News Scan for May 05, 2021

News brief

Study says COVID-19 recurrence could be less than 0.1%

Less than 0.1% of all COVID-positive patients in the Intermountain Healthcare system had probable or possible recurrence of SARS-CoV-2 infection, according to a PLOS One study yesterday.

The full cohort of 23,176 COVID-19 patients was pared down to 1,301 patients who had at least one additional SARS-CoV-2 test 60 or more days after the initial diagnosis. Almost 10% (122) had a positive test, of which 114 had sufficient data for recurrence evaluation (median test interval, 85.5 days).

Using both clinical and cycle threshold (Ct) values, the researchers found that four patients had probable and six had possible COVID-19 recurrence. Taken together, that's 4.3 people with probable or possible COVID recurrence per 10,000 patients (95% confidence interval [CI], 2.1 to 7.9), or 0.04%. Of the four patients with probable recurrent infections, all had symptoms and three required a higher level of medical care than with the initial illness.

The researchers note that using the adjudication standard adapted from Abu Raddard et al (Clinical Infectious Diseases, 2020) resulted in a probable or possible COVID-19 recurrence in 31.9 per 10,000 patients (95% CI, 25.1 to 40.1). Probable and possible recurrence numbers also increased to 44 COVID-19 patients if patients were assessed via purely clinical means.

"Neither clinical criteria nor Ct assessment alone appeared sufficient to accurately categorize likelihood of COVID-19 recurrence," the researchers write. "Although reinfection seems more likely in these immunocompetent patients, reactivation is also possible."
May 4 PLOS One study


Medicaid enrollment increased 5 million during pandemic

About 5 million more Americans enrolled in Medicaid by September 2020 compared with January 2020, a research letter today in JAMA Network Open reports. The data showed that enrollment was flat until March 2020, where expansion and nonexpansion states eventually increased enrollment by 1.4 and 1.6 percentage points, respectively. 

The researchers found that enrollment increases were associated with Medicaid expansion states (0.68 percentage point, adjusted; 95% CI, 0.07 to 1.29, P = 0.03) but not with steps to simplify the application process.

What was surprising, the researchers say, was that enrollment growth was lower in states with unemployment increases (-0.20 percentage point, adjusted; 95% CI, -0.34 to -0.06). The results were similar when the researchers were looking at September 2019 to September 2020 data.

"This may indicate that Medicaid growth is associated with factors other than job loss," the researchers write, "including reduced work hours making more people eligible, greater focus on health care during the pandemic, and the maintenance of effort requirement passed by Congress in March 2020, which offered states more funding in exchange for a requirement that they not disenroll anyone from Medicaid during the public health emergency."
May 5 JAMA Netw Open study


Guinea's Ebola outbreak still fragile, as country probes suspected cases

Though Guinea hasn't reported any confirmed Ebola cases in more than 3 weeks, its situation remains fragile, with 19 new suspected cases and 3 currently hospitalized, the World Health Organization (WHO) African regional office said in its latest weekly outbreaks and health emergencies update.

Three patients have been sampled, and 16 have refused testing. The outbreak centered in N'Zerekore prefecture currently remains at 23 cases, 16 of them confirmed, and 12 deaths. So far, 8,638 people have been vaccinated, and a "sweep vaccination" approach is being used in the remaining hot spots to prevent possible transmission chains.

The WHO warned that Guinea's situation still isn't stable, with some contacts lost to follow up and one confirmed case remaining in the community, which raises the risk of further spread. It added that the appearance of 19 new suspected cases is also concerning. The response plan is only 17% funded, a gap that needs to be urgently filled, the WHO said.

Guinea's outbreak began in early February. It marked the country's first since West Africa's massive outbreak of 2014-2016, and appeared in the same area where the earlier outbreak began. An Ebola outbreak in the Democratic Republic of the Congo was declared over on May 1.
May 4 WHO African regional office weekly report

Stewardship / Resistance Scan for May 05, 2021

News brief

WHO highlights importance of good hand hygiene

To mark World Hand Hygiene Day, the World Health Organization (WHO) today called for countries to reduce inequalities in the availability of good hand hygiene and other infection prevention and control (IPC) measures.

While good hand hygiene is considered vital in preventing healthcare-associated infections and the spread of antibiotic-resistant pathogens, research has shown that in some low-income countries, only 1 in 10 healthcare workers practices proper hand hygiene, and that's often because they lack the resources to do so. A 2020 WHO report found that globally, 1 in 4 healthcare facilities lacks basic water services, and 1 in 3 lacks hand hygiene supplies at the point of care.

Another WHO analysis found that, in 2018, only 45% of low-income countries had a functional national IPC program, compared with 70% of high-income countries. Overall, only 22% of countries monitored implementation roll-out and impact of IPC programs.

The lack of resources for good hand hygiene and IPC measures in poorer nations is reflected in healthcare-associated infection rates. The WHO notes that patients in low- and middle-income countries are more than twice as likely to acquire an infection during healthcare delivery as patients in high-income countries (15% vs 7%), and that the risk of infection in intensive care units (ICUs), especially among newborns, is two to 20 times higher.

The WHO also announced a new online monitoring IPC portal to help countries identify and address IPC gaps.

"Health care workers' compliance with hand hygiene practices is one of the key performance indicators for IPC, patient safety and quality of health services worldwide," the WHO said in a press release. "The new monitoring portal can play an important part in improving this."
May 5 WHO press release


Study describes bacterial, fungal coinfections in COVID-19 patients

A study of hospitalized COVID-19 patients in New York during the first wave of the pandemic found that 17% had bacterial or fungal coinfections, and that antibiotic-resistant bacteria were increasingly isolated from patients with prolonged hospital stays, researchers reported today in Open Forum Infectious Diseases.

In the study, researchers from New York-Presbyterian Hospital/Columbia University Irving Medical Center examined data on COVID-19 patients who were hospitalized for more than 24 hours from Mar 2, 2020, through May 21, 2020, including culture and susceptibility results from all body sources. Microbiologically confirmed bacterial and fungal pathogens from clinical cultures were evaluated to characterize community- and healthcare-associated infections and describe temporal changes in predominant organisms and antibiotic resistance.

Of the 3,028 COVID-19 patients admitted during the study period, 516 (17%) had positive cultures. Community-associated infections (identified within 72 hours of admission) were identified in 183 patients (6%), and healthcare-associated infections were identified in 350 patients (12%), with the median onset of hospital infection on day 16.

Among the isolates identified as healthcare-associated, 57% were gram-negative bacteria, 25% were gram-positive bacteria, and 19% were fungi. ICU stay, mechanical ventilation, and steroid use were all independently associated with healthcare-associated infections.

Drug susceptibilities differed by source of infection and duration of hospitalization, with the proportion of vancomycin-resistant Enterococci, cephalosporin-resistant (Ceph-R) Enterobacterales, and carbapenem-resistant Enterobacterales infections increasing with the duration of hospitalization. Ceph-R Enterobacterales, identified in 159 isolates, was the most common organism group with multidrug resistance.

The analysis also found that among all 3,028 patients, 2,015 (67%) had exposure to at least one dose of an antibiotic, including 60% of the patients with no confirmed co-infection.

"High rates of antimicrobial use in conjunction with other risk factors, such as prolonged hospital and ICU stays, invasive devices, and the need for patient cohorting, may have contributed to the increasing incidence of multidrug-resistant infections over the course of hospitalizations," the study authors wrote.

The authors say the findings highlight the importance of antibiotic stewardship principles in hospitalization of COVID-19 patients.
May 5 Open Forum Infect Dis abstract

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