News Scan for May 13, 2021

News brief

Most long-haul COVID-19 patients younger, healthier, Mayo Clinic says

The inaugural cohort of Mayo Clinic's COVID-19 Activity Rehabilitation Program (CARP) for post–COVID-19 syndrome (PCS) were mostly women, younger, had few pre-existing comorbidities, and experienced milder forms of COVID-19, but only a third were able to return to full-time work.

The descriptive study, published in Mayo Clinic Proceedings, involved 100 CARP participants from June to December 2020 and found the most common ailments to be fatigue (80%), neurologic complaints like headaches (59%), and respiratory complaints like breathlessness (59%). Other symptoms included cognitive impairment, sleep disturbance, and mental health symptoms. A little over a third of patients (34%) said they had difficulties performing basic daily activities, and only one in three who had been employed had fully returned to unrestricted work by the time they were evaluated.

Contrary to other studies, Mayo Clinic researchers found that the cohort consisted of younger (mean age, 45.4 years) and previously healthier patients, whose main pre-existing comorbidities were respiratory issues like asthma (23%), a history of depression or anxiety (34%), or high blood pressure (19%). More than two-thirds (68%) were women. Three in four did not have to be hospitalized during their initial COVID-19 symptoms. The average time between COVID-19 diagnosis or symptom onset and CARP enrollment was 93.4 days.

Also in contrast with previous findings, most diagnostic test results (eg, heart and lung function) returned to normal, and no life-threatening conditions were found. "These findings underscore that diagnostic testing should be performed judiciously, and that clinically significant symptoms may not be explained solely by diagnostic results," the researchers write.

They add, "Patients reported that their cognitive and mood symptoms were often minimized or dismissed by healthcare providers, which is concerning since many PCS symptoms are similar to prolonged sequela following traumatic brain injury for which prolonged or permanent inability to return to work has been recorded." The study notes that 26% of patients experienced increased anxiety and depression.

"As the pandemic continues, we expect to see more patients who experience symptoms long after infection, and health care providers need to prepare for this, know what to look for, and know how to best provide for their patients' needs," says first author Greg Vanichkachorn, MD, MPH, in a Mayo Clinic news release.
May 11 Mayo Clinic Proc study
May 12 Mayo Clinic news release


Manufacturing, retail among LA County sectors hit hardest by COVID-19

Nearly 60% of non-healthcare COVID-19 worksite outbreaks in Los Angeles County occurred in manufacturing (26.4%), retail (19.6%), and transportation and warehousing (10.5%), according to an Emerging Infectious Disease study yesterday. Data also showed that Hispanic people were disproportionately affected.

The 698 non-healthcare worksite outbreaks identified through September 2020 involved 7,625 COVID-19 patients. Median cases per outbreak was 6 (range, 3 to 277), and median duration was 13 days (range, 0 to 189). At the time of analysis, 14% of outbreaks (96) were still under investigation.

Overall, the three sectors with the most outbreaks (manufacturing, retail, and transportation and warehousing) also had the highest case counts, accounting for 43.5%, 11.4%, and 12.9% of patients, respectively.

The incidence rate in the manufacturing sector was more than five times greater than the overall incidence rate (980.8 vs 171.8 infections per 100,000 people) and more than twice as high as the second-ranked sector (transportation and warehousing, 425.1). The researchers say that manufacturing may present specific COVID-related challenges, such as many people in close contact, long shifts, shared equipment, common spaces, carpooling tendencies, and poor worksite ventilation and sanitation.

The investigation showed that 70.4% of COVID-19 patients were of Hispanic ethnicity, compared with the 40% of Hispanic people employed across the assessed sectors. Patients were also more likely to be male (60.2%), and 29.3% were 50 years or older.

"Regardless of whether workplace exposure has driven community transmission or vice versa, a controlled worksite environment provides an opportunity to mitigate transmission within highly affected communities," the researchers write. "Public health departments must continue to target essential workers in the affected industries in vaccination efforts to address gaps in vaccine access and barriers to uptake."
May 12 Emerg Infect Dis study

Stewardship / Resistance Scan for May 13, 2021

News brief

No increased Achilles tendon rupture risk with 3rd-gen fluoroquinolones

An analysis of administrative claims data in Japan found that newer, third-generation fluoroquinolones were not associated with an increased risk of Achilles tendon rupture, Japanese researchers reported this week in the Annals of Family Medicine.

Using data from patients enrolled in Japan's National Health Insurance and Elderly Health Insurance programs from April 2012 to March 2017, the study examined patients who had experienced Achilles tendon rupture after receiving an antibiotic prescription. Antibiotics were categorized into three groups: first- and second-generation fluoroquinolones, third-generation fluoroquinolones, and non-fluoroquinolones. The researchers then estimated the incidence rate ratio (IRR) of Achilles tendon rupture during the antibiotic exposure period relative to the non-exposure period.

Among the 504 patients analyzed, the risk was not significantly elevated during exposure to third-generation fluoroquinolones (IRR, 1.05; 95% confidence interval [CI], 0.33 to 3.37) and non-fluoroquinolones (IRR, 1.08; 95% CI, 0.80 to 1.47). In contrast, increased risk of Achilles tendon rupture tripled during exposure to first- and second-generation fluoroquinolones (IRR, 2.94; 95% CI, 1.90 to 4.54). The findings were similar when researchers analyzed subgroups stratified by sex and recent corticosteroid use.

The findings are noteworthy because several studies have found that Achilles tendon rupture is one of the adverse effects associated with fluoroquinolone use, but that association has not previously been investigated with third-generation fluoroquinolones. The authors say the findings suggest third-generation fluoroquinolones may be a safer option for patients who have an elevated risk of Achilles tendon rupture, such as athletes.
May 10 Ann Fam Med study


Decline seen in US antibiotic use since 1999, but progress has slowed

Overall short-term antibiotic use in the United States fell over the past 20 years, but progress stalled over the last decade, researchers from Johns Hopkins University School of Medicine reported today in Open Forum Infectious Diseases.

The researchers used data from National Health and Nutrition Examination Surveys (NHANES), which ask participants about medications taken over the past 30 days and have been collected and released in 2-year intervals since 1999, to identify trends in short-term non-topical antibiotic use from 1999 to 2018. They calculated the prevalence of antibiotic use overall and by subgroups of interest for the years 1999 to 2002, 2007 to 2010, and 2015 to 2018. They also calculated antibiotic use by class and examined factors associated with antibiotic use during 2015-2018.

The analysis found that the overall prevalence of past 30-day short-term non-topical antibiotic use adjusted for age, sex, race/ethnicity, poverty status, time of year of the interview, and insurance fell from 4.9% (95% CI, 3.9% to 5.0%) during 1999-2002 to 3.0% (95% CI, 2.6% to 3.0%) in 2015-2018, with the largest decline observed among children 0 to 1 years. Declines were also observed in age categories 6 to 11, 12 to 17, and 18 to 39 years. Short-term antibiotic use for all antibiotics (topical and non-topical) followed the same trend. The investigators noted significant declines in penicillins and cephalosporins.

From 2007-2010 to 2015-2018, however, there was no significant change in antibiotic use (adjusted prevalence ratio [aPR], 1.0; 95% CI, 0.8 to 1.2). Age was significantly associated with antibiotic use during this period, with children age 0 to 1 year having significantly higher antibiotic use than all other age-groups. Being non-Hispanic Black was negatively associated with antibiotic use compared with being non-Hispanic White (aPR, 0.6; 95% CI, 0.4 to 0.8).

"Overall, these data suggest that, despite the push for antimicrobial stewardship and reducing unnecessary antimicrobial prescriptions, the progress of reduction over the past decade may be slower than desired," the study authors wrote. "Further investigation should be conducted for the most recent years to verify if these finding hold across data sources, as this would imply that the US has not met the goals established in 2014 to reduce antibiotic use."
May 13 Open Forum Infect Dis abstract

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