Stewardship / Resistance Scan for May 09, 2022

News brief

Australian coalition to address antibiotic resistance in food, agribusiness

A coalition of 70 organizations in Australia is joining forces to combat antimicrobial resistance (AMR) in the food and agribusiness industries.

Announced last week, the Cooperative Research Centre for Solving Antimicrobial Resistance in Agribusiness, Food, and Environments (CRC SAAFE) will bring together partners from water, organic waste, aquaculture, horticulture, viticulture, animal feed, and livestock sectors to develop shared solutions to monitor, manage, and mitigate the spread of AMR.

The effort will focus on the emergence and spread of resistant pathogens on farms, in feed and food production systems, and in waste processing. Partner organizations will work on developing solutions such as vaccines, water treatment technologies, and new animal feed and supplements.

"Antimicrobial resistance makes our food supply less safe," CRC SAAFE CEO and University of South Australia professor Erica Donner, PhD, said in a university press release. "Internationally, there are many cases of multidrug resistant bacterial strains causing serious disease being spread via food. CRC SAAFE will help Australian industries stay on top of this risk, ensuring we remain a top producer of premium food and beverage products."

CRC SAAFE will receive $34.5 million Australian Dollars from the Australian government, and partner organizations will contribute an additional $115 million.
May 6 University of South Australia press release

Clinical decision support boosts stewardship at community hospital

Implementation of a clinical decision support system (CDSS) in a tele-antimicrobial stewardship program (TASP) at a community hospital was associated with reduced antibiotic use, higher use of oral antibiotics, and faster time to therapy, researchers reported today in Open Forum Infectious Diseases.

In the study, researchers from the University of Pittsburgh conducted an interrupted time series analysis to assess differences in antibiotic use before and after the CDSS was implemented at a 146-bed community hospital in Pennsylvania. In July 2018, infectious disease (ID) consult services at the hospital were transitioned to remote telemedicine utilizing ID physicians from the University of Pittsburgh Division of Infectious Diseases. The CDSS, which provides real-time alerts to ASP members on bug-drug mismatches, positive cultures, de-escalation opportunities, and other scenarios of interest, was implemented in February 2020 to address the challenges of not having an ID specialist on site.

Implementation of the CDSS into the TASP was associated with an immediate 11% reduction in antibiotic use. Prior to CDSS implementation, antibiotic use was trending downward by 0.25% per month, and continued to trend down after CDSS implementation by 0.24% per month. In addition, the frequency of conversion from intravenous (IV) to select oral (PO) agents increased from 38% to 57% in the 6 months after implementation compared with the 6 months prior, and median time to optimal therapy (TTOT) was one day faster (2.9 day pre-CDSS vs 1.9 days post-CDSS).

On average, pharmacists documented 2.2-fold more interventions per month (198 vs 90) and patients received 1.03 fewer days of antibiotics per admission post-CDSS.

"Implementation of a CDSS into an established, integrated TASP at a community hospital allowed for increased involvement and transfer of knowledge from remote ID experts, resulting in decreased total antimicrobial usage, increased rates of IV to PO conversion, improved TTOT, decreased antimicrobial exposure, and improved workflow efficiency," the study authors wrote. "Implementation of the CDSS addressed several challenges in our TASP, while minimizing the need for additional staffing support."
May 9 Open Forum Infect Dis abstract

News Scan for May 09, 2022

News brief

Study: Dogs can sniff out COVID-19 infections with high success rates

In a study published in Open Forum Infectious Diseases, researchers showed canine olfaction—or dog sniffing—was both highly sensitive and specific when it came to identifying patients with COVID-19, even those who were asymptomatic or presymptomatic.

The researchers, based in Hawaii, exposed dogs to sweat samples from 584 participants (ages 6 to 97 years; 24% positive SARS CoV-2 samples and 76% negative SARS CoV-2 samples). Samples were collected from cotton pads runs cross the necks of participants, and the dogs had no prior history of scent training.

During the first part of the study, the testing phase, the dogs detected SARS-CoV-2 from cotton pad samples with a diagnostic sensitivity of 98% and a specificity of 92%.

In the second part of the study, a follow-up screening test in a hospital setting, a single dog screened 153 patients before surgery, and results were compared to polymerase chain reaction (PCR) testing. The dog performed with 96.4% diagnostic sensitivity and 100% specificity.

"The results confirm that canines can be taught to discriminate between sweat samples from SARS-CoV-2-positive and SARS-CoV-2-negative individuals," the authors concluded. "Sensitivity and specificity were equally high in an implementation phase which took place in a hospital, demonstrating the potential for medical detection dogs to provide screening for COVID-19 in public places such as hospitals, schools, and businesses."

The authors said dog sniffing could be considered a useful tool for virus detection, especially in places or settings where mass rapid or PCR testing would be improbable.
May 7 Open Forum Infect Dis study

COVID study: Omicron patients shed more live virus than those with Delta

Hospitalized South Korean patients infected with the Omicron SARS-CoV-2 variant shed more live virus 8 days after illness onset than those with the Delta variant, finds a study published today in Open Forum Infectious Diseases.

Led by researchers from Incheon Medical Center, the study involved viral culture of 110 respiratory samples collected daily from 11 patients with mild to moderate COVID-19 within 14 days of symptom onset. The first Omicron case was identified in South Korea on Dec 2, 2021.

Median patient age was 38 years, 5 patients were male, 5 had pneumonia, and 2 had received one dose of COVID-19 vaccine in October 2021. None were immunocompromised, and all had at least one COVID-19 symptom at diagnosis. No patients required supplemental oxygen, the antiviral drug remdesivir, or anti-inflammatory drugs, but 2 received monoclonal antibodies.

Omicron was cultured in 48 of 110 specimens (43.6%) in the first 8 days after illness onset, all from unvaccinated patients. A total of 22% to 100% of unvaccinated patients were positive for Omicron on viral culture. Compared with Delta patients, those with Omicron tested positive for a shorter time (8 vs 10 days, respectively) but had a higher positivity rate (100% vs 74%, respectively). Omicron's viral load was slightly lower than that of Delta.

The authors said that the study, using culture positivity as a proxy for infectivity, may help explain the recent global Omicron surge. "This study suggests that the Omicron variant may have a shorter infectious stage than the Delta variant," they wrote. "However, the culture-positive rate of the Omicron variant was higher than that of the Delta variant."

The researchers added that duration of fever, which many isolation guidelines consider, may not correlate well with the time to positivity on culture. "Improvement of symptoms, including fever, is an important indicator of a decrease in infectivity, but our study results show that the duration of fever might not well correlate with the time to viral culture conversion," they wrote.
May 9 Open Forum Infect Dis study

Monkeypox case reported in United Kingdom

The UK Health Security Agency (UKHSA) last week reported a confirmed case of monkeypox.

The patient is currently hospitalized, and had a recent history of travel from Nigeria, which is where he is believed to have contracted the infection, UKHSA said in a news release. UKHSA officials are working with the National Health Service (NHS) to contact people who may have been in close contact with the patient, including those on the same flight from Nigeria to the United Kingdom.

Monkeypox is endemic in central and West African countries and is usually a mild, self-limiting illness. The infection can be spread to close contacts, but the risk to the general population is low. The United Kingdom reported three monkeypox cases last summer that involved an index patient who had traveled from Nigeria and two members of the person's household.

"UKHSA and the NHS have well established and robust infection control procedures for dealing with cases of imported infectious disease and these will be strictly followed," said UKHSA director of clinical and emerging infections Colin Brown, MBChB.
May 7 UKHSA news release