VA intervention linked to better treatment for asymptomatic bacteriuria

An antibiotic stewardship intervention for asymptomatic bacteriuria (ASB) was associated with a reduction in urine cultures and antibiotic use at four Veterans Affairs (VA) hospitals, researchers reported today in JAMA Network Open.

To reduce unnecessary antibiotic treatment for ASB—the presence of bacteria in the urinary tract without related symptoms—clinicians and researchers at four geographically distant VA hospitals implemented the Less is More for ASB project, which encompassed case-based education to train clinicians who order urine cultures and dispense antibiotics how to use an algorithm to distinguish ASB from a urinary tract infection.

Previous research by the VA has shown that 72% of ASB patients at 25 VA hospitals received antibiotics unnecessarily. The program was implemented by a centralized coordinating center that provided coaching and troubleshooting to site champions at each hospital.

To assess the effectiveness of the intervention, researchers conducted an interrupted time series study at the four intervention hospitals and four comparison hospitals from October 2017 through April 2020. The main outcomes were the total number of urine cultures ordered, antibiotic days of therapy (DOT), and length of therapy (LOT).

A total of 11,299 patients were included in the study (94.7% men; mean age, 72.6 years). The decrease in urine cultures before and after the intervention was not significant in the intervention hospitals per segmented regression analysis, but a difference-in-differences analysis comparing intervention with comparison hospitals found that the number of urine cultures ordered fell by 3.24 urine cultures per 1,000 bed-days.

In the segmented regression analyses, the relative percentage decrease of antibiotic DOT in the postintervention period at the intervention sites was 21.7%, from 46.1 (95% confidence interval [CI], 28.8 to 63.4) to 37.0 (95% CI, 22.6 to 51.4) per 1,000 bed-days. The relative percentage decrease of antibiotic LOT in the postintervention period at the intervention sites was 21.0%, from 36.7 (95% CI, 23.2 to 50.2) to 29.6 (95% CI, 18.2 to 41.0) per 1,000 bed-days.

"Overall, our project led to the desired direction of change (decrease) in all 3 clinical outcomes: urine cultures, DOT, and LOT," the study authors wrote. "The success of this project implies that our external and internal facilitation is a viable implementation strategy for implementing stewardship at a distance."
Jul 25 JAMA Netw Open study


Fully vaccinated COVID-19 patients less likely to have heart attack, stroke

Fully vaccinated COVID-19 patients in South Korea were less likely than their unvaccinated peers to be hospitalized for a heart attack or ischemic stroke 31 to 120 days after diagnosis, despite being older and having more underlying illnesses, finds a study published late last week in JAMA.

The researchers used data from the Korean nationwide COVID-19 registry and the Korean National Health Insurance Service on adults who tested positive for COVID-19 from July 2020 to December 2021.

Because of the difficulty differentiating cardiovascular events caused by COVID-19 from those caused by treatment, the authors excluded the first 30 days after diagnosis. Median follow-up beginning 30 days after COVID-19 diagnosis was 84 days in the fully vaccinated group and 90 days in unvaccinated participants.

Of the 231,037 included patients, 168,310 had received two doses of an mRNA or viral-vector COVID-19 vaccine, and 62,727 were unvaccinated.

Seventy-four fully vaccinated patients and 31 unvaccinated patients had a heart attack or ischemic stroke, for a respective incidence of 5.49 vs 6.18 per 1 million person-days. Vaccinated participants were at significantly lower risk of the composite outcome of hospitalization for a heart attack or stroke than their unvaccinated counterparts (adjusted hazard ratio [aHR], 0.42; 95% confidence interval [CI], 0.29 to 0.62).

Vaccinated patients were also significantly less likely to have the secondary outcomes of hospitalization for a heart attack (aHR, 0.48; 95% CI, 0.25 to 0.94) or ischemic stroke (aHR, 0.40; 95% CI, 0.26 to 0.63). A difference in severe or critical COVID-19 wasn't observed.

The researchers noted that previous studies have suggested that COVID-19 infection increases the risk of heart attack and ischemic stroke owing to a higher likelihood of blood clots. "The findings support vaccination, especially for those with risk factors for cardiovascular diseases," they concluded.
Jul 22 JAMA research letter


Florida reports high path avian flu in poultry flock

Florida has reported its first highly pathogenic avian influenza outbreak in poultry, according to a Jul 22 statement from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS).

The virus struck a backyard flock in Seminole County, located in central Florida, in an area that is part of the Orlando metro area. There are 160 birds in the flock. H5N1 has been detected several times in wild birds in Florida, mostly vultures but also some waterfowl and raptors. The outbreak brings the number of affected states to 38.

Also, APHIS reported three more outbreaks in Oregon, all involving backyard birds in Deschutes County.
Jul 22 USDA APHIS statement on Florida's outbreak
USDA APHIS poultry outbreak page


Spain reports CCHF infection

Spain has reported an infection involving Crimean Congo hemorrhagic fever (CCHF), a tickborne disease that is endemic in some parts of the world and has also been reported in eastern and southern Europe.

The patient is a middle-aged man who was diagnosed after he was hospitalized in Castile and Leon region, according to Reuters. His symptoms began after he was bitten by a tick, and he is reported to be in stable condition.

CCHF is caused by and orthonairovirus and is spread by Hyalomma ticks. The virus can also spread by direct and indirect contact with the blood or organs of infected humans or animals. Spain reported its first local cases in 2016 in Castile and Leon. Since then, it has reported sporadic cases, mostly from the same area.

CCHF is marked by a sudden onset of flulike symptoms, with bleeding symptoms that can accompany severe cases. The case fatality rate in hospitalized patients is 30%.
Jul 21 Reuters story
European Centre for Disease Prevention and Control CCHF background

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