Stewardship / Resistance Scan for Aug 03, 2021

News brief

Study examines ways to cut antibiotics in terminal cancer patients

A single-center study of terminal cancer patients found a high rate of antibiotic use within the last 30 days of life, with significantly lower use among those who asked for limited antimicrobial treatment, researchers reported yesterday in Open Forum Infectious Diseases.

Despite uncertain benefits and the risk of adverse events and antimicrobial resistance, antimicrobial use in patients with terminal cancer is frequently continued after transition to comfort care and discontinued less than 1 day prior to death. To determine whether completing a Physician Orders for Life Sustaining Treatment (POLST) form and an accompanying antimicrobial preferences document had any relationship with antimicrobial use at the end of life, researchers from the University of Washington and the Fred Hutchinson Cancer Research Center conducted a retrospective study of patients who died at the Seattle Cancer Care Alliance from Jan 1, 2016, through Jun 30, 2019.

Among the 1,295 patients identified for the study, 1,070 (83%) received one or more inpatient antibiotic within the last 30 days of life. The median total and intravenous (IV) antibiotic use was 1,077 and 677 days of therapy per 1,000 inpatient days, respectively. A total of 318 (24.6%) patients had a completed POLST form on file, and 120 (37.7%) of those were completed at least 30 days before death; 35/120 (29.2%) specified limited antimicrobial use, 55/120 (45.8%) specified full antimicrobial use, and 30/120 (25.8%) omitted antimicrobial preference.

Compared with those without a POLST, patients specifying limited antibiotic use at least 30 days before death had significantly lower total antimicrobial days of therapy (DOT; adjusted incidence rate ratio [IRR], 0.68; 95% confidence interval [CI], 0.49 to 0.95) and IV antibiotic DOT (IRR, 0.57; 95% CI, 0.38 to 0.86).

The study authors note that Washington is only 1 of 18 states that includes a separate section on antibiotics in their POLST forms.

"This supports our hypothesis that completion of the antimicrobial preferences section of the POLST form at an intermediate interval prior to death is associated with subsequent antimicrobial exposure in the 30 days prior to death," they wrote. They said states should include antimicrobial prescribing data on their POLST forms.
Aug 2 Open Forum Infect Dis abstract

Stewardship steps tied to less antibiotic use in COVID-19 patients

A retrospective study of patients in Kentucky suggests antibiotic stewardship interventions may safely cut antibiotic use in COVID-19 patients, researchers reported yesterday in Infection Control and Hospital Epidemiology.

Among 173 patients who received antibiotics for COVID-19 from June through July 2020 at a community healthcare system in Louisville, 91 (52.6%) met criteria for early discontinuation of antibiotics, and 82 patients (47.7%) were in the late-discontinuation group. The decision to discontinue antibiotics in COVID-19 patients without bacterial co-infection was made by trained clinical pharmacists who were part of the hospital's antimicrobial stewardship (AMS) team. Among the outcomes evaluated by the study were the percentage of AMS recommendations accepted, length of antibiotic therapy, length of hospital stay, and mortality.

In early-antibiotic-discontinuation patients, 41.8% had an AMS intervention, with an 86.8% acceptance rate, while 29.3% of patients in the late-antibiotic-discontinuation group had an AMS intervention, with a 54.2% acceptance rate. The median antibiotic length of therapy was 3 days in the early-discontinuation group and 7 days in the late-discontinuation group.

The overall in-hospital mortality rate was 17.3%; inpatient mortality occurred in 14.3% of the early-discontinuation group and 20.7% in the late-discontinuation group. Median length of stay was similar in the two groups, at 7 and 9 days, respectively.

The study authors say the findings may add to prescriber confidence when discontinuing antibiotics in COVID-19 patients, and demonstrate that stewardship interventions may lead to shorter lengths of antibiotic therapy.

"AMS recommendations could be a key factor in promoting appropriate antibiotic use in COVID-19 patients," they wrote.
Aug 2 Infect Control Hosp Epidemiol abstract

News Scan for Aug 03, 2021

News brief

Rising incidence of myopia in kids tied to indoor time during pandemic

A new study based on data from Hong Kong shows a rising incidence of myopia, or short-sightedness, in children during the COVID-19 pandemic, possibly linked to increasing time spent indoors and on screens. The study was published in the British Journal of Ophthalmology.

The research was part of the ongoing Hong Kong Children Eye Study (HKCES). A total of 709 children ages 6 to 8 were recruited in December of 2019 and January of 2020 and monitored for 8 months. Their vision was tested against children previously enrolled in the study.

The authors found the 1-year incidence of short-sightedness was 28%, 27%, and 26%, for 6-, 7-, and 8-year-olds in the COVID-19 group, compared with 17%, 16%, and 15%, respectively, in the pre-COVID-19 group.

During the study period, participants reported a dramatic jump in screen use: from 2.5 hours per day pre-pandemic to 7 hours per day in 2020. They also reported spending less time outdoors, going from an average of 75 minutes to 24 minutes.

"Our study is one of the first to report myopia progression during this pandemic, showing a myopia incidence of 19.44% over 8-months' follow-up in COVID-19." the authors concluded. "Our results serve as a warning to eye care professionals, policy makers, educators, and parents on the effect of restricted outdoor activities and intensive near work during this quarantine period on myopia progression in school children."
Aug 2 Br J Opthamol study

Ontario's stillbirth and preterm births not affected in pandemic, study says

Ontario hospitals did not see any significant changes in preterm or stillbirth rates after the COVID-19 pandemic began in 2020, according to a study today in CMAJ.

The researchers looked at 2,465,397 pregnancies in Ontario hospitals, including 13,781 stillbirths, from July 2002 to December 2020. During the pandemic era, defined as January to December 2020, both preterm birth rates and stillbirth rates did not see any "special cause variations," or significant and unusual variations, data showed.

The average pandemic preterm birth rate (22 to 36 gestation weeks) was 7.87%, compared with the overall rate of 7.96%. The average stillbirth rate during COVID-19 was 0.53%, compared with 0.56% across the entire period. No special cause variation was found during the pandemic between stillbirth and preterm birth rates between rural and urban regions or neighborhood income quintiles. The researchers note, however, that the absolute number of average Ontario hospital births decreased during the pandemic, from 66,425 to 63,370.

While previous studies have shown inconsistencies on whether the pandemic has affected stillbirth and preterm birth rates, the researchers say their study's strength is in its longer-term, large population cohort.

"Within a jurisdiction, these rates are known to fluctuate between epochs and, thus, it is preferable to evaluate rates over longer periods to establish whether observed variations are usual (common cause variation) or unusual (special cause variation)," the researchers write. "We found no changes in slope or gap between prepandemic and pandemic periods using interrupted time-series analyses."
Aug 3 CMAJ study

Togo reports more H5N1 avian flu in poultry

Togo reported another highly pathogenic H5N1 avian flu outbreak in poultry, its second since June, according to a notification yesterday from the World Organization for Animal Health (OIE).

The latest event began Jul 27 at a layer farm in Maritime region in the south. The virus killed 129 of 1,590 susceptible birds, and the surviving ones were culled as part of response efforts.

Investigators found that bags used to transport litter had previously been used several times and on other farms, suggesting a lapse in farm biosecurity practices. The affected farm isn't far from the border with Ghana, but officials say the event in Togo doesn't appear to be epidemiologically linked to recent outbreaks in Ghana.

Earlier this summer, Togo reported outbreaks at two layer farms in the same region, the first since 2019. A few other African nations have also reported H5N1 outbreaks over the past few months, including South Africa, Mali, and Niger.
Aug 2 OIE report on H5N1 in Togo