News Scan for Feb 02, 2022

News brief

Pharmacist-led intervention tied to fewer antibiotics for E coli bacteremia

A 3-year prospective audit and feedback (PAF) intervention led by pharmacists at a Japanese hospital was linked to reduced antibiotic duration and more appropriate antibiotic use in patients with Escherichia coli bacteremia, Japanese researchers reported yesterday in the American Journal of Infection Control.

The before-and-after study was conducted at a public hospital in Japan where a PAF led by an infection control pharmacy specialist (ICPS) was implemented in 2017 for all injectable antibiotics. The impact of the PAF on the effectiveness of treatment of patients with E coli bacteremia was compared annually over a 4-year period (periods 0 through 3, 2016 through 2019). Thirty-day mortality and duration of antibiotic use were the primary outcomes, and duration of anti-pseudomonal antibiotic was a secondary outcome. Researchers also looked at the economic impact of the intervention.

During the study period, 821 patients with E coli bacteremia were treated, and 537 were included in the final analysis. The pharmacists had 12 and 54 suggestions for antibiotic use in patients in periods 0 and 3, respectively. The most common suggestion was de-escalation of antibiotic therapy.

In periods 0 through 2, the median duration of antimicrobial use was 12 days, then fell to 9 days in period 3. In period 3, the duration of antimicrobial use was reduced by 29% compared with period 0, while the duration of anti-pseudomonal drug use dropped 42%. The 30-day mortality rates were not significantly different between the periods. The total costs of antibiotic use per patient fell 24%.

"This study suggests that a 3-year intervention by ICPS for all injectable antimicrobials may lead to a shorter duration of antimicrobial use, more appropriate use of antimicrobials, and lower healthcare costs by recommending appropriate antimicrobial doses for patients with E. coli bacteremia and promoting de-escalation," the study authors wrote.
Feb 1 Am J Infect Control abstract

Harvesting equipment pinpointed as source of Dole salad Listeria outbreak

The Centers for Disease Control and Prevention (CDC) yesterday announced that the source has been found for a multistate Listeria outbreak linked to Dole prepackaged salad that has sickened at least 17 people since 2019, 2 of them fatally.

In an outbreak update, the CDC said Dole collected samples from its facilities and equipment and found Listeria monocytogenes on equipment used to harvest iceberg lettuce. Genome testing conducted by the Food and Drug Administration (FDA) determined that the Listeria on the equipment matched the outbreak strain.

The CDC had been investigating the outbreak in 2019 and 2020, but scientists weren't able to gather enough data to identify a source. It reopened the probe in November 2021 when four new illnesses were reported since the end of August 2021, with new data suggesting that Dole packaged salads were the source.

As of Feb 1, 17 people infected with the outbreak strain have been reported from 13 states, an increase of 1 since the CDC's initial outbreak announcement on Dec 22. Thirteen patients have been hospitalized, and the number of deaths remains at two.

On Jan 7, Dole expanded its recall to include more products that contained iceberg lettuce harvested by the contaminated equipment. Of interviews with nine sick patients, two reported Dole and one reported Little Salad Bar, a brand sold by Aldi. The expanded recall applied to all Dole-brand and private-label packaged salads processed at its facilities in Springfield, Ohio, and Soledad, California.
Feb 1 CDC outbreak update
Jan 7 FDA recall notice
Dec 27, 2021, CIDRAP News scan

Virginia reports avian flu detections in waterfowl

Agriculture officials in Virginia recently reported highly pathogenic avian flu in two hunter-harvested migratory waterfowl in Henrico County, marking the third such detection in the United States over the past month.

In a Jan 27 statement, the Virginia Department of Agriculture and Consumer Services (VDACS) didn't specify the avian influenza subtype, but noted that the detection in Henrico County isn't surprising, given that it is in the same Atlantic Flyway migratory path as locations in North Carolina and South Carolina where highly pathogenic avian flu was detected earlier

The events in the Carolinas—announced in the middle of January—involved the Eurasian H5N1 strain that has infected wild birds and poultry in other parts of the world. The US detections were preceded by similar events in Canada.

So far, the Virginia findings don't appear on the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) list of US avian flu detections.
Jan 27 VDACS statement
Jan 19 CIDRAP News scan
APHIS list of avian flu detections

COVID-19 Scan for Feb 02, 2022

News brief

Imaging shows post-vaccine breakthrough COVID-19 less severe

A study yesterday in Radiology used imaging to determine that breakthrough infections are less severe when a patient is fully vaccinated against COVID-19 compared with patients who are unvaccinated or partially vaccinated.

The study was based on images collected from the COVID-19 Korean Imaging Cohort for COVID-19 (KICC-19) from June to August 2021 of 761 hospitalized patients with COVID-19. Forty-seven patients (6.2%) were fully vaccinated (breakthrough infection), 127 were partially vaccinated (17%), and 587 (77%) were unvaccinated.

Initial chest x-rays showed no pneumonia in 75% of fully vaccinated patients with breakthrough infection, compared with 63% of unvaccinated patients. Computed tomography chest scans showed differing levels of severity based on vaccination status: The proportion of scans without pneumonia was 22% (71/326) in unvaccinated patients, 30% (19/64) in partially vaccinated patients, and 59% (13/22) in fully vaccinated patients.

"Mechanical ventilation and in-hospital death occurred only in the unvaccinated group," said senior study author Yeon Joo Jeong, MD, PhD, from the department of radiology and biomedical research institute at Pusan National University Hospital in Busan, South Korea, in a press release. "After adjusting for baseline clinical characteristics, analysis showed that fully vaccinated patients were at significantly lower risk of requiring supplemental oxygen and of [intensive care unit] admission than unvaccinated patients."
Feb 1 Radiology study
Feb 1 Radiological Society of North America press release

High BMI more strongly connected with COVID death in racial minorities

Body mass index (BMI) was more strongly associated with COVID-19–related death in racial minorities than among White patients, according to a study today in Nature Communications.

A team led by the University of Leicester in England examined the electronic health records and census and death data of 12.6 million adults older than 40 years who had a recorded BMI from January to December 2020.

Of 33,951 deaths, 0.29% each were of patients of Black or South Asian race, 0.27% were White, and 0.18% were of other races. BMI was tied to COVID-19 death in all races, but compared with White patients, the association was stronger in Black, South Asian, and other races (P < 0.001 for interaction).

For instance, at a BMI of 40 kg/m² (obese), hazard ratios (HRs) for death among White, Black, South Asian, and other races were 1.73, 3.01, 5.25, and 3.89, respectively, relative to a BMI of 22.5 kg/m² (healthy weight) in White patients.

At a low BMI of 20 kg/m², the risk of COVID-19 death was similar in Black (HR, 0.95) and other minority patients (HR, 1.13), compared with White patients, and South Asian patients were at slightly higher risk (HR, 1.21). At a BMI of 40 kg/m², the risk of COVID-19 death in Black, South Asian, and other minority groups relative to White patients widened to 1.74, 3.05, and 2.25, respectively.

The associations between race, obesity, and COVID-19 hospitalizations was similar to those of death, with 1.13% of Black and South Asians, 0.84% of other minority groups, and 0.76% of White patients needing hospital care.

The authors said that obesity may worsen COVID-19 outcomes by triggering a change in the role of inflammatory mediators produced by fat tissue, which leads to a pro-inflammatory state, predisposition to blood clots, exaggerated immune responses, and limited antibody responses.

In a University of Leicester press release, coauthor Kamlesh Khunti, MD, PhD, said the study "gives insights that will allow healthcare professionals and policy makers to put measures in place and create tailored plans to protect people from ethnic minority groups who are overweight or obese and thus try to reduce mortality."
Feb 2 Nat Commun study
Feb 2 University of Leicester press release