Stewardship / Resistance Scan for Jun 21, 2022

News brief

New project to explore link between gender, antimicrobial resistance

Researchers in Africa and Asia have been selected to lead an upcoming research project that will explore the interconnections between antimicrobial resistance and gender.

The International Centre for Antimicrobial Resistance Solutions (ICARS) and the International Development Research Centre announced yesterday that the project will be led by South Africa's Human Sciences Research Council (HSRC), Jive Media Africa, and the Mahidol Oxford Tropical Medicine Research Unit (MORU) at Mahidol University in Thailand. The team will conduct systematic reviews, workshops, and interviews with key experts to develop guidance for AMR research teams that are integrating gender into their work.

The ultimate aim of the guidance is to help strengthen the gender inclusiveness of AMR intervention and implementation research projects in low- and middle-income countries, particularly in sub-Saharan Africa and South Asia.

"We anticipate that this project will provide researchers with the necessary tools to capitalise on the potential of a gender lens to improve the quality, contextual relevance and impact of their AMR research," lead Investigators Ingrid Lynch of HSRC and Poy Naemiratch of MORU said in an ICARS news release.

The project is underway and will end in April 2023.
Jun 20 ICARS press release

Study finds frequent treatment failure for complicated urinary tract infections

An analysis of US health insurance data found frequent treatment failure in patients with complicated urinary tract infections (cUTIs), researchers reported yesterday in Open Forum Infectious Diseases.

Using data from two IBM MarketScan databases on privately insured and Medicare patients covering 2017 through 2019, researchers conducted a retrospective cohort study that looked at antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients, stratified by age (younger than 65 and 65 and over), over a 12-month follow-up period. Data from a recent US national database study indicates there are more than 2.8 million cUTI cases a year, but resistance to commonly used oral antibiotics is on the rise, and data on recurrent cUTIs is limited.

Among the 95,322 patients who met the study criteria, the initial setting of care was outpatient (OP) for 84%, and 87% were under 65 years of age. Treatment failure, which was defined as receipt of a new unique OP antibiotic or a cUTI-related emergency department visit or hospital admission, occurred in 23% of OPs under 65 and 34% of those over 65, and over 38% of inpatients (IPs), irrespective of age.

Across both insurance cohorts and age strata, more than 78% received two or more unique OP antibiotics, more than 34% received four or more unique OP antibiotics, more than 16% received repeat OP antibiotics, and more than 23% received one or more intravenous (IV) OP antibiotics. The mean 12-month cUTI-related total healthcare costs were $4,697 for OPs 65 years and older, $15,401 for IPs under age 65, and $17,431 for IPs 65 and older.

"In conclusion, the findings from this study indicate that many cUTIs do not resolve with the initial course of treatment and that a fair proportion of patients have recurrent infections," the study authors wrote. "The results also indicate that many patients receive prolonged durations of OP antibiotics despite data suggesting that shorter courses are as effective as longer durations of treatment."

They added that the findings highlight the need for new oral cUTI antibiotics and treatment approaches.
Jun 20 Open Forum Infect Dis abstract

News Scan for Jun 21, 2022

News brief

UK expands monkeypox vaccination to more risk groups

The United Kingdom today expanded monkeypox vaccination to include men who have sex with men who are in high-risk groups, instead of just those who are known contacts and those at occupational risk.

In an update, the UK's Health Security Agency (HSA) said the risk criteria now includes people who have recently had multiple sex partners, participate in group sex, attend sex-on-premises venues, and have a proxy marker such as a recent bacterial sexually transmitted infection in the past year.

In other developments, the UK reported 219 more cases over a 4-day period, according to the HSA's latest update. The new cases lift its total to 793 as of Jun 20. The highest proportion, 80%, involve London residents.

In the United States, New Jersey yesterday announced its first probable case, a patient who tested positive for orthopox on Jun 18 whose samples will undergo confirmatory monkeypox testing at the Centers for Disease Control and Prevention (CDC). The patient is isolating at home, and the New Jersey Department of Health (NJDOH) had no other details about the patient or exposure.
Jun 21 UK HSA vaccination update
Jun 21 UK HSA update
Jun 20 NJDOH statement

Study: Hospitalized Omicron patients benefited from fourth vaccine dose

When the Omicron variant surge hit at the end of 2021, which came with breakthrough COVID-19 infections in vaccinated people, Israel was one of the first countries to offer fourth vaccine doses for those age 60 and older. Yesterday, Israeli researchers reported that a fourth dose was linked to significant protection against severe outcomes in hospitalized patients.

In a multicenter retrospective cohort study, they examined outcomes in people who were hospitalized in the last half of January, looking for any differences in outcomes between those who received three and those who received four doses. Most people in Israel received the Pfizer-BioNTech vaccine. The team published its findings in Clinical Infectious Diseases.

They analyzed outcomes of 1,049 patients, defining poor outcomes as mechanical ventilation or death. Of the group, 394 were unvaccinated, 386 had received three doses, and 88 had gotten a fourth dose. The three-dose group, which had more men and immunocompromised people, had similar severe outcomes to the unvaccinated group, which were 49% and 51%, respectively.

Though people who received their fourth doses had similar age and immune compromise profiles, they had better outcomes than unvaccinated people (34% vs 51%).

"These findings suggest that administration of a fresh booster dose should be considered for at-risk individuals upon an impending new COVID-19 wave," the group wrote.
Jun 20 Clin Infect Dis abstract

US COVID markers show declines, but BA.4 and BA.5 levels rising

US COVID-19 activity appears to be decreasing or stabilizing, with the 7-day average for new cases now below 100,000. According to a Washington Post analysis, the 7-day average is at 94,437, down 11.9% from a week ago. However, it's difficult to get a more precise assessment, given reduced testing and the wider use of at-home tests.

Meanwhile, the proportions of BA.4 and BA.5 Omicron subvariants, which are more transmissible and have mutations linked to immune escape, are steadily rising. In its latest estimates, the CDC said today that BA.4 and BA.5 make up about 35% of sequenced SARS-CoV-2 samples, up from about 23% the week before. The south-central region has the highest proportion of two subvariants. That region includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.

Hospitalizations appear stable, as are deaths, which average about 300 per day.

Late last week, the CDC said nearly 61% of the US population lives in areas with medium or high COVID-19 community levels, down from 67% the previous week.
Washington Post COVID-19 tracker
CDC variant estimates
CDC community transmission estimates