Stewardship initiative linked to improved antibiotic prescribing for kids' pneumonia

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Chest x-rays and pillsA quality improvement (QI) initiative implemented at five community hospitals was associated with increased prescribing of narrow-spectrum antibiotics for pediatric pneumonia, a team of researchers from Harvard Medical School reported yesterday in Pediatrics.

The initiative involved the creation of multidisciplinary teams at each hospital that were tasked with increasing narrow-spectrum antibiotic use (ampicillin or amoxicillin) from 60% to 80% in patients aged 3 months to 18 years presenting with a pneumonia diagnosis in the emergency department (ED).

After four collaborative meetings, the teams developed site-specific interventions that were implemented at 3-month intervals, including deployment of an evidence-based treatment guideline, educational sessions, and order-set modification. To evaluate the interventions, the teams collected monthly prescribing data for 1 year, compared those data with baseline data from the previous year, and added an additional year to assess the sustainability of the intervention.

The analysis included 1,641 patients—531 in the baseline period, 703 during the intervention phase, and 407 in the sustainment phase. The aggregated rate of narrow-spectrum antibiotic prescriptions for pediatric pneumonia rose from 60% during the baseline period to 78% during the intervention period, then rose to 92% during the sustainment phase. During the intervention period, narrow-spectrum antibiotic prescribing rates improved from 72% to 85% for pediatric physicians and from 53% to 70% for general emergency medicine providers, then climbed 93% and 91%, respectively, during the sustainment phase. No change in the 72-hour emergency department return rate was observed.

Our findings ... reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics.

The authors say improving use of narrow-spectrum antibiotics for pediatric pneumonia is particularly important in community hospitals, because they see 90% of pediatric emergency patients, and pneumonia is one of the most common diagnoses in pediatric emergency medicine.

"Our findings, in the setting of 5 pediatric EDs within community hospitals, reinforce the ability of QI interventions to be a sustainable tool to increase prescribing of narrow-spectrum antibiotics," they wrote.

Ground beef suspected in Salmonella outbreak probe

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Raw burgers on grill
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The Illinois Department of Public Health (IDPH), local departments, and federal health officials are investigating a Salmonella outbreak linked to ground beef, which has so far sickened 26 people in Illinois, with a few cases in other states.

In a statement, the IDPH said the source of the ground beef hasn't been identified, but lab testing and other investigations are still under way. The US Department of Agriculture (USDA) list of outbreak investigations notes an active investigation into a Salmonella Typhimurium outbreak with ground beef as the suspected source.

The IDPH said illnesses have been reported from Chicago and six of the state's counties. Illness onsets range from Apr 25 to May 18. Some of the sick people said they ate undercooked ground beef.

The IDPH reminded people that Salmonella can be found in a variety of foods, including beef, chicken, and pork. It urged consumers to follow four key food safety steps, including cooking ground beef to an internal temperature of at least 160°F.

CDC ends flour Salmonella investigation

In other foodborne illness developments, the Centers for Disease Control and Prevention (CDC) yesterday said a Salmonella Infantis outbreak linked to certain types of Gold Medal flour is over.

In its final report, the CDC reported 1 more cases, raising the total to 14 infections from 13 states. Three people were hospitalized, but no deaths were reported. The CDC said the true number of sick people is likely much higher, because many recover without medical care and aren't tested. The latest illness onset was May 2.

CDC advises you to throw away or return any bags of recalled flour.

Of eight people who were interviewed, seven said they eight raw dough or batter. Of six people who had flour brand information, all reported using Gold Medal flour. Investigators traced the source to a single production plant in Kansas City, Missouri, and the outbreak strain was identified in one of the samples from the facility.

The CDC said, "Although this outbreak investigation has ended, CDC advises you to throw away or return any bags of recalled flour and to wash any containers used to store recalled flour with warm water and soap."

Having a heart attack in early COVID-19 lockdown tied to lower life expectancy

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Man having heart attack

New research from Spain and the United Kingdom shows patients who suffered heart attacks during the initial COVID-19 lockdowns can expect to live up to 2 years less than those who had heart attacks before the pandemic, likely because they were limited in accessing life-saving treatments quickly.

The findings are presented in the European Heart Journal - Quality of Care and Clinical Outcomes.

To assess the impact on healthcare costs and life expectancy, the authors created a model to compare outcomes from STEMIs (ST-elevation myocardial infractions) seen in patients during the first month of COVID-19 lockdowns with those who had a heart attack at the same time in the previous year.

They estimated that 77% of prepandemic STEMI patients in the United Kingdom were hospitalized during the prior month, compared with 44% during lockdown. The equivalent rates for Spain were 74% and 57%. Patients likely avoided going to a hospital during a STEMI because of fear of contracting a COVID-19 infection and because of limited health services.

Estimated 1.5 to 2 years of life lost

In total, UK STEMI patients were predicted to lose an average of 1.55 life-years and 1.17 QALYs (quality-adjusted life-years). In Spain the model predicted STEMI patients during the lockdown would survive 2.03 years less than pre-pandemic patients. Moreover, the delays in care were predicted to cost both countries more money in health services.

"The findings illustrate the repercussions of delayed or missed care," said lead study author William Wijns, PhD, of the University of Galway, Ireland, in a press release from the European Society of Cardiology, which publishes the journal. "Patients and societies will pay the price of reduced heart attack treatment during just one month of lockdown for years to come.

Health services need a list of lifesaving therapies that should always be delivered.

"Health services need a list of lifesaving therapies that should always be delivered, and resilient healthcare systems must be established that can switch to emergency plans without delay."

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