antibiotics were prescribed less frequently across all tiers during COVID-19: tier 1 (63% vs 56%), tier 2 (37% vs 27%), and tier 3 (16% vs 5%). Less than 1% of COVID-19 encounters were associated with an antibiotic prescription.

The study authors say the reasons for the decline likely include changes in healthcare use, local epidemiology, and the impact of local masking and physical distancing measures on common respiratory pathogen transmission.

"Future studies are needed to investigate these factors with a goal of promoting optimal antibiotic prescribing for all viral respiratory conditions," they wrote. "The big question remains as to whether the lower antibiotic prescribing rates will be sustained beyond the COVID-19 pandemic."
Jan 22 Open Forum Infect Dis abstract