Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2021/10/news-scan-oct-21-2021
News Scan for Oct 21, 2021
Antibiotic prescribing on mental health units; Salmonella outbreak tied to onions
Filed Under:
Antimicrobial Stewardship; Salmonella; Foodborne Disease
Data show low antibiotic prescribing, UTI misdiagnosis on mental health units
A review of antibiotic prescribing at Veterans' Health Administration (VHA) mental health units found that only 1 in 10 patients were exposed to antibiotics, but urinary tract infections (UTIs) appeared to be frequently misdiagnosed, researchers reported today in Infection Control & Hospital Epidemiology.
In the study, researchers from the Iowa City VA Health Care System looked at data on inpatient and post-discharge antibiotics at 111 VHA mental health units from 2016 through 2018. They also conducted chart reviews for a subset of patients to assess adherence to standard recommended practices and professional guidelines for UTIs, cystitis, skin and other soft-tissue infections (SSTIs), and acute respiratory infections (ARIs).
During the study period, 27,401 (10.9%) of 252,588 admitted patients had an antibiotic administered while hospitalized on the mental health unit. The median inpatient antibiotics days of therapy across all 111 units was 73.5 per 1,000 days present. The infections most commonly associated with an antibiotic prescription were UTIs (18.3%), SSTIs (10.9%), and ARIs (7.1%).
Chart review found that, among 111 UTI cases, 63 (56.8%) were not supported by patient history or laboratory findings, and in 24.3% of UTI cases, the presence of altered mental status appeared to be the driver of antibiotic therapy, even though antibiotics are not recommended for bacteriuria in the context of cognitive impairment alone.
"Overall, these findings suggest that UTI is commonly misdiagnosed and therefore represent an optimal target for stewardship efforts," the study authors wrote.
The study also found that 25.3% of the antibiotic recommendations were made by emergency department physicians, and 27.8% by internal medicine physicians, a finding the authors say suggests that these specialties should be included in any efforts to improve antibiotic prescribing at VHA mental health units.
Oct 21 Infect Control Hosp Epidemiol abstract
Large US Salmonella outbreak linked to onions; 652 cases confirmed
The Centers for Disease Control and Prevention (CDC) first reported a Salmonella Oranienburg outbreak in mid-September, and now the rapidly growing outbreak has been linked to fresh yellow, red, and white onions from Chihuahua, Mexico, distributed by ProSource, Inc. Investigators are still seeing if other onions or suppliers have been affected.
As of Oct 18, 652 illnesses, 129 known hospitalizations, and zero deaths have been reported. Thirty-seven states have been affected, with the most cases in Texas (158), Oklahoma (98), and Virginia (59).
Investigators were able to connect the outbreak to the onions after 75% of 193 interviewed people reported consuming raw onions or dishes likely containing raw onions. From that information, 20 illness clusters from restaurants were identified, and one of the clusters was at a restaurant where Salmonella Oranienburg was identified in a condiment container.
No food recalls have been issued, but the CDC recommends that people throw away their onions if they were from ProSource or Chihuahua or if they do not know their onions' origins. They should also wash contaminated surfaces. ProSource says the last import was Aug 27, but the onions, which were distributed to grocers and restaurants, can last up to 3 months in storage.
Whole-genome sequencing from 609 people's bacteria samples did not predict any antibiotic resistance to Salmonella-related treatment.
Oct 20 CDC update
Oct 1 CIDRAP News scan on previous update
News Scan for Oct 21, 2021
Antibiotic prescribing on mental health units; Salmonella outbreak tied to onions
Filed Under:
Antimicrobial Stewardship; Salmonella; Foodborne Disease
Data show low antibiotic prescribing, UTI misdiagnosis on mental health units
A review of antibiotic prescribing at Veterans' Health Administration (VHA) mental health units found that only 1 in 10 patients were exposed to antibiotics, but urinary tract infections (UTIs) appeared to be frequently misdiagnosed, researchers reported today in Infection Control & Hospital Epidemiology.
In the study, researchers from the Iowa City VA Health Care System looked at data on inpatient and post-discharge antibiotics at 111 VHA mental health units from 2016 through 2018. They also conducted chart reviews for a subset of patients to assess adherence to standard recommended practices and professional guidelines for UTIs, cystitis, skin and other soft-tissue infections (SSTIs), and acute respiratory infections (ARIs).
During the study period, 27,401 (10.9%) of 252,588 admitted patients had an antibiotic administered while hospitalized on the mental health unit. The median inpatient antibiotics days of therapy across all 111 units was 73.5 per 1,000 days present. The infections most commonly associated with an antibiotic prescription were UTIs (18.3%), SSTIs (10.9%), and ARIs (7.1%).
Chart review found that, among 111 UTI cases, 63 (56.8%) were not supported by patient history or laboratory findings, and in 24.3% of UTI cases, the presence of altered mental status appeared to be the driver of antibiotic therapy, even though antibiotics are not recommended for bacteriuria in the context of cognitive impairment alone.
"Overall, these findings suggest that UTI is commonly misdiagnosed and therefore represent an optimal target for stewardship efforts," the study authors wrote.
The study also found that 25.3% of the antibiotic recommendations were made by emergency department physicians, and 27.8% by internal medicine physicians, a finding the authors say suggests that these specialties should be included in any efforts to improve antibiotic prescribing at VHA mental health units.
Oct 21 Infect Control Hosp Epidemiol abstract
Large US Salmonella outbreak linked to onions; 652 cases confirmed
The Centers for Disease Control and Prevention (CDC) first reported a Salmonella Oranienburg outbreak in mid-September, and now the rapidly growing outbreak has been linked to fresh yellow, red, and white onions from Chihuahua, Mexico, distributed by ProSource, Inc. Investigators are still seeing if other onions or suppliers have been affected.
As of Oct 18, 652 illnesses, 129 known hospitalizations, and zero deaths have been reported. Thirty-seven states have been affected, with the most cases in Texas (158), Oklahoma (98), and Virginia (59).
Investigators were able to connect the outbreak to the onions after 75% of 193 interviewed people reported consuming raw onions or dishes likely containing raw onions. From that information, 20 illness clusters from restaurants were identified, and one of the clusters was at a restaurant where Salmonella Oranienburg was identified in a condiment container.
No food recalls have been issued, but the CDC recommends that people throw away their onions if they were from ProSource or Chihuahua or if they do not know their onions' origins. They should also wash contaminated surfaces. ProSource says the last import was Aug 27, but the onions, which were distributed to grocers and restaurants, can last up to 3 months in storage.
Whole-genome sequencing from 609 people's bacteria samples did not predict any antibiotic resistance to Salmonella-related treatment.
Oct 20 CDC update
Oct 1 CIDRAP News scan on previous update