News Scan for Mar 18, 2021

News brief

Australian study shows long-term benefits of ICU stewardship intervention

An audit of an electronic medical record–integrated antimicrobial stewardship intervention in an Australian intensive care unit (ICU) demonstrated long-term benefits and sustainability, Australian researchers reported today in Infection Control & Hospital Epidemiology.

The intervention in the ICU at Austin Health, a tertiary referral hospital in Melbourne, Australia, was implemented in August 2017 and involved 5-day-a-week stewardship ward rounds and review of compliance with stewardship recommendations 24 hours after each ward round. The impact of the intervention over a 9-month period had previously been demonstrated.

A review of antibiotic use in the ICU 2 years before and after the intervention showed an immediate decrease in the use of ceftriaxone, meropenem, piperacillin/tazobactam, and vancomycin, and an ongoing significant reduction in the use of vancomycin and ciprofloxacin after the intervention, but no significant long-term change in the use of piperacillin/tazobactam. Prescribing appropriateness rose from 51% during the pre-intervention period (2015-2016) to 73% after the intervention was implemented (2017-2018).

During the first year after the intervention, 87.6% of stewardship recommendations were implemented by ICU staff, and 89.3% of recommendations were implemented during the second year.

The study authors say future research should focus on risk-stratifying ICU patients who would benefit most from a stewardship review.
Mar 18 Infect Control Hosp Epidemiol study


MERS sickens United Arab Emirates camel farmer

The United Arab Emirates (UAE) has reported a MERS-CoV infection in a 39-year-old man who owns a camel farm, according to a statement yesterday from the World Health Organization (WHO).

The man got sick with a fever and cough on Jan 18 and sought care at a private hospital several times, during which his symptoms didn't improve. He was admitted to the hospital on Jan 26, then was transferred 2 days later to a government hospital, where a sample obtained on Jan 31 tested positive for MERS-CoV (Middle East respiratory syndrome coronavirus). He is listed in stable condition.

An investigation found that he had close contact with his camels in the 14 days before his illness began. All human contacts completed their monitoring periods, and no other cases were detected. Veterinary officials are investigating the link to camels.

The UAE reported its last cases in January 2020. It has now reported 92, including 12 deaths. The WHO said the new case lifts the global MERS-CoV total to 2,567 cases, mostly in Saudi Arabia, since the virus was first detected in humans in 2012. Of those, 882 deaths have been reported.
Mar 17 WHO statement

COVID-19 Scan for Mar 18, 2021

News brief

CDC report spotlights socioeconomic status in COVID vaccine coverage

COVID-19 vaccination coverage in less socioeconomically vulnerable US counties was 1.9 percentage points higher than that in the most susceptible counties in the first 2.5 months of vaccine rollout, a study yesterday in Morbidity and Mortality Weekly Report (MMWR) finds.

Centers for Disease Control and Prevention (CDC) researchers led the study, which used the agency's social vulnerability index (SVI) to classify counties according to low, moderate, or high vulnerability and vaccine data for 49,264,338 residents of 49 states and Washington, DC, who received one or two COVID-19 vaccine doses from Dec 14, 2020, to Mar 1, 2021, and for whom county of residence was available.

Vaccine coverage was 15.8% in counties with low social vulnerability, compared with 13.9% in those with high susceptibility. Much of the disparity was tied to socioeconomic status, with 2.5 percentage points higher coverage in low-vulnerability counties than in those with high-vulnerability status.

Low- and high-vulnerability counties had similar vaccine coverage in terms of percentage of residents with a disability and those with limited English proficiency.

Compared with highly vulnerable counties, less susceptible counties' vaccine coverage was at least 0.5 percentage points lower in residents aged 65 and older (-2.3 percentage points), multiunit housing (-1.3), and households without a vehicle (-0.7). But the largest disparity between the two types of counties was the percentage of adults with less than a high school diploma (2.8-percentage-point difference).

"Although vaccination coverage estimates by county-level social vulnerability varied widely among states, disparities in vaccination coverage were observed in the majority of states," the authors said.

Better vaccine coverage in vulnerable populations needs to be prioritized in light of their increased COVID-19 infection and mortality burdens, according to the researchers.

"As vaccine supply increases and administration expands to additional priority groups, CDC, state, and local jurisdictions should continue to monitor vaccination levels by SVI metrics to aid in the development of community efforts to improve vaccination access, outreach, and administration among populations most affected by COVID-19," they concluded.
Mar 17 MMWR study


Aspirin linked to less serious COVID-19 outcomes

A low-dose aspirin treatment is associated with a lower likelihood of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality in hospitalized COVID-19 patients, according to a study published yesterday in Anesthesia & Analgesia.

The retrospective observational study looked at 412 hospitalized COVID-19 patients across the United States from March to July 2020, 98 of whom (23.7%) received aspirin. Of those who received aspirin, 75.5% were taking it before admission and 86.7% received it within 24 hours of hospital admission.

Those treated with aspirin had adjusted hazard risks for mechanical ventilation, ICU admission, and in-hospital mortality of 0.56 (95% confidence interval [CI], 0.37 to 0.85), 0.57 (95% CI, 0.38 to 0.85), and 0.53 (95% CI, 0.31 to 0.90), respectively.

While no major bleeding or overt thrombosis differences were recorded, the initial levels of fibrinogen, a protein involved in blood clotting, were lower in those on aspirin (524 vs 635 milligrams per deciliter). The aspirin group also needed significantly less oxygen support upon hospital admission.

Overall, patients who received aspirin were more likely to have hypertension (78.6% of aspirin users vs 52.5% of nonaspirin users), diabetes mellitus (55.1% vs 29.0%), coronary artery disease (34.7% vs 5.7%), renal disease (31.6% vs 12.4%), and liver disease (13.3% vs 6.7%), and they were more likely to be on home beta blockers (34.7% vs 16.9%). If they received aspirin upon hospital arrival, the dose was a median of 81 milligrams for a median duration of 6 days.

"Aspirin is low cost, easily accessible and millions are already using it to treat their health conditions," said lead author Jonathan Chow, MD, in a George Washington University press release. "Finding this association is a huge win for those looking to reduce risk from some of the most devastating effects of COVID-19."
Mar 17 Anesth Analg study
Mar 17 George Washington University press release

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