Stewardship / Resistance Scan for Jun 29, 2022

News brief

Antimicrobial use in animals on the decline globally, new report finds

A new report from the World Organisation for Animal Health (WOAH, formerly OIE) shows global use of antimicrobials in animals fell by 27% from 2016 through 2018.

The sixth annual report on animal antimicrobial use, which focuses on drugs given to animals raised for human consumption and is based on data provided by WOAH member-states, found that, among the 72 nations that provided consistent data (representing 65% of global animal biomass), antimicrobial use fell from 120 milligrams of antimicrobials per kilogram of estimated animal biomass (mg/kg) in 2016 to 88 mg/kg in 2018. The declining trend was observed across all WOAH regions and confirms trends observed on the fifth report.

Analysis of trends by antimicrobial class showed a 21% decline in the use of tetracyclines (the most widely used antimicrobial in food-producing animals), a 43% decline in macrolide use, and a 62% decline in polypeptides. Data provided for 2018 by 109 countries showed that the total amount of antimicrobials intended for use in animals oscillated between 69,445 and 76,704 tons. Bovine species like cattle accounted for 43% of total use, followed by swine (20%), poultry (18%), and aquatic species (8%).

The report also found that, among the 157 countries that provided data for 2020, 108 (69%) no longer use antimicrobials for growth promotion. In addition, progress has been made in phasing out the use of high-priority critically important antimicrobials in animals, such as colistin.

WOAH officials say the data indicate that a growing number of farmers, animal owners, and animal health professionals are adapting their practices to use antimicrobials more judiciously. They note that a new interactive information technology system for data collection, scheduled to be delivered later this year, could help provide more granular data for future reports on global and regional trends and help countries develop national guidance.

"We are on the right track in the animal sector—we must now seize this momentum and continue to use antimicrobials prudently if we want to preserve their efficacy for future generations," WOAH Director-General Monique Eloit, DVM, said in a press release.
Jun 27 WOAH report
Jun 27 WOAH press release


Discharged patients may be getting antibiotics longer than necessary

An analysis of patients treated for common infections at an academic medical center found that antibiotics were given for longer than necessary on discharge for multiple conditions, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

The retrospective chart review included 300 adult patients discharged from Temple University Hospital who were on oral antibiotics for acute infections from January to March 2019. The infections included community- and hospital-acquired pneumonia, cystitis, pyelonephritis, skin and other soft-tissue infection (SSTI), intra-abdominal infection (IAI), chronic obstructive pulmonary disease exacerbation, bronchitis, and pharyngitis.

The primary outcome was total prescribed duration of antibiotic therapy, compared with the duration recommended by Infectious Diseases Society of America (IDSA) guidelines, the minimum supported by clinical guidelines and trials, and the duration beyond the point of clinical stability.

Of the 300 patients, 171 (57%) were women, and the median age was 59 years; 73% of inpatients received intravenous therapy, 76% received oral antibiotics, and 70% of those prescribed oral antibiotics were transitioned to these patients prior to discharge. The most common antibiotics prescribed were fluoroquinolones (30%), amoxicillin-clavulanate (18%), and azithromycin (18%).

Overall, patients received a median of 8 total days of antibiotics—a median of 2 days of excessive antibiotics compared with IDSA guidelines, 3 days compared with the minimum possible duration based on clinical guidelines and published literature, and 6 days past the point of clinical stability. The most inappropriate prescription durations were seen with SSTI, IAI, and cystitis.

"This finding supports the results from several other studies; despite the growth of data supporting shorter courses of therapy for multiple common infections and the inclusion in clinical guidelines, patients are often prescribed longer courses than clinically indicated," Temple University School of Pharmacy researchers wrote.

The authors said a pilot program targeting transitions of care has been initiated at the hospital to address the problem.
Jun 29 Antimicrob Resist Healthc Epidemiol study

News Scan for Jun 29, 2022

News brief

UK study shows long COVID more common in women, adults 50 to 60

Symptoms of long COVID are more frequently reported by women, those with poor overall health before the pandemic, and those aged 50 to 60, according to a new UK-based study in Nature Communications.

The study was based on results gathered from 6,907 people with self-reported COVID-19 from 10 population-based longitudinal health surveys in the United Kingdom that had been in place prior to the pandemic.

The proportion of participants reporting symptoms for longer than 12 weeks post-acute infection ranged from 7.8% to 17.0%, with 1.2% to 4.8% reporting debilitating symptoms.

Women were more likely to report long COVID symptoms compared to men, as were those with poorer pre-pandemic mental health and overall health. Participants who were obese or had asthma were also identified as more at risk for long COVID.

The authors compared these responses with electronic health records of 1.1 million UK residents in the spring of 2021, which showed that only 4,189 people also had a recorded long COVID code, constituting 0.4% of COVID-19 cases.

"While just 0.3% of COVID-19 cases had long COVID codes in primary care, up to 17% of adult COVID-19 cases in midlife reported symptoms attributed to COVID-19 for more than 12 weeks in longitudinal studies," the authors concluded. "Our findings justify further investigations into the role of sex difference, age related change, and/or immunity and respiratory health in development of long COVID. Older working individuals, with high levels of comorbidity, may particularly require support."
Jun 28 Nat Commun


Persistent symptoms common after COVID-19 in children, MIS-C

More than one in four children hospitalized with acute COVID-19 or COVID-related multisystem inflammatory syndrome in children (MIS-C) experienced persistent symptoms or problems with daily activity for at least 2 months, a study across 25 US pediatric hospitals finds. It was published today in Pediatrics.

The study included 358 patients younger than 21 years who were hospitalized from May 2020 to May 2021. Of those, survey data collected 2 to 4 months after admission was available for 119 of 155 who had acute COVID-19 and 160 of 203 with MIS-C, for a total of 279 patients. Thirteen patients (11%) with acute COVID-19 and 12 (8%) with MIS-C required hospital readmission.

The researchers found that 32 patients (26.9%) with acute COVID-19 had persistent symptoms (22.7%) or activity impairment (14.3%) and 48 patients (30.0%) with MIS-C had persistent symptoms (20.0%) or activity impairment (21.3%). For patients with acute COVID-19, having more symptoms involved raised the risk of persistent symptoms 29% and the risk of activity impairment 37%. Patients with MIS-C and pre-existing respiratory conditions—mostly asthma—had triple the rate of persistent symptoms (adjusted risk ratio [aRR], 3.09; 95% confidence interval [CI], 1.55 to 6.14) and obese patients with MIS-C more frequently had activity impairment (aRR, 2.52; 95% CI, 1.35 to 4.69).

Fatigue or weakness were the most common symptoms in both the COVID-19 and MIS-C groups, followed by cough and shortness of breath in the COVID-19 group and headache in the MIS-C group.

The authors conclude, "Our study highlights that, while most children recover, many children with both acute COVID-19 and MIS-C have persistent sequelae, and further follow-up to determine if these sequelae persist is warranted."
Jun 29 Pediatrics study


NIH launches universal flu vaccine clinical trial

The National Institute of Health (NIH) yesterday announced the launch of a phase 1 clinical trial of a universal flu vaccine, with a goal of enrolling up to 100 adults 18 to 55 years old.

Developed by researchers at the NIH's National Institute of Allergy and Infectious Diseases (NIAID), BPL-1357 is an inactivated whole-virus vaccine that contains four low-pathogenic avian influenza strains given in two doses.

Study participants will be randomized into three groups who will receive two doses of vaccine or placebo 2 weeks apart. The first will receive BPL-1357 intramuscularly with an intranasal saline placebo, the second will receive the intranasal candidate vaccine with an intramuscular placebo, and the third will receive intramuscular and intranasal placebo doses. The study will last 7 months, and researchers will examine blood and mucosal samples to assess immune response.

Matthew Memoli, MD, lead investigator, said in an NIH news release that the approach with the BPL-1357 vaccine is different than for nearly all other flu or other respiratory disease vaccines. He said with the intranasal approach, scientists are trying to prompt a comprehensive immune response that closely mirrors immunity following natural influenza infection. He added that the trial will allow the team to gauge the importance of mucosal immunity and if a strategy of inducing both cellular and antibody parts of the immune system can broaden protection against ever-changing flu viruses.

Also in the statement, NIAID Director Anthony Fauci, MD, said flu vaccines that can provide long-lasting protection against a wide range of flu viruses, both seasonal and pandemic, would be an invaluable public health tool. He added that the trial performed well in preclinical animal studies, and officials look forward to seeing how it performs in people.
Jun 28 NIH news release

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