Stewardship / Resistance Scan for Nov 07, 2022

News brief

Study finds uncomplicated UTI antibiotics are frequently inappropriate

A study of electronic health record (EHR) data from a US hospital network found that more than a third of antibiotic prescriptions for uncomplicated urinary tract infections (uUTIs) were inappropriate or suboptimal, researchers reported late last week in Antimicrobial Resistance and Infection Control.

Using EHR data from a large integrated delivery network in Mid-Atlantic states, researchers analyzed female patients ages 12 and over who had been diagnosed as having a uUTI, received one or more antibiotics, and had one or more urine cultures with an antibiotic susceptibility test from July 2016 through March 2020. The goals of the study were to examine the proportion of antibiotics that were inappropriate (not recommended according to Infectious Diseases Society of America guidelines) or suboptimal (switched within 28 days because of treatment failure) and the total healthcare costs 6 months after infection.

Among the 2,565 women with a uUTI included in the study, the most commonly prescribed antibiotics were nitrofurantoin (61%), trimethoprim-sulfamethoxazole (19%), and ciprofloxacin (15%). More than one third of patients (40.2%) had an isolate that was not susceptible to one or more antibiotic indicated for treating uUTI patients. In total, 66.6% of patients received appropriate antibiotic therapy, while 29.9% received inappropriate treatment and 11.9% received suboptimal treatment. Inappropriate prescribing was more common for patients with non-susceptible (48.2%) versus susceptible (23.5%) isolates.

Patients who received inappropriate or suboptimal antibiotics had greater all-cause and UTI-related costs compared with appropriately prescribed patients, with the greatest difference seen among patients with antibiotic non-susceptible isolates.

The study authors note that while the results should not be extrapolated to a regional level, the findings are in line with previous studies that have found high rates of inappropriate prescribing for uUTIs and higher treatment costs linked to antibiotic resistance.

"As the incidence of antibiotic resistance has significantly increased in the US among community-acquired uUTIs, it is critical to understand regional resistance rates through local community surveillance to inform and improve empiric prescribing," the study authors wrote. "More rapid diagnostic tests are needed in order to optimize prescribing accuracy and avoid manifestation of painful symptoms."
Nov 4 Antimicrob Resist Infect Control study

Survey gauges interest in milk with responsible antibiotic use label

A survey and follow-up experiment conducted by researchers at Cornell University's College of Veterinary Medicine found that consumers will buy milk with a label indicating responsible antibiotic use, but they won't pay significantly more for it than conventionally raised milk. The results of the survey were published last week in the Journal of Dairy Science.

In the telephone survey, conducted among a nationally representative, random sample of 1,000 adults, respondents were asked about their awareness of antibiotic resistance-related issues and whether they would be willing to buy responsible antibiotic use (RAU)-labeled milk. That designation, which would allow for antibiotics to be used in dairy cattle only for therapeutic purposes, does not currently exist, but it has been proposed as an alternative to organic milk. Organic dairy farmers can use antibiotics to treat their cattle with antibiotics if needed, but cannot then market their milk as organic, which has led to some concerns about animal welfare.

In the survey, 75.1% of respondents said they were aware of antibiotic resistance-related issues and 48.5% said they would buy RAU-labeled milk, while 8.4% said they would continue to buy organic milk and 22.3% said they would continue to buy conventionally raised milk. Respondents who said they would prefer RAU-labeled milk over conventional described themselves as younger, aware of issues with antibiotic use, politically moderate, and having higher education.

But in an experimental auction conducted at Cornell, a sample of 85 residents of Ithaca, New York, after receiving information on what the different labels entailed, were unwilling to pay a significant premium for the RAU-labeled milk compared with unlabeled milk, while the premium for organic milk remained (mean willingness to pay per half-gallon: $2.24 for organic milk vs $1.92 for RAU-labeled milk vs $1.86 for unlabeled milk).

"This result suggests that despite consumers' aversion to antibiotic use in milk production, a market could exist for simply reducing their administration in exchange for a price premium lower than for organic milk," the study authors wrote.
Nov 1 J Dairy Sci study

News Scan for Nov 07, 2022

News brief

Common antidepressants don't appear to protect against severe COVID-19

Selective serotonin reuptake inhibitors (SSRIs), the most commonly used class of antidepressants in the United States, don't appear to prevent severe COVID-19 or death among outpatients, according to a study presented this week at the American Heart Association's Scientific Sessions in Chicago.

Researchers from Intermountain Healthcare in Salt Lake City retrospectively studied 33,088 nonhospitalized people who tested positive for COVID-19 from Mar 14, 2020, to Dec 31, 2021. Of that number, 25% were taking the SSRIs fluoxetine or fluvoxamine.

A greater proportion of the SSRI group were hospitalized or died than among those not taking the antidepressants, and not taking an SSRI was tied to a lower risk of COVID-related hospitalization at 14 days.

The authors said the findings don't imply that taking an SSRI leads to severe infection, only that they didn't seem to provide any protection in this study. But they do cast doubt on the conclusions of observational studies conducted early in the pandemic suggesting that the anti-inflammatory and anti-clotting properties of SSRIs could help fend off severe illness.

"At the start of the pandemic, everyone was searching for how to help prevent severe COVID, and SSRIs became a focus of interest," principal investigator Heidi May, PhD, said in an Intermountain press release. "However, those initial observations of a possible connection didn’t pan out when we looked for a possible link on our patient population."
Nov 6 Intermountain Healthcare press release

Risk of severe COVID spotlighted in those with chronic kidney disease

A new report presented at the American Society of Nephrology Kidney Week shows that people with chronic kidney disease (CKD) are vulnerable to developing severe COVID-19 and that acute kidney injury is a common complication of COVID-19, placing chronic kidney disease in the same risk category for developing severe COVID as heart disease, diabetes, and high blood presure.

The study was based on 64,246 COVID-19 cases seen during four waves of virus activity at Columbia University Medical Center in New York City. In total, 8% of cases were labeled as severe, and 18% required hospitalization.

Acute kidney injury occurred in 49% of severe cases and 35% of hospitalized ones.

"Pre-existing CKD was one of the most consistent clinical predictors of COVID-19 severity, complications, and poor outcomes across multiple pandemic waves," said lead author Ning Shang, PhD, in a press release.

The authors of the study said hospitals should consider kidney disease patients in future waves of the virus.

"Hospitals could include kidney function evaluation in patient populations as part of consideration for planning treatments and evaluating hospital capacities during future pandemic waves," said coauthor Krzysztof Kiryluk, MD.
Nov 5 American Society of Nephrology press release

Officials responding to more than 6,000 cholera cases in Malawi

From early March through October, Malawi has reported 6,056 cholera cases, including 183 deaths, the World Health Organization (WHO) said in an update today.

The outbreak in the landlocked country in southeastern Africa has affected all but 2 of 29 districts and is Malawi's largest in 10 years, the WHO said. The disease is endemic in the country but typically surges during the wet season. This year, cases have increased dramatically during the dry season.

The outbreak originated in the south but is now hitting northern districts the hardest and is especially affecting men 21 to 30 years old. "The upcoming rainy season in November poses the threat of further disease spread nationwide," the WHO said. The southern region is low-lying and flat, and prone to flooding during the rainy season.

Five districts account for 79% of the reported cases and 68% of the deaths: Nkhata Bay (1,128 cases and 31 deaths), Nkhotakota (811 and 40), Rumphi (783 and 13), Karonga (683 and 14), and Blantyre (650 and 26). The overall case-fatality rate is 3.0%.

Health officials from Malawi and the WHO are conducting emergency response activities, and the WHO emphasized the risk of further spread not only in Malawi but internationally. Across the border, Mozambique declared a cholera outbreak in Lago district in September.
Nov 7 WHO update