Study reveals COVID-19 death rate 3 times higher than for flu in adults

Adults hospitalized early in the pandemic with COVID-19 were at more than triple the risk of death than those with influenza, despite the flu patients being older and having more chronic illnesses, according to new data from Spain to be presented at this year's European Congress of Clinical Microbiology & Infectious Diseases (ECCMID), which starts tomorrow.

The researchers also found that COVID-19 is associated with longer hospital and intensive care unit (ICU) stays, and its treatment costs nearly twice as much as flu treatment.

The team examined medical records of 187 flu patients (average age 76 years, 55% male) hospitalized from 2017 to 2019, and compared their data with 187 COVID-19 patients (average age 67 years, 49% male) hospitalized from March to May 2020. All the COVID patients required oxygen therapy at admission.

The 30-day COVID-19 mortality rate was 15% compared with 5% for flu. The 90-day mortality rate was 19% in the COVID-19 group and 6% in flu patients. After the investigators adjusted for confounders, they found COVID-19 to raise the risk of 30-day mortality more than four times (hazard ratio [HR] 4.04; 95% confidence interval [CI], 1.86 to 8.77) and 90-day mortality more than three times (HR 3.68; 95% CI, 1.75 to 7.74) compared with flu.

Median hospital stay was 17 versus 11 days, and median ICU stay was 15 versus 10 days, with costs for critical care almost twice as high for COVID-19 patients (€21,350 vs €12,082, or $27,400 vs $15,506).

Flu patients tended to have more existing chronic illnesses and problems performing activities of daily living than COVID-19 patients, but they were less likely to be overweight or obese.

"Our findings suggest COVID-19 is far more lethal than influenza," said lead author Inmaculada Lopez Montesinos, MD. from the Hospital del Mar in Barcelona, in an ECCMID news release. "Even for those people who are lucky enough to survive COVID-19 and make it out of the hospital, they will be forever scarred by the consequences. It is vital that people get fully vaccinated and boosted against both viruses."
Apr 21 ECCMID press release
Apr 21 ECCMID study abstract

Six states report more highly pathogenic avian flu outbreaks

Six states reported more highly pathogenic avian flu outbreaks in poultry flocks, including Iowa, which reported its first after a 2-week lull.

Iowa's outbreak involved a commercial turkey farm in Bremer County in the north central region, the Iowa Department of Agriculture and Land Stewardship (IDALS) said yesterday. The state has now reported 17 outbreaks, mostly involving layer and turkey farms.

Elsewhere in the Midwest, Minnesota reported four more outbreaks—all involving turkey farms—raising its total to 50. In its update, the Minnesota Board of Animal Health (MBAH) said the outbreaks have now led to the loss of nearly 2.3 million birds.

Outbreaks in four other states are reflected in updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS). They include three outbreaks in backyard birds in Colorado (La Plata County), Idaho (Madison County), and Montana (Glacier County), as well as two more outbreaks on layer farms in Pennsylvania's Lancaster County, which affected more than 2 million birds.

The outbreaks are related to the spread of the Eurasian H5N1 strain, which has now led to the loss of nearly 31 million poultry across 29 states, according to APHIS.
Apr 21 IDALS statement
MBAH avian flu outbreak page
USDA APHIS poultry avian flu outbreak page

Flu rise continues, with bigger impact in certain regions

Flu activity in the United States, as measured by outpatient visits for flulike illness, continues a steady rise that began in the middle of February, with activity highest in the northeast, south central, and mountain regions of the country, the US Centers for Disease Control and Prevention (CDC) said in its latest update today.

The CDC included the caveats that other respiratory viruses are circulating at various levels in different regions, and though some ares are above their baselines for outpatient visits, as a whole the nation's level is at 2.1%—below the baseline of 2.5%. Of respiratory samples that tested positive for flu at public health labs, 99.8% were influenza A, and of the subtyped influenza A viruses, all were the H3N2 strain.

Hospital admissions have been rising for 11 weeks in a row, but the impact is still less than the most recent pre-COVID-pandemic flu seasons.

Three more pediatric flu deaths were reported, bringing the season's total to 22. One was from an unsubtyped influenza A virus in January, and two were linked to H3N2 and occurred in February and March.
Apr 22 CDC FluView update

Pakistan reports first wild poliovirus case in over a year

Pakistan reported its first wild poliovirus type 1 (WPV) case in more than a year, a disappointing development amid a steep downturn in WPV 1 cases over the past few years.

In other developments, three countries—the Democratic Republic of the Congo (DRC), Nigeria, and Yemen—reported more circulating vaccine-derived poliovirus type 2 (cVDPV2), the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

Pakistani health officials said the WPV1 case involved a 15-month-old boy from North Waziristan whose paralysis began on Apr 9, according to the Express Tribune, an English-language newspaper based in Pakistan. The illness was confirmed as WPV1 on Apr 22 by the country's polio lab, which also confirmed a closely related virus in an environmental sample from the same region. Pakistan reported its last WPV1 case in January 2021.

The case marks the third WPV1 case of the year, following detections in Afghanistan and Malawi.

In vaccine-derived poliovirus developments, the DRC reported 6 more cases, five in Maniema province and one in North Kivu province, lifting its total for the year to 22. Nigeria reported 1 more case, which affected a patient from Katsina, bringing its 2022 total to 16.

In the Middle East, Yemen reported 34 new cases, some of which are counted in its 2021 total. So far, its 2022 total is 5 cases, with 61 registered in 2021. The latest cases are from 11 different governorates.
Apr 22 Express Tribune story
Apr 21 GPEI update

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Study finds MRSA, other resistant pathogens in Finnish hedgehogs

Testing conducted on hedgehogs in Helsinki, Finland, revealed the presence of antibiotic-resistant pathogens and genes known to cause human infections, according to a paper to be presented at the upcoming European Congress of Clinical Microbiology & Infectious Diseases (ECCMID).

In the study, researchers from the University of Helsinki tested samples from 115 dead hedgehogs collected from a wild animal hospital in Helsinki for the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase–producing Enterobacterales (ESBL-E). Previous studies have found European hedgehogs to be carriers of these pathogens, including a study published earlier this year that indicated hedgehogs may be a reservoir for livestock-associated MRSA strains.

MRSA was isolated from 10% (11 of 115) and ESBL-E from 9% (10/115) of the hedgehog samples, with four hedgehogs carrying a strain (mecA-MRSA) that causes most clinical infections in Finland and a clone (t304/ST6) that has been emerging in humans in northern Europe. Three hedgehogs carried mecC-MRSA, a livestock-associated MRSA strain that's been found in hedgehogs in Sweden and Denmark.

"This is the first report of the successful t304/ST6 clone (with the capability of global spread) in urban hedgehogs and underscores the need for additional monitoring of possible t304/ST6 sources and its spread in urban environments," study author Venla Johansson, PhD, said in an ECCMID press release. "However, the clinical importance of the zoonotic potential, or whether mecA-MRSA in hedgehogs are of clinical concern to the animals themselves, is not known."

The ESBL-E isolates were found to carry two of the most common ESBL genes (blaCTX-M-1 and blaCTX-M-15) encountered in human and animal isolates. The researchers also found two human-associated sequence types (ST68 and ST69) in ESBL-producing Escherichia coli isolates.

Johansson and her colleagues say the findings could indicate a spillover of antimicrobial resistance (AMR) from anthropogenic sources to hedgehogs and other species of urban wildlife, which could become a secondary reservoir for clinically relevant pathogens. They sug gest hedgehogs should be monitored in different environments and a wider geographic context to determine whether they could act as an AMR sentinel.
Apr 21 ECCMID abstract
Apr 21 ECCMID press release

High prevalence of resistant Pseudomonas in European ICUs

Analysis of Pseudomonas aeruginosa isolates from intensive care units (ICUs) in 11 European countries found a high prevalence of antibiotic resistance, with wide inter-country variability driven by high-risk clones, researchers reported today in the Journal of Antimicrobial Chemotherapy.

A total of 723 isolates from respiratory samples or perianal swabs of 402 patients in 29 European hospitals were studied as part of ASPIRE-ICU, a prospective cohort study that aimed to determine the susceptibility profiles and resistome of P aeruginosa isolates. Researchers assessed resistance against a panel of 12 antipseudomonal agents, used phenotypic and genetic assays to determine the presence of resistance genes, and conducted whole-genome sequencing on the first respiratory isolates from 105 patients.

All agents except colistin and amikacin showed resistance rates above 20%, including the novel antipseudomonal combination drugs ceftolozane/tazobactam and ceftazidime/avibactam. Up to 32.9% of the isolates were multidrug-resistant (MDR), 24.9% were extensively drug-resistant (XDR), 13.2% were classified as difficult-to-treat resistance (DTR), and 0.9% were pan-drug resistant (PDR); 21.4% produced ESBLs or carbapenemases.

The prevalence of the XDR phenotype was highest in hospitals in Serbia (62.5%), followed by those in Hungary (35.3%), Bulgaria (27.5%), and the Czech Republic (15.8%). No XDR isolates were found in isolates from the United Kingdom, Germany, Turkey, or Estonia.

WGS showed that the high-risk P aeruginosa clone ST235 was strongly associated with MDR/XDR/PDR profiles and was frequently detected in Serbian facilities. WGS also revealed a wide repertoire of mutation-driven resistance mechanisms, with multiple lineage-specific mutations.

The analysis also found evidence of a clear tendency towards increased resistance during the course of colonization and infection.

The study authors say the findings highlight the need to reinforce infection-control measures.
Apr 22 J Antimicrob Chemother abstract

Antibiotic prescribing fell 23% to 38% in Australia during COVID-19

Originally published by CIDRAP News Apr 21

Data being presented at this month's ECCMID meeting and published in Clinical Infectious Diseases reveal that antibiotics prescribed in Australia fell 23% to 38% during COVID-19.

Australian researchers analyzed a representative sample of 10% of outpatient antibiotic prescriptions issued from January 2014 to April 2021. They found that, before 2020, antibiotic prescribing was 29% higher on average during the winter months of June, July, and August than during the summer months of December, January, and February.

That seasonal variation, however, disappeared during the pandemic. In winter 2020, practitioners prescribed 38% fewer antibiotics than in the winters of 2018 and 2019 (1,432,000 prescriptions per month vs 2,313,000). Summer 2021 showed a 23% reduction in prescriptions compared with the summers of 2018 and 2019 (1,374,000 per month vs 1,817,000).

Reductions were predominantly in antibiotics used to treat community-acquired respiratory infections such as pneumonia and bronchitis. For example, amoxicillin prescriptions fell 52% in the winter and 23% in summer. In a similar vein, prescriptions for amoxicillin-clavulanate followed a similar pattern: down 51% in the winter and 37% in the summer.

Decreases in antibiotic prescriptions were observed across all age-groups, with the greatest change in children, who saw a 52% decrease in winter and a 24% drop in summer. Further assessment revealed that 84% of winter and 97% of summer declines were driven by reductions in prescribing among general practitioners.

First author Jack Skeggs, MBBS, said in an ECCMID press release, "Existing community antimicrobial stewardship programmes, community education related to personal hygiene and handwashing, culture shifts in mask wearing and social distancing, and, possibly, reduced prescribing for viral syndromes may all play a role.

"However, the finding that significant reductions existed in states without high [COVID-19] case numbers or lockdowns is promising and suggests that we may be able to maintain at least some of these decreases after the pandemic by encouraging these same culture shifts."
Apr 20 ECCMID press release
Apr 11 Clin Infect Dis study

Five groups issue guidance for preventing catheter-related infections

Originally published by CIDRAP News Apr 20

Updated practical guidance from five large US healthcare organizations published yesterday in Infection Control and Hospital Epidemiology highlights practices for preventing central line–associated bloodstream infections (CLABSIs) in hospitals that include detailed infection-control steps in inserting catheters and a caution against the routine use of preventive antibiotics.

The recommendations come from efforts of more than 100 global experts. The guidance was produced by Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission.

The previous version was published in 2014.

"Data show that despite the heroic and unceasing efforts of infection prevention teams and frontline workers during the past two years, the rates of CLABSIs and several other healthcare-associated infections have substantially worsened during the COVID-19 pandemic, reversing years of progressive improvement," said Deborah Yokoe, MD, MPH, chair of SHEA's efforts to prevent healthcare-associated infections in acute-care hospitals, in a SHEA news release. "These infections seriously threaten patients' lives and recovery, and the rising rates are further evidence for the need to build more resilient systems of care."

Some highlights of the guidance include advice that the subclavian vein is now preferred for central venous catheter insertion in intensive care unit patients, and chlorhexidine-containing dressings are now considered an "essential practice" in patients older than 2 months. The experts recommend against using antimicrobial prophylaxis for short-term or tunneled catheter insertion or while catheters are in situ.
Apr 19 Infect Control Hosp Epidemiol guidance
Apr 19 SHEA news release