Stewardship / Resistance Scan for Jul 14, 2022

News brief

Prior antibiotic use, longer hospital stays increase risk of CRE infections

A study of patients at a large tertiary-care medical center found that antibiotic exposure and length of stay were associated with an increased risk of developing a carbapenem-resistant Enterobacterales (CRE) infection, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

To identify risk factors for CRE infection, Ohio State researchers conducted a retrospective case-case-control study, comparing patients who had been diagnosed as having a CRE infection at the hospital from 2011 through 2016 with patients diagnosed as having carbapenem-susceptible Enterobacterales (CSE) infections and a random selection of control patients. Data collected from patient medical records included age at admission, sex, length of hospital stay, and prescription for antibiotics in the 90 days prior to admission.

A total of 81 unique CRE patients were identified during the study period, and they were compared with 87 CSE patients and 89 control patients. In the unadjusted analysis, CRE patients were more than 18 times more likely to have been prescribed any antibiotic in the previous 90 days than CSE patients (odds ratio [OR], 18.35; 95% confidence interval [CI], 5.37 to 62.8) and 51 times more likely than control patients (OR, 51.1; 95% CI, 14.9 to 176.0).

In multivariable models, prescription of a beta-lactam antibiotic was associated with a fivefold increase in odds for CRE infection (OR, 5.43; 95% CI, 1.95 to 15.1) and a more than twofold increase in odds for CSE infection (OR, 2.65; 95% CI, 1.18 to 5.95). Each additional day of hospital admission was associated with an increased odds of infection of about 13% for CRE patients (OR, 1.14; 95% CI, 1.08 to 1.19) and CSE patients (OR, 1.13; 95% CI, 1.08 to 1.18).

"Future studies of this type may consider conducting more thorough reviews of medical records to determine specific residence type prior to admission and whether patients are coming from common locations that have seen patients previously diagnosed with either CRE or CSE," the study authors wrote. "Long-term and other group care facilities may have increased incidence of infection in general and of resistant organisms specifically and determining where patients are being admitted from can be important factors in determining how to care for these patients upon admission to a medical facility."
Jul 14 Antimicrob Stewardship Healthc Epidemiol study

Stewardship interventions linked to reduce antibiotics in urgent care

A multifaceted quality-improvement program implemented at urgent care clinics in an integrated academic health system was associated with reductions in inappropriate and overall antibiotic prescribing, without negatively affecting patient satisfaction, researchers reported yesterday in Infection Control & Hospital Epidemiology.

The program implemented in 2019 at Northwestern Medicine was developed by an ambulatory antibiotic stewardship committee and focused on improving antibiotic prescribing for "stewardship target visits," which included non–antibiotic-appropriate conditions like upper respiratory tract infections. The program also targeted "diagnosis shifting visits," in which clinicians add antibiotic-appropriate diagnoses to evade stewardship measures, overall antibiotic prescribing, and patient satisfaction for acute respiratory infections (ARI) visits. Interventions included comparative feedback and clinician and patient education.

From 2019 through 2021, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied.

The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in 2019 to 12% in 2021 (absolute change, −22 percentage points; 95% CI, −23 to −22), for diagnosis-shifting visits from 63% to 35% (−28 percentage points; 95% CI, −28 to −27). The overall antibiotic prescribing rate declined from 30% to 10% (−20 percentage points; 95% CI, −20 to −20). The patient satisfaction rate increased from 83% in 2019 to 89% in 2020 and 2021. There was no significant association between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.

"In conclusion, it is possible to decrease antibiotic prescribing for presumed viral illnesses in the urgent-care setting and maintain patient satisfaction," the study authors wrote. "Key elements of success may have included an ambulatory antimicrobial stewardship committee, physician champions, having data for analysis and reporting, and educational resources for patients and prescribers."

They added that reducing antibiotic prescribing for non–antibiotic-appropriate diagnoses has the potential to start a "virtuous cycle" for patients, as non-receipt of antibiotics may be associated with less antibiotic seeking in the future.
Jul 13 Infect Control Hosp Epidemiol abstract

News Scan for Jul 14, 2022

News brief

Study: Long COVID has significant impact on UK workforce

A new study published in Applied Economics Letter estimates long COVID symptoms have forced 80,000 UK residents out of employment as of March of this year.

The estimate is based on data that show 5.5% of people infected with COVID-19 will develop chronic illness symptoms that limit their activity, including shortness of breath, brain fog, and headaches.

"Continued waves of coronavirus infections, which may go on for a number of years, will keep people off work while sick with Long Covid. Many will lose their jobs and some will remain out of the workforce for a long time or permanently," said Donald Houston, PhD, of the University of Portsmouth and a co-author of the study, in a university press release.

Houston and coauthor Darja Reuschke, PhD, of the University of Southampton, said that, for the first time in recent history, there are more job opportunities in Britain than unemployed people, a phenomenon that followed the high infection rates seen during the Omicron wave this past winter. At the peak of Omicron in February of 2022, they said 2.9 million people of working-age (7% of that population) had experienced persistent COVID-19 symptoms for more than 12 weeks.

Since the start of the pandemic, roughly 69% of the British population has tested positive for COVID-19 at least once. The authors estimate that, of those aged 17 to 69 who are double-vaccinated, 9.5% will go on to develop long COVID lasting more than 12 weeks after testing positive for COVID-19, and 5.5% will develop activity-limiting long COVID. The rates are higher for unvaccinated people.

"Given current national labour shortages in the UK, and the devastating financial, personal and family consequences for some individuals suffering from Long COVID, we urge the Government to extend employment protection and financial support offered to those suffering from Long COVID and their employers," the authors conclude.
Jul 6 Appl Econ Lett study
Jul 13 University of Portsmouth press release

Salmonella tied to backyard poultry now at 572 cases in 48 states

In an update on multistate Salmonella outbreaks tied to backyard poultry, the Centers for Disease Control and Prevention (CDC) yesterday reported 353 more cases, including 1 more death, and 10 more affected states. The developments push the overall total to 572 cases, 2 of them fatal, from 48 states.

In its original announcement on Jun 9, the CDC said four strains were involved in the outbreaks: Enteritidis, Hadar, Infantis, and Typhimurium. In yesterday's update, it identified a fifth strain, Mbandaka.

The latest illness onset is Jun 22, and of cases with known information, 92 were hospitalized. The two deaths were reported from Tennessee and Wyoming.

Patient ages range from younger than 1 to 102, and 23% are children under 5. Interviews with sick patients found links to contact with backyard poultry, eating eggs from backyard poultry, or consuming meat from backyard poultry.

People bought poultry from 130 different retail locations across 36 states. Health officials from North Dakota, Tennessee, and Wisconsin identified outbreak strains in samples from poultry and poultry environments in stores and at people's homes.

Whole-genome sequencing of 583 samples from sick people, animals, and the environment to identify risk of antibiotic resistance found that 35% were resistant to 13 key antibiotics. Though most people with Salmonella infections recover without antibiotics, the CDC said some illnesses would be difficult to treat with recommended drugs and would require a different antibiotic choice.
Jul 13 CDC Salmonella outbreak update
Jun 10 CIDRAP News scan

Tanzanian officials probe unknown hemorrhagic fever cluster

Health officials in Tanzania are investigating a cluster of hemorrhagic fever cases from an unknown cause, according to a health ministry statement posted yesterday and translated by Avian Flu Diary, an infectious disease news blog.

The outbreak is centered in Mbekenyera area of Lindi region in the country's southeast. The illnesses were first identified when two patients sought care for fever, nose bleeds, headache, and fatigue at the health center over 3 days during the first week of July. So far, 13 similar illnesses have been reported, 3 of them fatal.

The health ministry is conducting clinical and epidemiological investigations as officials await test results.

The authors of a recent study on viral hemorrhagic fevers and malaria coinfections in Tanzania said Rift Valley fever and Crimean Congo hemorrhagic fever outbreaks have been reported in Tanzania. No clinical cases of Ebola, Marburg, or yellow fever have been reported, but its geographic location poses a high risk. They also noted that Tanzania is among the 10 countries with the highest malaria burden.

FluTrackers, an infectious disease message board, flagged media reports that said testing so far has ruled out Ebola and Marburg viruses.
Jul 13 Tanzania health ministry statement
Jul 14 Avian Flu Diary post
FluTrackers thread
Apr 25 BMC Infect Dis Pov study