News Scan for Nov 16, 2021

News brief

Death rate 68% lower in COVID outpatients sent text message check-ins

An automated text messaging system for adult COVID-19 outpatients developed at Penn Medicine saved two lives a week during the first US pandemic surge, and users were 68% less likely than controls to die, finds a study today in the Annals of Internal Medicine.

The text messaging system, COVID Watch, sent twice-daily automated text check-ins to outpatients who tested positive for COVID-19 from Mar 23 to Nov 30, 2020, at the Penn Medicine health system. Patients could report worsening symptoms to a small team of registered nurses 24 hours a day, 7 days a week.

The researchers compared the outcomes of 3,488 patients enrolled in COVID Watch with those of 4,377 controls who received usual care. Of the intervention patients, 86.8% responded to at least one text (average, 23 responses), and 14.3% triggered an escalation to a registered nurse (average response time, 24 minutes).

Thirty days after enrollment, 3 (0.09%) of intervention patients had died, compared with 12 (0.27%) of control patients. None of the COVID Watch deaths occurred outside the hospital, versus 6 among control patients. At 60 days, 5 COVID Watch patients (0.14%) had died, compared with 16 control patients (0.37%).

COVID Watch participants' odds ratio for death was 0.32 (95% confidence interval [CI], 0.12 to 0.72), with 1.8 fewer deaths per 1,000 patients (95% CI, 0.5 to 3.1). At 60 days, there were 2.5 fewer deaths per 1,000 patients (95% CI, 0.9 to 4.0) in the COVID Watch group.

COVID Watch patients had a 68% lower death rate than control patients, which the authors said could be because they had more telemedicine and emergency department (ED) visits and hospitalizations and visited the ED sooner than control patients (average number of days sooner, 1.9 [95% CI, 0.9 to 2.9]).

Lead author M. Kit Delgado, MD, said in a University of Pennsylvania news release that the text messaging system benefitted all patients, including those at high risk for poor outcomes. "It's crucial that we found all major racial and ethnic groups benefited because non-white and low-income communities have had disproportionately higher infection rates, lower access to care, and higher death rates," he said.
Nov 16 Ann Intern Med study
Nov 15 University of Pennsylvania
news release


IDSA issues advice for COVID-19 PPE use in healthcare workers

An Infectious Diseases Society of America (IDSA) guideline panel published eight evidence-based recommendations for the use of personal protective equipment (PPE) to protect healthcare workers against COVID-19, according to a paper yesterday in Clinical Infectious Diseases.

The panel, led by a University of Washington at Seattle researcher, conducted a systematic review of the literature to determine the standards of PPE use in conventional, contingency, and crisis situations.

The panel recommended that healthcare personnel caring for patients with confirmed or suspected COVID-19 don a medical/surgical mask or N95 respirator and eye protection but made no recommendation about the use of double gloves or shoe covers.

The group also recommended that healthcare workers involved in aerosol-generating procedures wear an N95 respirator rather than a medical/surgical mask and that if N95s are in short supply, wear a reprocessed N95 and a face shield to allow for extended respirator use and/or reuse.

The panel cautioned that the guidance will continue to evolve with new knowledge.

"There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence," the researchers wrote. "These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies."
Nov 15 Clin Infect Dis report


Multistate E coli outbreak linked to organic spinach sickens 10

The Centers for Disease Control and Prevention (CDC) yesterday announced an Escherichia coli O157:H7 outbreak linked to Josie's Organics fresh baby spinach that has sickened 10 people from 7 states.

No one has died, but two people have required hospitalization, the CDC said. The outbreak is concentrated in the Midwest, with cases reported in Minnesota, Iowa, Missouri, South Dakota, Michigan, Indiana, and Ohio. Illness-onset dates range from Oct 15 through Oct 27.

Five of the seven case-patients reported eating spinach in the week before they got sick, and one person reported eating Josie's Organics brand. The CDC also said Minnesota health officials found E coli O157:H7 in a package of leftover Josie's Organics baby spinach collected from a sick person's home. So far no recalls have been issued.

Patients range in age from 2 to 71 years, with a median age of 26. Seven are female.

In other foodborne pathogen news, there are now 155 cases identified as part of a Salmonella Thompson outbreak traced to seafood from a Denver company, Food Safety News reports. The majority of people sickened have been identified in the Denver area, but 14 states have reported cases.

On Oct 8, the CDC had tracked 102 cases; the new number of patients comes from data collected by the National Center for Biotechnology Information.
Nov 15 CDC
Nov 16 Food Safety News


CDC, Michigan officials investigate large university flu outbreak

The CDC is working with health officials in Michigan to investigate a large and sudden spike in flu infections caused by the H3N2 influenza strain at the University of Michigan, the CDC said yesterday.

Since Oct 6, the school's University Health Services (UHS) has recorded 528 cases, with respiratory test positivity rising steadily over the past 2 weeks. About 77% of people with confirmed infections were unvaccinated, according to the University of Michigan press office.

Lindsay Mortenson, MD, UHS medical director, said the investigation will help shed light on how the flu season may unfold regionally and nationally against the backdrop of the COVID-19 pandemic. The school also said the spike's timing comes as many students prepare to return to their homes for Thanksgiving break.

The investigation goals are to look at flu vaccine uptake, vaccine effectiveness, and risk factors for spread, the university said.

The CDC said in its statement that it has received anecdotal reports of flu outbreaks in young adults, possibly attending colleges and universities in several states. It added that flu viruses are known to spread in close quarters like common living spaces, classrooms, and shared social activities; however, young adults regularly have the lowest flu vaccine uptake.

During the 2020-21 flu season, US flu levels were historically low, probably owing to COVID-19 measures, the CDC said. With relaxed measures, circulation of other respiratory viruses has resumed, and health officials are watching to see if flu takes a similar track. CDC surveillance over the past 3 weeks shows that flu activity is starting to resume, mainly due to H3N2, which has been linked to more severe flu seasons, with the biggest impacts on seniors and young children.
Nov 15 CDC statement
Nov 15 University of Michigan press release 

Stewardship / Resistance Scan for Nov 16, 2021

News brief

Scottish report shows 5-year decline in human antibiotic use

A report today from Scotland highlights reduced antibiotic use in the country since it adopted a One Health approach to combatting antimicrobial resistance (AMR).

The report, from Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) Scotland, shows that total antibiotic use in people was 19.2 defined daily doses per 1,000 population per day in 2020, a 17.1% reduction since 2016. The report notes that the 11.8% reduction from 2019 to 2020 likely reflects the impact of the COVID-19 pandemic, which affected antibiotic use in all healthcare settings.

The vast majority of antibiotic use (84.2%) in Scotland in 2020 occurred in primary care settings, while acute care hospitals accounted for 13.2% and non-acute hospitals for 2.6%. Antibiotic use in primary care fell by 20.9% from 2016 to 2020, but rose by 2.3% in acute care settings, despite a decline in use during the pandemic.

"Access" antibiotics—the antibiotics classified by the World Health Organization (WHO) as first-line treatments for common infections—accounted for 61.2% of all antibiotics used in people in 2020, and 76.8% of all antibiotics dispensed in primary care. Use of Watch and Reserve antibiotics, which are broad-spectrum drugs that the WHO recommends should be restricted to more severe, drug-resistant infections, fell by 10.4% in acute care settings since 2016.

Surveillance data show that gram-negative bacteria continue to be a common cause of serious infections in both healthcare and community settings in Scotland, with Escherichia coli accounting for most drug-resistant infections. Nearly a quarter of E coli bacteremia cases in Scotland in 2020 were resistant to one or more key antibiotics.

On the animal side, the report shows that the percentage of companion animal veterinary consultations that resulted in an antibiotic prescription was 16.2% in 2020, down from 19.2% in 2016. Scotland is still in the process of developing systems to collect data on antibiotic use in livestock.

"Tackling AMR, which has been described as a slow burning pandemic, remains vitally important," the report states. "Sustained action to preserve antibiotics and reduce drug resistant infections is crucial to secure the future delivery of healthcare through and beyond the COVID-19 pandemic."
Nov 16 ARHAI Scotland report


Africa CDC issues antibiotic treatment guidelines for common infections

The Africa Centres for Disease Control and Prevention (Africa CDC) and the Center for Disease Dynamics, Economics & Policy (CDDEP), based in Washington, D.C., last week published the first edition of Africa-specific guidelines for antibiotic treatment of common bacterial infections.

Developed by an interdisciplinary panel of infectious disease clinicians, pharmacists, and public health experts, the guidelines aim to provide African healthcare workers with expert recommendations on antimicrobial selection, dosage, and duration of treatment for common bacterial infections and syndromes in African adults and children. They are designed to promote appropriate use of antimicrobials to limit the spread of drug-resistant pathogens.

They're based on a systematic review of existing national treatment guidelines, available AMR data, and expert opinion, and are intended to complement existing national and international clinical guidelines.

Africa CDC notes that the guidelines fill a long-existing gap. With the exception of infectious diseases like HIV, tuberculosis, and malaria, many countries in Africa lack guidelines that define appropriate treatment for common infections, and healthcare providers often have to rely on their own judgment or guidelines developed outside of Africa.

The agency says it hopes the guidelines serve as a standardized model for other jurisdictions or healthcare facilities in Africa to develop their own guidelines.
Nov 12 African Antibiotic Treatment Guidelines
Nov 12 CDDEP blog post

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