Stewardship / Resistance Scan for Jun 13, 2022

News brief

Study ties rotavirus vaccination to fewer antibiotics for gastroenteritis

A study of data from insured US children found that rotavirus vaccination was associated with reduced antibiotic prescribing for acute gastroenteritis, researchers reported last week in Open Forum Infectious Diseases.

Using data from a large commercial database of people with employer-sponsored health insurance coverage, researchers from Oregon Health and Science University and Emory University School of Medicine constructed a cohort of children born from 2007 through 2018 and followed those children for 5 years. They then estimated the cumulative incidence of antibiotic prescriptions associated with acute gastroenteritis—which is frequently treated with antibiotics even when caused by rotavirus or other viruses—among children who had completed a full rotavirus vaccination series by 8 months and those who had not received any dose of rotavirus vaccine. The investigators adjusted for receipt of pneumococcal vaccine, provider type, and rural/urban status.

Of the 2,136,136 children in the data set, 69.9% completed the rotavirus vaccination series by 8 months, and 15.7% had no rotavirus vaccination. Overall, 17,318 children (1.7%) received an antibiotic following an acute gastroenteritis diagnosis.

At 5 years of age, the adjusted relative cumulative incidence of antibiotic prescription following an acute gastroenteritis diagnosis was 0.793 (95% confidence interval [CI], 0.761 to 0.827) among children with complete rotavirus vaccination compared with children without rotavirus vaccination—or 21% lower. Additionally, the adjusted relative cumulative incidence of receiving a second, unique antibiotic prescription within 28 days was 0.820 (95% CI, 0.750 to 0.905), or 18% lower.

Using annual US trends in rotavirus vaccination, the researchers estimated that rotavirus vaccination has averted 67,045 antibiotic prescriptions nationally among children born from 2007 through 2018.

"These results demonstrate an additional important, non-targeted benefit of rotavirus vaccination and bolster evidence for the use of rotavirus vaccines for reducing antibiotic prescribing for acute gastroenteritis," the study authors wrote. "The reduction of antibiotic prescribing likely contributes to the broader effort of reducing antimicrobial resistance. Thus, increasing rotavirus vaccination coverage should be encouraged both for its intended and non-targeted effects."
Jun 9 Open Forum Infect Dis abstract


Encouraging results found for MDR-TB treatment in pregnant women

A systematic review and analysis of studies on pregnant women with multidrug-resistant tuberculosis (MDR-TB) found some encouraging results, researchers reported late last week in JAMA Network Open.

A total of 10 studies containing 275 pregnant patients with available data were reviewed by a team of researchers from Australia, Ethiopia, and the United States to quantify treatment and pregnancy outcomes among pregnant women with MDR-TB, who currently have limited treatment options because of the potential harmful effects that second-line TB drugs can have on embryonic and fetal development. Their meta-analysis found that the pooled estimate was 72.5% (95% CI, 63.3% to 81.0%) for treatment success, 6.8% (95% CI, 2.6% to 14.2%) for death, 18.4% (95% CI, 13.1% to 24.2%) for loss to follow-up, and 0.6% (95% CI, 0.0% to 2.9%) for treatment failure.

Treatment success was significantly higher in studies in which the proportion of patients taking linezolid was greater than the median (20.1%) compared with studies in which this proportion was lower than the median (odds ratio, 1.22; 95% CI, 1.05 to 1.42). More than half of patients (54.7%; 95% CI, 43.5% to 65.4%) experienced at least one adverse event, most commonly liver function impairment, kidney function impairment, and hearing loss.

The pooled proportion of favorable pregnancy outcomes was 73.2% (95% CI, 49.4% to 92.1%). The most common types of adverse pregnancy outcomes were preterm birth (9.5%; 95% CI, 0.0% to 29.0%), pregnancy loss (6.0%; 95% CI, 1.3% to 12.9%), low birth weight (3.9%; 95% CI, 0.0% to 18.7%), and stillbirth (1.9%; 95% CI, 0.1% to 5.1%).

The study authors note that the treatment success rate of 72.5% is close to the World Health Organization's target of 75%, and higher than that found among non-pregnant adults with MDR-TB in previous studies (60% to 69%). They suggest that increasing use of recently recommended novel drugs like linezolid, bedaquiline, and pretomanid among pregnant women with MDR-TB could further improve the treatment success rate.

"Given the limited drug options available to treat individuals with MDR-TB, especially pregnant patients, the high proportion of patients with treatment success in our study compared with previously reported findings in the general adult population is encouraging," they wrote.
Jun 10 JAMA Netw Open study


Antibiotic use fell in South Korea after national action plan

An analysis of health insurance claims data in South Korea found a decline in overall antibiotic use after implementation of a national action plan (NAP) on antimicrobial resistance (AMR), researchers reported yesterday in the International Journal of Infectious Diseases.

For the retrospective, population-based study, researchers looked at data from the Korean National Health Insurance claims database from 2011 to 2020. South Korea established its first NAP on AMR in 2016, and it included guidelines for antibiotic use for several types of infection and stronger monitoring of antibiotic use. Total antibiotic consumption over the study period, both inpatient and outpatient, was measured using defined daily doses per 1,000 inhabitants per day (DID), and data were analyzed for each year, dimension, and category of the WHO's AWaRe (Access, Watch, and Reserve) antibiotic classification system.

Overall, the consumption of antibiotics increased from 25.78 DID in 2011 to 28.02 DID in 2016, then decreased in 2017 following the implementation of the NAP on AMR and fell to 26.35 DID in 2019.

Consumption of Access antibiotics increased from 12.51 DID in 2011 to 13.83 in 2016, followed by a decrease in 2017. In the Watch group, antibiotic use continuously increased over the study period, from 13.24 DID in 2011 to 15.69 DID in 2019, while the Reserve group showed a small downward trend beginning in 2017. Analysis of the most frequently used antibiotics found that, after implementation of the NAP, use of amoxicillin and beta-lactamase inhibitors fell from 7.18 DID in 2016 to 4.84 DID in 2017 , use of ciprofloxacin fell from 0.81 DID to 0.7 DID, and consumption of levofloxacin declined from 0.81 DID to 0.65 DID.

An interrupted time series analysis showed that the level and the slope of the trend of total antibiotic use decreased by 0.17 and 0.001, respectively.

The study authors say the findings are in line with similar studies in Japan and Italy, and suggest the NAP could further cut antibiotic use in South Korea by improving the understanding and awareness of AMR, strengthening AMR surveillance and research, and optimizing the use of antimicrobials.
Jun 12 Int J Infect Dis study

News Scan for Jun 13, 2022

News brief

Childcare-related work disruptions increased by a third during COVID-19

Work disruptions related to a lack of childcare in 2020 increased by one-third relative to before the pandemic—especially for caregivers of children with special healthcare needs, low-income families, and those from racial minority groups, estimates a study published today in JAMA Pediatrics.

University of North Carolina researchers studied the responses of caregivers of 49,546 children aged 5 years and younger to the 2016 to 2020 versions of the National Survey of Children's Health. The 2020 survey covered July 2020 to January 2021 and asked whether participants had "to quit a job, not take a job, or greatly change [their] job because of problems with child care for this child."

In 2020, 12.6% of children had a caregiver with a childcare-related job disruption, up from 9.4% in 2019 and 8.9% of those in the pooled 2016 to 2019 sample. Nearly one quarter (24.8%) of children with special healthcare needs had a caregiver who experienced a work disruption due to a lack of childcare, up from 11.1% of caregivers of children without special needs.

After adjustment, children with special healthcare needs were at a 2.7-fold higher risk of a caregiver having work disruptions than children without special needs (adjusted odds ratio [aOR, 2.73). In 2020, all children were at a 1.4-fold higher risk of having a caregiver with a work disruption than in 2019 (aOR, 1.41). The interaction between 2020 and special-needs status didn't reach significance (aOR, 1.06).

Men had lower chances of experiencing a childcare-related work disruption, while children aged 2 years or younger; Black, Asian, and multiracial children; low-income families; and those without two married parents were at higher risk.

"Parents’ job loss can lead to loss of insurance coverage for their children and may be directly detrimental to children’s health," the researchers wrote. "Without increased access to childcare, caregivers may struggle to meet the basic human and health care needs of their children."
Jun 13 JAMA Pediatr research letter


Stress during pandemic may have altered ovulation in women

The stress and disruptions of COVID-19 led to lower progesterone levels in women, altering ovulation in otherwise healthy women, according to research presented yesterday at ENDO 2022, the Endocrine Society's annual meeting in Atlanta.

The study compared results from the Menstruation Ovulation Study (MOS), which was conducted in a group of 301 women from 2006 through 2008, and MOS2, which studied 112 women during the pandemic. All women in the study were ages 19 to 35 and were not taking any hormonal birth control.

Almost 60% of the MOS2 participants experienced short luteal phases (egg released without enough time from ovulation for pregnancy to occur) or anovulation (no egg released).

"We can infer that the SARS-CoV2 pandemic life disruptions cause silent ovulatory disturbances within mostly regular menstrual cycles—providing a unique experiment of nature," said Jerilynn C. Prior, MD, professor of endocrinology at the University of British Columbia in Vancouver, in a press release from the Endocrine Society.

The findings may explain why some women also reported menstrual disturbances following COVID-19 vaccination.

"These silent ovulatory disturbances likely explain why so many women who are not taking hormonal forms of birth control reported having early or unexpected periods in the days following a COVID-19 vaccination," Prior added.
Jun 12 Endocrine Society
press release


Avian flu outbreaks hit more poultry in US, Bulgaria

Though the pace of highly pathogenic avian flu outbreaks has slowed in the United States and abroad, sporadic event in poultry continue to occur, and federal officials reported two events, in Colorado and Washington.

According to updates from the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS), the outbreak in Colorado struck a farm raising layer hens in Weld County that houses 205,000 birds. Weld County is northwest of Denver. Washington's outbreak involved backyard birds in Snohomish County, north of Seattle.

So far, outbreaks in the United States this year have led to the loss of 39.9 million birds across 36 states.|
USDA APHIS poultry avian flu updates

In global developments, Bulgaria reported a highly pathogenic H5 outbreak, according to a notification from the World Organisation for Animal Health (WOAH). The event began at a commercial duck farm on Jun 9 in a village in Dobrich region, located in the northeast. The facility houses 3,200 birds.
Jun 10 WOAH report on H5 in Bulgaria


European countries report more unexplained hepatitis cases in kids

Countries in the World Health Organization (WHO) European region have reported 102 more cases of unexplained hepatitis in children from 10 countries, raising the total as of Jun 9 to 402 cases in 20 countries, roughly half of them in the United Kingdom, the European Centre for Disease Prevention and Control (ECDC) and the WHO European regional office said in a Jun 10 update.

The majority (77.9%) of cases are in kids ages 5 and younger. Of 250 children with outcome information, 181 recovered and 68 are still receiving medical care. Seventeen kids are known to have received liver transplants, and one died from his or her illness.

The epidemiologic curve shows an increase that began at the end of 2021, rising sharply in the first months of 2022. The rate of new cases appears to have decreased, which the groups said is difficult to interpret.

Of 293 children who received adenovirus testing and had a valid results, 53.9% tested positive. Of 273 who received a polymerase chain reaction (PCR) test for COVID-19, 10.6% were positive. SARS-CoV-2 serology results were available for just 47 kids, for whom 63.8% tested positive. And of 94 cases with COVID-19 vaccination information, 85.1% were unvaccinated.

In a related development, the UK Health Security Agency (HSA) said last week that the investigation continues to suggest a strong association with adenovirus and that it expects to publish preliminary findings on Jun 16.
Jun 10 joint ECDC-WHO Europe surveillance update
Jun 9 UK HSA update

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