Stewardship / Resistance Scan for Oct 11, 2021

News brief

Stewardship rules, drug review tied to better antibiotic prescribing

Implementing a set of rules targeting antimicrobial stewardship (AMS) into a hospital-wide medication review service was associated with a dramatic decline in inappropriate antibiotic prescribing, Belgian researchers reported last week in the Journal of Antimicrobial Chemotherapy.

The interrupted time series (ITS) analysis looked at inappropriate antibiotic prescribing at a tertiary care hospital in Belgium in the year before and 2 years after 41 AMS-related clinical rules were added to the hospital's Check of Medication Appropriateness (CMA) service. The CMA is a pharmacist-led medication review service that screens electronic medical record data for potentially inappropriate prescriptions (PIPs). For each identified PIP, the pharmacist formulated a recommendation for the prescribing physician. The study aimed to estimate the effect of the CMA on AMS-related residual PIPs.

Pre-implementation, a median proportion of 75% residual PIPs per day was observed at the hospital. After the CMA intervention, the proportion was reduced to 8% per day. Use of the AMS-related clinical rules resulted in an immediate relative reduction of 86.7% in AMS-related residual PIPs. No significant underlying time trends were observed during the study period.

Post-implementation, 2,790 recommendations were provided, of which 81.32% were accepted. The clinical rule "inappropriate dosing of piperacillin-tazobactam" accounted for the highest proportion of recommendations (24.34%).

"Our ITS analysis showed that this approach is effective in supporting clinicians in antimicrobial prescribing, ultimately aiming to optimize clinical outcomes and minimize unintended consequences of antimicrobial use," the study authors wrote.
Oct 7 J Antimicrob Chemother abstract

Tanzanian study finds high antibiotic use in postnatal women, newborns

Point-prevalence surveys at three hospitals in Tanzania found substantial overuse of antibiotics in postnatal women and newborns, researchers reported late last week in Antimicrobial Resistance and Infection Control.

The surveys were conducted at three public-sector hospitals in Dar es Salaam in 2018 to collect data on antibiotic use and infections in maternity and neonatal wards. Researchers collected data on a total of 376 mothers and 162 newborns across three rounds.

Antibiotic prescribing was high in all three hospitals among women in caesarean section wards, ranging from 90% to 100%. Antibiotic use varied considerably among women in the postnatal vaginal delivery wards, ranging from 1.4% to 63%. Antibiotic use in newborns ranged from 89% to 100%. The most common reasons for antibiotic prescriptions at all three hospitals were medical or postoperative surgical prophylaxis (prevention).

The study authors said that they expected to see high levels of antibiotic use on caesarean section wards, given that the procedure carries a higher risk of infection and surgical prophylaxis is recommended, but they point out that those antibiotics should be given pre- rather than postoperatively. In addition, they note that, of the 76 newborns treated with antibiotics, 57% had no clear indication for antibiotic use.

"Irrational overuse of antibiotics is likely to ultimately lead to severe illness and death in mothers and newborns as a result of increasing levels of antibiotic resistance in low-income countries," they wrote. "Better infection control policies, local and national guidelines, and antimicrobial stewardship programs need to be implemented to avoid unnecessary prescription of the antibiotics and promotion of antibiotic resistance."
Oct 9 Antimicrob Resist Infect Control study

News Scan for Oct 11, 2021

News brief

Mental disabilities, disorders linked to mortality risk during pandemic

People with mental disorders and intellectual disabilities had a greater mortality risk during the COVID-19 pandemic in 2020, according to a study published late last week in The Lancet Regional Health – Europe.

The researchers looked at 167,122 people from the South London & Maudsley NHS Foundation Trust from 2019 to 2020. Across the cohort, 40.0% had at least one affective disorder, 34.7% neurotic/stress-related and somatoform disorders, 22.5% substance use disorder, and 15.8% schizophrenia-spectrum disorder. Overall, all-cause mortality from Jan 1, 2019, to Dec 31, 2020, was 4.0%, with 48.4% of those (3,227) occurring prior to Jan 30, 2020, when the World Health Organization declared a public health emergency of international concern.

When compared with mortality data from the general London population, age- and gender-standardized mortality rates (SMRs) for COVID-19 were higher in those with mental disorders or learning disabilities. Learning disabilities had the highest SMR (9.24), followed by pervasive developmental disorders (5.01), personality disorders (4.58), eating disorders (4.81), dementia (3.82), and schizophrenia-spectrum disorders (3.26). By the last quarter of 2020, COVID-19 deaths remained high only for dementia (SMR, 1.50).

While all-cause deaths for anyone with a mental health condition or intellectual disability declined from July to September 2020, when the COVID-19 surge and related lockdown recessed, rates were twice as high as the SMR of the year prior, particularly among minorities. The researchers also noted that non-COVID deaths were at least double the general population's average during the pandemic period, with people with substance use disorders reaching a 5.09 SMR in the second quarter of 2020.

"We suggest a need to prioritise vaccination and optimise physical health care and suicide risk reduction, before, during and after peaks of COVID-19 infection in people living with mental health conditions," said lead author Jayati Das-Munshi, PhD, in a King's College London press release.
Oct 7 Lancet Reg Health Eur study
Oct 8 King's College London press release

Monoclonal antibodies lowers COVID-19 hospitalizations, deaths in trial

In a study matching 2,879 COVID-19 patients who received monoclonal antibodies with those who didn't on a 1:1 ratio, the treatment cohort had significantly lower 28-day hospitalization and mortality rates.

The results, published late last week in Open Forum Infectious Diseases, involved 1,718 patients treated with bamlanivimab, 346 treated with bamlanivimab-etesevimab, and 815 treated with casirivimab-imdevimab. All patients were 18 or older (median age, 60) and considered high-risk for age, health condition, or comorbidity. They received transfusions from Nov 22, 2020, to May 31, 2021, in Houston, Texas.

Both 14-day and 28-day hospitalization rates post-transfusion were lower in the monoclonal antibody group (5.3% vs 12.0% and 5.8% vs 12.7%, respectively), and 28-day hospitalization risk lowered 55% for the treatment cohort (95% confidence interval [CI], 0.36 to 0.57, p < 0.001). Receiving monoclonal antibodies also lowered 28-day mortality risk by 71% (95% CI, 0.09 to 0.90, p = 0.03), and lowered intensive care unit (ICU) admission risk by 70% (95% CI, 0.15 to 0.61, p = 0.001).

Age, Hispanic and Asian ethnicity, body mass index (BMI), chronic lung disease, chronic kidney disease, or diabetes were associated with hospitalization risk, but the researchers noted that monoclonal antibodies appeared to have the greatest benefit in those 65 and older and those with BMI 35 kilograms per square meter or higher. No differences were seen across hospitalization or ICU length of stay.

While the data suggested that casirivimab and imdevimab led to the best outcomes, the researchers say that sample size, changing patient cohorts (in reflection of emergency-use authorization criteria), increased vaccination, and variants of concern may have affected this. Only two patients in the cohort had confirmed Delta (B1617.2) infection.
Oct 8 Open Forum Infect Dis study

CWD causes temporary ban on Minnesota deer farm movement

The Minnesota Department of Natural Resources (DNR) issued a temporary ban on white-tail deer movement to and within all of the state's deer farms, effective today. The emergency rule has been enacted to help the department analyze movements of farmed deer with known chronic wasting disease (CWD) exposures and those who may have been potentially exposed, according to a DNR news release today.

"This disease poses a clear, immediate and serious threat to Minnesota's wild deer, and these actions reflect what's at stake," said DNR Commissioner Sarah Strommen, MEM. "We are committed to doing everything we can to reduce the continued risk of CWD transmission in Minnesota, including from farmed deer to Minnesota's wild whitetails."

The ban was sparked by the late September discovery of farmed deer traveling from a CWD-positive farm in Wisconsin to Minnesota deer farms in 2016 and 2017. As previous CIDRAP News coverage reported, the five involved deer were in contact with three Minnesota farms, two of which are now closed.

Two of the deer were eventually sold to a Wisconsin deer farm in late 2019. Of the three remaining in Minnesota, two were already harvested and negative for CWD and the remaining is awaiting testing on a now-quarantined deer farm.

CWD is a fatal prion disease affecting the cervidae family, like deer, elk, and moose. Besides being spread from animal-to-animal through contact with infected fluids or shed antler velvet, animals can also get infected through contaminated environments. There is no cure.
Oct 11 Minnesota DNR notice
Sep 29 CIDRAP scan

CDC reports new multistate Salmonella outbreak linked to seafood

The Centers for Disease Control and Prevention (CDC) late last week issued a food safety alert concerning a Salmonella Thompson outbreak linked to raw and cooked seafood—a variety of fish species—distributed by Northeast Seafood Products. The outbreak has mainly affected Colorado residents or recent visitors.

So far, there are 102 known illnesses in 14 states. Nineteen people have required hospitalization, but no deaths have been reported. Among 62 people interviewed, 51 (82%) reported eating seafood in the week prior to illness. Eighty-two sickened people live in Colorado.

"Sick people reported eating a variety of types of raw and cooked seafood in restaurants and grocery stores. Northeast Seafood Products was identified as a common supplier where some ill people ate or shopped," the CDC said.

The fish was distributed to restaurants and grocery stores in Colorado through Oct 7, including seafood counters at Albertsons, Safeway, and Sprouts grocery stores in Colorado.

Northeast Seafood Products of Denver recalled certain types of seafood processed at their facility through Oct 7, on Oct 8. The CDC recommends all consumers who purchased fish at Albertsons, Safeway, or Sprouts discard the fish if they cannot identify that it is not a Northeast Seafood Product.
Oct 8 CDC report