News Scan for May 24, 2021

News brief

Rapid test linked to quicker optimal therapy for blood infections

Implementation of a test that provides rapid bacterial identification and susceptibility results from positive blood cultures shortened the time to optimal antibiotic therapy and reduced unnecessary antibiotic exposure in hospitalized patients with bacteremia, researchers reported late last week in the Journal of Antimicrobial Chemotherapy.

The Improving Outcomes and Antibiotic Stewardship for patients with gram-positive bloodstream infections (IOAS) study, led by scientists from Accelerate Diagnostics (which also provided funding), evaluated clinical and antimicrobial stewardship metrics at two hospitals in Arkansas and Iowa following implementation of the Accelerate PhenoTest BC Kit (AXDX), a diagnostic platform that can identify bacteria from blood cultures and provide antimicrobial susceptibility testing (AST) results up to 40 hours faster than conventional methods.

The researchers analyzed two groups of patients with gram-positive bacteremia, one that underwent traditional identification and AST (pre-AXDX) and one that underwent testing with AXDX (post-AXDX). The primary outcome was time to optimal therapy (TTOT), and secondary outcomes included time to first antibiotic modification (overall and gram-positive antibiotics) and duration on unnecessary coverage for methicillin-resistant Staphylococcus aureus (MRSA).

A total of 219 patients with gram-positive bacteremia (109 pre-AXDX and 110 post-AXDX) were included in the study. The median TTOT was 36.3 hours in the pre-AXDX group and 20.4 hours in the post-AXDX group. Analysis of secondary outcomes showed that the median time to first antibiotic modification was also reduced in the post-AXDX patients (15.9 hours vs 29.1 hours), as was the median time to first gram-positive antibiotic modification (17.2 hours vs 33.2 hours) and the median duration of unnecessary MRSA coverage (29.7 hours vs 58.4 hours).

The researchers also observed a trend toward decreased acute kidney injury in the post-AXDX group compared with the pre-AXDX group (13% vs 24%) but found no differences in clinical outcomes such as mortality, Clostridioides difficile infection (CDI), and readmission to the hospital.

"In summary, implementation of AXDX offered a comprehensive solution to replace various identification and phenotypic testing methods and had a meaningful impact on the management of patients with Gram-positive bacteraemia in the IOAS study," the study authors wrote. "TTOT and initial antibiotic modifications were significantly faster, and patients received less unnecessary antibiotic therapy compared with conventional microbiology diagnostics."
May 22 J Antimicrob Chemother study

WHO, Switzerland to launch first BioHub lab to share pathogen samples

In a step designed to speed pathogen risk assessment and countermeasure development, as well as to broaden access, the World Health Organization (WHO) and Switzerland today signed a memorandum of understanding to launch the first WHO BioHub facility, part of the WHO BioHub system first announced in November.

The biosafety lab in Spiez will safely receive, sequence, store, and prepare pathogen samples for sharing with other laboratories, the WHO said in a press release. It said the current system is slow and done bilaterally on an ad hoc basis, which leaves some countries without access to the resulting benefits and tools.

The WHO said BioHub sharing is done according to pre-agreed conditions that relate to biosecurity, biosafety, and other regulations, ensuring more timely and predictable response operations.

Also, the WHO said it will broaden the BioHub system to include qualified manufacturers and is currently running a pilot system with SARS-CoV-2 and its variants to test such sharing. Pending those results, BioHub will expand to other pathogens in 2022.
May 24 WHO press release

COVID-19 Scan for May 24, 2021

News brief

Age, health conditions are linked with COVID severity in pregnant women

Increased age and underlying medical conditions were associated with a greater likelihood for more severe COVID-19 infections in pregnant women, according to a study late last week in Clinical Infectious Diseases.

The researchers used the Surveillance for Emerging Threats to Mothers and Babies Network to identify 7,950 pregnant women, 20.9% of whom had moderate-to-severe or critical illness. Mothers were identified from Mar 29, 2020, to Mar 5, 2021. Most were 20 to 39 years old (91.2%) and had Medicaid (54.5%). About one in three (36.4%) had at least one underlying condition, with the most common being pre-pregnancy obesity (28.2%).

Crude odds showed increased risk associations of moderate or worse COVID-19 infections with increasing age among pregnant women with COVID-19. Risk ratios (RRs) went from 1.32 for those 25 to 29 up to 1.66 for those 40 and older, compared with those under 20. Other independent associations included healthcare occupation (RR, 1.25), pre-pregnancy obesity (RR, 1.36), chronic lung disease (RR, 1.37), chronic hypertension (RR, 1.45), and pregestational diabetes mellitus (RR, 1.66). Any one health condition, whether pre-pregnancy or pregnancy-related, increased risk of moderate-to-severe or critical COVID-19 infection 1.39 times, and three or more health conditions increased the risk 2.31 times.

While non-private health insurance was associated with a 0.62 RR in crude analysis among pregnant women with COVID-19, the adjusted RR did not show any association—the only factor to have different results after adjustment. Cardiovascular disease, immunosuppression, gestational diabetes, and gestational hypertension did not have increased risk. Additionally, although the researchers noted that 42.0% of pregnant women with COVID-19 were Hispanic, the data did not show associations for any race or ethnicity.

"In this analysis, approximately half of pregnant women with moderate-to-severe or critical illness had no reported underlying medical conditions, which reinforces the importance of preventive measures, including vaccination, for pregnant women," the researchers write.
May 22 Clin Infect Dis study

Medication patterns changed for hospitalized COVID-19 patients

Since the start of the COVID-19 pandemic, medication use patterns for hospitalized COVID-19 patterns have changed. To help quantify these trends, a JAMA Network Open study published late last week looks at the changes across the University of California (UC) Health medical centers for 10 medications or medication classes: dexamethasone, remdesivir, enoxaparin, heparin, colchicine, hydrocortisone, tocilizumab, azithromycin, hydroxychloroquine, angiotensin-2 converting ace inhibitors, and angiotensin receptor blockers.

Using the UC COVID Research Data Set, the researchers looked at daily use and overall use percentages for medication treatments that 3,546 hospitalized COVID-19 patients received from Mar 10 to Dec 31, 2020. Some of the most notable changes were in hydroxychloroquine, azithromycin, dexamethasone, and remdesivir. The drug enoxaparin saw steady use throughout 2020, most likely because its use as thrombosis prevention and treatment also appeared to help with COVID-related blood clots.

Hydroxychloroquine and azithromycin were two antimicrobials that were each used in more than 40% of hospitalized patients at the beginning of the pandemic, but by June, use declined to below 5% and below 40%, respectively, as new studies came out.

Dexamethasone and remdesivir, on the other hand, saw increases as the pandemic continued, with the former going from 1.4% patient use on Mar 31 to 67.5% by the end of the year, in part, the researchers said in a UC-Irvine press release, due to large trial results in the United Kingdom. Remdesivir grew 12-fold from June to December, which the researchers may say be because early on, the medication was only available for patients enrolled in UC trials.

"You can clearly see how usage of certain medicines grew or declined over the course of the pandemic and how those movements were tied to evidence-based decisions being made by UC healthcare providers in real time," said lead author Jonathan Watanabe, PharmD, PhD, UC professor, in the press release. "You can monitor the evolution in how we treat our sickest patients."
May 21 JAMA Netw Open study
May 21 UC-Irvine press release