News Scan for Jun 08, 2022

News brief

Gender bias may affect acceptance of antibiotic stewardship efforts

A single-center study suggests gender bias may play a role in whether antibiotic stewardship recommendations by pharmacists are accepted by hospitalists, researchers reported yesterday in Infection Control & Hospital Epidemiology.

To examine the role of gender in acceptance of stewardship recommendations, researchers retrospectively evaluated the effectiveness of the ROAD (Reducing Overuse of Antibiotics at Discharge) Home intervention at an academic medical center in Michigan. The intervention consisted of an antibiotic timeout (a structured conversation to review appropriateness of discharge antibiotics) during pharmacist rounds with hospitalists. The primary outcome of the study was the percentage of recommendations made by pharmacists that were accepted by hospitalists.

During the intervention period (May to October 2019), pharmacists conducted 295 antibiotic timeouts: 158 were conducted by 12 women and 137 were conducted by 8 men. Pharmacists recommended an antibiotic change in 82 timeouts (27.8%), of which 51 (62.2%) were accepted. Compared with male pharmacists, female pharmacists were less likely to recommend a discharge antibiotic change (19.0% vs 38.0%). Female pharmacists were also far less likely to have a recommendation accepted (33.3% vs 78.8%). Thus, timeouts conducted by female versus male pharmacists were less likely to result in an antibiotic change (6.3% vs 29.9%).

After adjusting for patient characteristics, pharmacist gender remained significantly associated with whether recommended changes were accepted (adjusted odds ratio [aOR], 0.10; 95% confidence interval [CI], 0.03 to 0.36 for female versus male pharmacists) and whether the timeout resulted in an antibiotic change (aOR, 0.15; 95% CI, 0.07 to 0.33).

The study authors say that while the findings need to be confirmed in larger studies, the implication that gender bias may play a role in whether physicians accept antibiotic stewardship recommendations could have "profound effects" on whether antibiotic stewardship interventions reach patients and improve their outcomes, and could also affect other pharmacy-led interventions. They also note that women make up 56% of clinical pharmacists, and the number has been growing.

"Given this growth and the importance of pharmacists in areas beyond stewardship (eg, medication reconciliation, transitions of care, patient counselling), there is a critical need to study and mitigate any gender related biases that may exist," they conclude.
Jun 7 Infect Control Hosp Epidemiol study

CDC reports 28 more kids' unexplained hepatitis cases; global total grows

In a regular update today, the US Centers for Disease Control and Prevention (CDC) reported 28 more unexplained hepatitis cases in children that health officials are investigating, raising the national total to 274. One more state or jurisdiction reported a case, raising the total to 39.

The CDC has said that many recent cases are retrospective, with investigations covering illnesses going back to October 2021. A definitive cause hasn't been established, but a possible role for adenovirus is a strong lead, and scientists are still weighing other potential causes, such as COVID-19 or toxin exposure.

At a World Health Organization (WHO) briefing today, Director-General Tedros Adhanom Ghebreyesus, PhD, said more than 700 probable cases have been reported from 34 countries, with 112 more under investigation. He said at least 38 kids needed liver transplants, and 10 have died.

"WHO receives reports of unexplained hepatitis in children every year, but a few countries have indicated that the rates they are seeing are above what is expected," he said.
Jun 8 CDC update
Jun 8 Tedros briefing speech

Avian flu strikes more US poultry and wild birds

Federal veterinary officials reported two more highly pathogenic avian flu outbreaks in poultry, one of which struck a large layer farm in Colorado.

In the latest updates, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said Colorado's latest outbreak occurred in Weld County, about 60 miles north of Denver. The facility houses nearly 1.93 million birds. The other outbreak occurred in a backyard flock in North Dakota at a location in McHenry County, about 35 miles east of Minot, that houses 30 birds.

The outbreaks in US poultry, which began in February, have slowed. So far, the outbreaks have led to the loss of 39.8 million birds across 36 states.

In related developments, H5N1 detections in wild birds continue, and today APHIS reported 56 more, raising the total to 1,422. Most were from Midwestern states, including Minnesota, North Dakota, South Dakota, and Wisconsin. There were also a few in other states, including Colorado, Illinois, Indiana, and Vermont. Most involved raptors and waterfowl found dead, but there were also a few detections in crows.
USDA APHIS poultry avian flu updates
USDA APHIS wild bird avian flu updates

COVID-19 Scan for Jun 08, 2022

News brief

COVID-19 quintupled in-hospital deaths in pregnant women in Africa

COVID-19 infection and pregnancy independently raised the risk of intensive care unit (ICU) admission, the need for supplemental oxygen, and death among hospitalized women in sub-Saharan Africa, finds a study published today in Clinical Infectious Diseases.

A team led by researchers from the University of Pittsburgh studied the outcomes of 1,315 hospitalized women of childbearing age in six sub-Saharan African countries (Democratic Republic of the Congo, Ghana, Kenya, Nigeria, South Africa, and Uganda) from Mar 1, 2020, to Mar 31, 2021. The cohort included 510 pregnant COVID-19 patients, 403 infected nonpregnant women, and 402 noninfected pregnant women.

Among COVID-19 patients, pregnancy was tied to increased risk of ICU admission (adjusted risk ratio [aRR], 2.38; 95% confidence interval [CI], 1.42 to 4.01), oxygen supplementation (aRR, 1.86; 95% CI, 1.44 to 2.42), and in-hospital death (adjusted subhazard ratio [aSHR], 2.00; 95% CI, 1.08 to 3.70).

In pregnant patients, COVID-19 infection raised the risk of ICU admission (aRR, 2.0; 95% CI, 1.20 to 3.35), the need for supplemental oxygen (aRR, 1.57; 95% CI, 1.17 to 2.11), and death (aSHR, 5.03; 95% CI, 1.79 to 14.13).

HIV or a history of tuberculosis doubled the risk of ICU admission among infected pregnant and non-pregnant women.

"Our findings indicate that hospitalized pregnant women with COVID-19 in Sub-Saharan Africa have two to five times greater risk of needing intensive care and dying than uninfected, hospitalized pregnant women," lead author Jean Nachega, MD, PhD, MPH, of Pitt Public Health and Stellenbosch University in Cape Town, South Africa, said in a University of Pittsburgh news release.

In a summary, the authors said vaccine hesitancy fueled by misinformation is another barrier to preventing COVID-19 in women and infants. "It is critical to evaluate and implement evidence-based educational and counseling interventions that address misinformation and disinformation to reassure pregnant women and their families and increase their confidence in proven effectiveness and safety of COVID-19 vaccines," they wrote.
Jun 8 Clin Infect Dis study and author summary
Jun 8 University of Pittsburgh news release

Low COVID vaccine uptake noted in homeless, jail prisoners in Minnesota

By the end of 2021, 60.4% of the general population of Minnesota was fully vaccinated against COVID-19, including 70.9% of people recently incarcerated in state prisons, according to a new study in Health Affairs. But rates for the state's homeless population and those incarcerated in local jails were far less, at 33.7 % and 29.9 %, respectively.

Jails are typically short-term places of confinement at the city, district, or county level for those awaiting a trial or sentencing, while prisons are for people convicted of a crime.

The vaccination gap widened in the fall of 2021, the study found, when booster doses were introduced in the state population. Thirty-one percent of the general population got a booster dose by November of 2021, compared with 8.4% of the homeless, 6.6% of those in jail, and 24.5% of those imprisoned.

Overall, 99.5% of the general population aged 65 years and older were fully vaccinated. Non-Hispanic Asians were the most vaccinated ethnic group, at 70.3%, and females were more likely to be vaccinated than males (66.6% vs 60.2%).

Black Minnesotans had the lowest vaccination rates, in both the general population and among those homeless or incarcerated.

"These findings are worrisome, as people living in congregate settings, compared with the general population, are at higher risk for COVID-19 transmission because of challenges in practicing social distancing and taking other precautions," the authors said. "These data highlight the urgency of targeted outreach to populations in congregate settings amid the resurgence of SARS-CoV-2 variants."

One approach, the authors add, is to offer vaccination when people first enter jail.
Jun 7 Health Aff abstract