More stewardship strategies linked to fewer discharge antibiotics
An analysis conducted at hospitals in Michigan found that the more antibiotic stewardship strategies a hospital reported, the lower its overuse of antibiotics at discharge, researchers reported yesterday in Clinical Infectious Diseases.
To assess the association of different types of stewardship strategies with antibiotic overuse at discharge, researchers developed the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework, which identifies potential strategies for improving antibiotic prescribing at discharge across three tiers: Tier 1 (critical infrastructure), Tier 2 (broad inpatient interventions), and Tier 3 (discharge-specific strategies). Using this framework, the researchers surveyed 39 Michigan hospitals on their antibiotic stewardship strategies.
The 39 hospitals had been part of a previous study describing antibiotic overuse at discharge in patients treated for community-acquired pneumonia (CAP) and urinary tract infection (UTI). The study found that nearly half (49.1) of CAP and UTI patients at 46 Michigan hospitals had antibiotic overuse at discharge. From July 2017 through July 2019, the 39 hospitals treated 20,444 patients for CAP and UTI.
The hospitals reported a median of 12 of 34 possible stewardship strategies. On analysis of individual strategies, only a Tier 3 strategy—review of antibiotics at discharge—was associated with fewer days of antibiotic overuse at discharge for CAP and UTI combined (46% reduction; adjusted incident rate ratio [aIRR], 0.543; 95% confidence interval [CI], 0.335 to 0.878). When weighted by ROAD Home tier, having more weighted stewardship interventions was associated with fewer days of antibiotic overuse at discharge overall (aIRR, 0.957; 95% CI, 0.927 to 0.987 per weighted intervention).
This means that a hospital with the most interventions (16) would be predicted to have 45.3% fewer days of antibiotic overuse at discharge than a hospital with the least (2) interventions.
The study authors say the findings suggest that different pathways to reducing antibiotic overuse at discharge exist and that discharge strategies should be targeted to an individual hospital's resources and needs.
"Specifically, hospitals with limited existing resources and infrastructure should consider implementing a discharge-specific strategy straightaway while hospitals with substantial existing infrastructure may benefit the most from incorporating discharge practices into their existing inpatient stewardship strategies," they wrote.
Feb 10 Clin Infect Dis abstract
Two deer on Wisconsin farm test positive for chronic wasting disease
Two white-tailed bucks on a farm in Waukesha County, Wisconsin, have tested positive for chronic wasting disease (CWD), which is always fatal, the Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) said yesterday in a news release.
Both deer were 3 years old. The 9-acre farm had been under quarantine since November 2021 after a white-tailed deer transported from its herd tested positive at an Eau Claire County ranch. The farm will remain under quarantine while DATCP and US Department of Agriculture scientists complete their epidemiologic investigation.
The samples were confirmed positive for the prion disease by the National Veterinary Services Laboratories in Ames, Iowa.
CWD, which affects cervids such as deer, elk, and moose, has been detected in 29 US states and in four Canadian provinces. CWD-infected deer may show signs of weight loss, excess salivation, frequent drinking and urination, coordination problems, and a lack of fear of people.
CWD has yet to be detected in people, but the US Centers for Disease Control and Prevention warns against eating cervid meat that tests positive for the disease.
Feb 10 Wisconsin DATCP news release
High-path H5 avian flu turns up in Delaware, New Hampshire waterfowl
Federal health officials reported 48 more highly pathogenic H5 avian flu detections, some already characterized at H5N1, in waterfowl on the East Coast, including two newly affected states: Delaware and New Hampshire.
According to the US Department of Agriculture Animal and Plant Health Inspection Service (APHIS), Delaware had three detections in Kent County, all in hunter-harvested birds that were tested as part of surveillance activities. Kent County is in the central part of the state on the Delaware Bay. New Hampshire has 20 detections, all involving live testing of mallards from Rockingham County, located in the state's southeast corner, on the Atlantic shore.
APHIS also detailed more detections in already affected counties in North Carolina. There are now 139 H5 detections in waterfowl on the East Coast, stretching as far south as Florida. The Eurasian H5N1 strain has been implicated in the detections, which have also been found in Canada and have sparked poultry outbreaks in Canada and most recently the United States, involving a turkey farm in Indiana.
The virus is fueling outbreak in on multiple continents, leading to large poultry losses, especially in Europe. The strain has also been tied to a small number of detections in mammals and a few human illnesses, which occurred in people who had extensive contact with poultry. The infections were mild, with no known onward transmission.
In a related development today, APHIS announced it is expanding surveillance into the Mississippi and Central migratory bird flyways, in an effort to track avian flu viruses in all four of the nation's flyways. Surveillance was already under way in the Atlantic Flyway, where the extensive H5N1 findings have been reported, and in the Pacific Flyway.
APHIS said its goal is to adding the Mississippi and Central flyways will collect an additional 14,500 samples, for a total of 31,000 samples from 49 states.
USDA APHIS high-path avian flu page
Feb 11 USDA APHIS announcement
Afghanistan reports first polio case of 2022
Four countries reported new polio cases this week, including the first wild poliovirus type 1 (WPV1) case of the year, which was reported in Afghanistan, according to a weekly update from the Global Polio Eradication Initiative (GPEI).
Afghanistan's WPV1 case was in Paktika province, located in the east. WPV1 detections have declined sharply in Afghanistan and Pakistan. Last year, Afghanistan reported only four cases.
Elsewhere, three African countries reported more circulating vaccine-derived poliovirus type 2 cases (cVDPV2). The Democratic Republic of the Congo reported 1 case, which involves a patient from Maniema province. The illness is counted in its total for 2021, which now stands at 25. Niger reported 5 more cases in four provinces, all included in last year's total, which is now at 15.
Also, Nigeria reported 2 more cases, 1 each from Gombe and Plateau states, lifting its case total for 2021 to 397 cases.
Feb 10 GPEI update
WHO notes large measles spike in Afghanistan
Afghanistan is reporting a spike in measles cases that has been unmatched in recent years, with weekly cases now approaching 1,500, the World Health Organization (WHO) said in an update yesterday.
Afghan officials reported 35,319 suspected cases from Jan 1, 2021, through Jan 29, 2022. Of those, 3,221 (9%) were lab-confirmed. The vast majority (91%) of suspected cases were in children younger than 5 years. Cases and deaths increased 18% and 40%, respectively, in the first week of February compared with the previous week.
Measles is endemic in Afghanistan, with almost all provinces reporting cases. "Amid the humanitarian crisis in Afghanistan, weekly notifications of suspected measles cases have been increasing in all provinces since the end of July 2021," the WHO said.
The most affected provinces are Balkh, Ghazni, Helmand, Kandahar, Kabul, Paktika, and Paktya. In December 2021, a measles immunization campaign reached more than 1.5 million children under age 5 in Balk, Ghazni, Ghor, Helmand, Kandahar, and Paktika provinces.
The WHO is providing technical support on surveillance, vaccination, laboratory testing, case management, and risk communication.
"Afghanistan is considered a fragile, conflict-affected and vulnerable setting," the WHO said. "According to UNICEF, 14 million people in Afghanistan are facing acute food insecurity, and an estimated 3.2 million children under five years suffer from acute malnutrition." The measles increase is due to a variety of factors, the agency said, including low vaccine uptake.
Feb 10 WHO update