News Scan for Feb 09, 2021

News brief

Resistance to 3 or more antibiotics in 13% of serious urinary infections

One in eight US patients hospitalized with a complicated urinary tract infection (cUTI) have a pathogen with resistance to three or more routinely used antibiotic classes, researchers reported yesterday in BMC Infectious Diseases.

To assess the prevalence of overlapping resistance to antibiotics commonly used to treat cUTIs and its impact on patient outcomes, the researchers conducted a retrospective study of patients hospitalized with a culture-positive carbapenem-susceptible cUTI using data from approximately 180 US institutions that submitted microbiology data from 2013 through 2018.

Triple resistance (TR) was defined as resistance to three or more common antibiotics: third-generation cephalosporins, fluoroquinolones, trimethoprim-sulfamethoxazole, fosfomycin, and nitrofurantoin.

Multivariable models quantified the impact of TR and inappropriate empiric therapy (IET) on patient mortality, 30-day hospital readmission, hospital length-of-stay (LOS), and costs.

Among 23,331 patients with a cUTI, 13% (3,040) had a TR pathogen. Compared with patients with non-TR pathogens, those with TR pathogens were more likely to be male (57.6% vs 47.7%), black (17.9% vs 13.6%), and located in the South (46.3% vs 41.5%).

They also had a higher chronic disease burden (median Charlson comorbidity score, 3 vs 2) and a higher acute disease burden (mechanical ventilation, 7.0% vs 5.0%; intensive care unit [ICU] admission, 22.3% vs 18.6%). Patients with a TR pathogen were more likely to receive IET than those without (19.6% vs 5.4%).

Although the adjusted outcomes showed that TR was not associated with a rise in hospital mortality or 30-day readmission rate, it added 0.38 days to hospital LOS (95% confidence interval [CI], 0.18 to 0.49) and $754 to hospital costs (95% CI, $406 to $1,103). In patients with a cUTI that was not catheter-associated, however, TR was associated with increased risk of mortality (odds ratio, 2.44; 95% CI, 1.30 to 4.56).

"In summary, we have demonstrated that resistance to combinations of regularly used antimicrobials is prevalent and on the rise in the most common cUTI organisms in the US hospitals," the authors wrote. "Though increasing resistance alone does not impact hospital mortality, it does expose patients to an elevated risk of worsened outcomes through increasing the likelihood of inappropriate empiric therapy."
Feb 8 BMC Infect Dis study

H5N6 avian flu sickens 2 children in China, 1 fatally

China reported two more human H5N6 avian flu cases, one of them fatal and both involving children, according to a flu update from the World Health Organization (WHO) Western Pacific regional office.

One of the patients was a 3-year-old girl from Guizhou province, in the country's southwest, who was hospitalized and died on Dec 22. The second is a 1-year-old girl from Anhui province, in eastern China, who had a mild illness in December.

Both patients had been exposed to poultry at markets before they became ill.

China continues to report sporadic H5N6 cases, and the latest cases raise the country's total since 2014 to 29, which includes 9 deaths.

Highly pathogenic H5N6 avian influenza outbreaks have been reported in China and a handful of other Asian nations, but so far, only China has reported human cases.
Feb 5 WHO update

H5N8 avian flu strikes more poultry, including first time in Algeria

In the latest avian influenza outbreaks in poultry, Algeria became that latest African country to detect H5N8, and already affected nations in Asia and Europe reported more events, according to the latest notifications from the World Organization for Animal Health (OIE).

Algeria reported an outbreak at a layer farm in Oum El Bouaghi province in the central part of the country, which began on Jan 17, killing 50,000 of 51,200 birds. So far, the source of the virus isn't known.

In Asia, South Korea reported seven more outbreaks from commercial duck and layer farms from four different provinces. The outbreaks began between Jan 29 and Feb 5, and taken together, the virus killed 180 of 510,000 birds.

In Europe, the Czech Republic reported two more outbreaks in poultry, both involving backyard birds, one in Central Bohemian region and the other in Pardubice region. The events began on Feb 2 and 3, and between the two outbreaks, the virus killed 40 of 114 susceptible birds. Also, Hungary reported three more outbreaks, which started on Jan 31 and Feb 1 at layer farms in Bacs-Kiskun county. Between the three events, the virus killed 18 of 111,403 birds.
Feb 8 OIE report on H5N8 in Algeria
Feb 7 OIE report on H5N8 in South Korea
Feb 8 OIE report on H5N8 in the Czech Republic
Feb 8 OIE report on H5N8 in Hungary

COVID-19 Scan for Feb 09, 2021

News brief

Study shows breastmilk poses little risk of mom-to-baby COVID-19 transfer

A study today in mBio offers support to continue breastfeeding infants even when mothers have mild to moderate COVID-19 infections. The study showed breastmilk samples did not contain SARS-CoV-2 (the virus that causes COVID-19) RNA, but the authors suggest risk of transmission via breast skin to baby should be evaluated.

The study used multiple breastmilk samples (37) from 14 women following a positive COVID-19 test. None of the 37 samples had detectable SARS-CoV-2 RNA, but two of the infants tested positive for COVID-19. No illnesses were severe.

The authors conducted tests on skin swab samples taken from the mothers, which found evidence of viral RNA on 8 out of 70 breast skin swabs, with only one considered a conclusive positive result. The authors said more testing needs to be done to understand the risk of skin-to-skin transmission.

This is the first study to also demonstrate breastmilk produced by women with COVID-19 is able to neutralize SARS-CoV-2 infectivity, the authors said.

"In addition, 62% of the milk samples were able to neutralize SARS-CoV-2 infectivity in vitro, whereas milk samples collected prior to the COVID-19 pandemic were unable to do so," the authors concluded. "Taken together with the well-documented benefits of breastfeeding to maternal and infant health, our data support recommendations to encourage breastfeeding in women with mild-to-moderate COVID-19 illness."
Feb 9 mBio study

Dementia, COVID synergy associated with worse COVID outcomes

Not only are adults with dementia twice as likely to have COVID-19 infections, but those who get infected also experience higher mortality rates and increased COVID severity, according to an observational Alzheimer's & Dementia study published today.

Racial disparities persist in this subpopulation, as well: The study reports that black people with dementia have increased odds for COVID infection, hospitalization, and mortality.

Using electronic health record data, the researchers winnowed down 61,916,260 possible people to 810 who had both COVID and dementia from February through August 2020 (5.1% of the COVID-infected subgroup). Patients with dementia were at increased risk for COVID-19 compared with patients without dementia (adjusted odds ratio [aOR], 2.00).

Vascular dementia had the highest COVID infection risk (aOR, 3.17), followed by pre-senile dementia (aOR, 2.62), Alzheimer's disease (aOR, 1.86), senile dementia (aOR, 1.99), and post-traumatic dementia (aOR, 1.67). Because of the association between vascular dementia and COVID infection, the researchers suggest that brain pathology, particularly damaged endothelium tissues, may be a risk for SARS-CoV-2, the virus that causes COVID-19.

Overall, the 6-month mortality risk for adults with dementia and COVID-19 (21.0%) was higher than both the mortality rates for those with COVID but no dementia (4.8%) and those with dementia but no COVID infections (7.6%). Compared with white people with dementia, black people with dementia had greater hospitalization (73.1% vs 53.6%) and mortality rates (23.1% vs 19.2%). Black people with dementia were also 2.86 times more likely to have COVID infections once sex, age, and COVID-19 risk factors were adjusted for.

"COVID‐19 and dementia had a synergistic effect on 6‐month mortality risk as the risk was greater than the sum of their individual effects," the researchers write. "We anticipate significant long‐term neurological effects of SARS‐CoV-2 infection in triggering or worsening dementia in survivors of COVID‐19 and expect higher prevalence of dementia in patients with COVID‐19 compared to the non‐infected population in the future."

Maria Carillo, PhD, Alzheimer's Association chief science officer, adds in a Case Western Reserve University press release, "It is critical we develop and implement strategies that strike a balance between keeping people, especially long-term care residents, safe from COVID-19 but also protecting them from health-related harms associated with social isolation."
Feb 9 Alzheimer's & Dementia study
Feb 9 Case Western press release

SARS-CoV-2 found to last longer on nonporous surfaces like glass, plastic

SARS-CoV-2 survives longer on nonporous surfaces like glass, plastic, and stainless steel as opposed to porous ones such as paper and cloth, reports a study published today by the American Institute of Physics' (AIP's) Physics of Fluids. While this helps confirm past studies on fomite surfaces, with this study, the researchers were able to provide a hypothesis as to why.

Researchers from the Indian Institute of Technology Bombay demonstrated that droplets of the virus can survive for 7 days on plastic or stainless steel, 4 days on glass, 2 days on cloth, and 3 hours on paper by using 1 microliter of pure water as a surrogate for SARS-CoV-2 droplets.

The droplet decay process is completed in two main parts, according to an AIP press release. First is the initial bulk evaporation, which decays 99.9% of the droplet in minutes. This is followed by the evaporation of the remaining thin liquid film where viral material can still survive. Porous materials speed up both parts by allowing absorption, not simply diffusion, to evaporate the initial bulk and then create disjoining pressures across the residual film because of its geometric fiber structure.

"The fact that just the geometric features rather than the chemical details of the porous material make the thin-film lifetime significantly less was surprising," study author Rajneesh Bahrdwaj, PhD, said in the press release.

"Based on our study, we recommend that furniture in hospitals and offices, made of impermeable material, such as glass, stainless steel, or laminated wood, be covered with porous material, such as cloth, to reduce the risk of infection upon touch," co-author Sanghamitro Chatterjee, PhD, MSc, added. The study itself goes on to suggest how these findings could be extrapolated to schools, warehouses and package sorting centers, clothes outlets, and more.
Feb 9 Phys Fluids study
Feb 9 AIP press release