Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2020/07/news-scan-jul-13-2020
News Scan for Jul 13, 2020
New DRC Ebola cases; Antimicrobial resistance in Canada; Antibiotic prescribing for kids' bronchiolitis; Stewardship in Chinese primary care
Filed Under:
Ebola; VHF; Antimicrobial Stewardship
More Ebola cases reported in DRC's latest outbreak
The Democratic Republic of the Congo's Ebola outbreak in Equateur province has risen to 51 cases, 48 confirmed, and 3 probable, reflecting an increase of 5 since Jul 9.
At a World Health Organization (WHO) media briefing today, Mike Ryan, MD, who leads the group's health emergencies program, said as of Jul 12, 20 deaths have been reported, 17 in confirmed cases and 3 in probable ones.
In Equateur province, the cases are spread across 21 health areas in 6 health zones, which means they are broadly distributed and concerning. Ryan said some areas are remote and hard to access, and some are located near the Congo River, posing a risk of spread to Kinshasa and bordering countries. "It's still a very active outbreak," he said.
In an update today, the DRC's multisectoral Ebola technical committee (CMRE) said as of Jul 10, 10,916 people in the outbreak region have been vaccinated with VSV-EBOV.
The DRC's latest outbreak, its 11th, is occurring in the same area where its 9th outbreak unfolded in 2018, which resulted in 54 cases, 33 of them fatal.
Jul 13 CMRE update
Canadian report shows worrisome rise in drug-resistant infections
A new report from the Public Health Agency of Canada (PHAC) indicates antimicrobial resistance (AMR) is worsening in the country, highlighted by dramatic increases in drug-resistant bloodstream infections (BSIs).
The 2020 Canadian Antimicrobial Resistance Surveillance System Report, released late last week, shows that from 2014 through 2018, the rate of healthcare-associated vancomycin-resistant Enterococcus (VRE) BSI more than doubled, while the rate of community-associated methicillin-resistant Staphylococcus aureus (MRSA) BSI rose by 140%. Approximately 30% of VRE-BSI and 20% of MRSA-BSI patients died within 30 days of diagnosis.
The report also showed a nine-fold increase in the number of patients testing positive for carbapenem-resistant organisms without signs of infection, detection of carbapenemase genes in Acinetobacter isolated from hospital patients, a 78% increase in the proportion of multidrug-resistant gonorrhea isolates (including the first Canadian reports of ceftriaxone-resistant gonorrhea), and rising ceftriaxone resistance in Salmonella Typhi (typhoid fever) infections.
The frequency of highly drug-resistant Salmonella enterica isolated from animals, humans, and the food chain reached new highs (132 isolates in 2018).
Antimicrobial use in the country increased as well, with rising prescription rates for Canadians over age 65 and a 30% uptick in antimicrobial purchasing by hospitals. In addition, the use of antibiotics that should be reserved for treating multidrug-resistant infections rose by 10%, and the use of carbapenems increased by more than 120% in the community setting. Kilograms of antimicrobials distributed for use in animals dropped overall by 11% but saw a 6% increase from 2017 to 2018.
The reported also highlighted several new surveillance initiatives, including a pilot project to track AMR in the community sector by looking at patterns of resistance in urinary tract infections, and the implementation of whole-genome sequencing to help identify factors associated with food production and AMR.
"No one country, level of government or single sector can slow the growing problem of AMR on its own," the report said. "Preserving the effectiveness of existing antimicrobial drugs will be achieved through collaboration among governments and partners in healthcare, animal health, agri-food, industry, academia, professional associations and the general public."
Jul 9 PHAC report
International study finds low rate of antibiotic prescribing for kids' bronchiolitis
A large international study of infants evaluated in the emergency department (ED) for bronchiolitis found that the overall rate of antibiotic therapy was low, but the use of laboratory testing was substantial, researchers reported today in Pediatrics.
To address the knowledge gap in the understanding of antibiotic use and laboratory testing in infants with bronchiolitis—both of which are discouraged unless bacterial infections are suspected—researchers with the Pediatric Emergency Research Networks conducted a secondary analysis of a retrospective cohort study of previously healthy infants with bronchiolitis treated at 38 EDs in eight countries (United States, Canada, United Kingdom, Ireland, Spain, Portugal, Australia, and New Zealand).
The primary outcome was administration of at least one antibiotic in the ED or a prescription for an antibiotic at discharge, and the secondary outcome was performance of at least one non-recommended laboratory test.
In total, 180 of 2,359 infants (7.6%) received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. Chest x-rays (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.6 to 3.2), apnea (aOR, 2.2; 95% CI, 1.1 to 3.5), and fever (aOR, 2.4; 95% confidence interval [CI], 1.7 to 3.4) were associated with antibiotic use.
Antibiotic use did not vary across networks. A total of 768 of 2,359 infants (32.6%) had at least one non-indicated test, with rates of testing ranging from 14.9% in the United Kingdom and Ireland to 50% in Spain and Portugal. Testing was associated with the network, indicators of respiratory distress, fever, and suspected bacterial infection.
The authors said that while the rate of antibiotic use for bronchiolitis is close to the published achievable benchmarks of care, the rate of unnecessary testing observed needs to come down.
"In view of the high global prevalence of bronchiolitis and the cost of bronchiolitis care, our results highlight the need for development of international bronchiolitis benchmarks, guidelines, and quality initiatives to optimize the global management of bronchiolitis," they concluded.
Jul 13 Pediatrics abstract
National stewardship campaign in China tied to fewer primary care antibiotics
A study of community health centers in China found that strict enforcement of a national antimicrobial stewardship campaign had a strong effect on antibiotic prescribing, Chinese researchers reported last week in Clinical Infectious Diseases.
The study used an interrupted time series (ITS) analysis to evaluate the impact of local interventions, based on China's long-term national antimicrobial stewardship campaign, on antibiotic prescribing for primary care in Shenzhen, China, a city of 13 million. Previous studies have shown that the campaign, launched in 2011, has been associated with declines in antibiotic use in Chinese general hospitals, but no studies have assessed the impact on primary care.
The ITS analysis lasted 72 months, including 24 months before the intervention (January 2010 to December 2011) and 48 months after the intervention (January 2012 to December 2015).
Overall, 1,482,223 outpatient prescriptions were obtained from 11 community health centers in Shenzhen. The results of the ITS analysis showed that intervention was associated with an immediate decline of 5.2% and a monthly decline of 3.1% in the percentage of prescriptions with antibiotics, with a cumulative decline of 74% at the end of the study, representing 420,057 antibiotic prescriptions avoided during the 48 post-intervention months.
The percentage of prescriptions for acute upper respiratory infection containing antibiotics fell by 76.2%. In addition, the percentage of prescriptions with broad-spectrum and parenteral antibiotics fell by 36.7% and 77.3%, respectively, immediately after the intervention. But no significant decline in broad-spectrum and parenteral antibiotic use was observed over the course of the study.
The authors of the study said the decline in the percentage of prescriptions with antibiotics was attributed to the multidimensional interventions implemented at the community health centers.
"Additionally, achieving such a good intervention effect was attributed to the strict enforcement of this stewardship campaign," they wrote. "The Chinese government should embed the multidimensional interventions into the routine management of antibiotic prescribing in primary care to optimize antibiotic prescribing and prevent AMR."
Jul 10 Clin Infect Dis abstract
News Scan for Jul 13, 2020
New DRC Ebola cases; Antimicrobial resistance in Canada; Antibiotic prescribing for kids' bronchiolitis; Stewardship in Chinese primary care
Filed Under:
Ebola; VHF; Antimicrobial Stewardship
More Ebola cases reported in DRC's latest outbreak
The Democratic Republic of the Congo's Ebola outbreak in Equateur province has risen to 51 cases, 48 confirmed, and 3 probable, reflecting an increase of 5 since Jul 9.
At a World Health Organization (WHO) media briefing today, Mike Ryan, MD, who leads the group's health emergencies program, said as of Jul 12, 20 deaths have been reported, 17 in confirmed cases and 3 in probable ones.
In Equateur province, the cases are spread across 21 health areas in 6 health zones, which means they are broadly distributed and concerning. Ryan said some areas are remote and hard to access, and some are located near the Congo River, posing a risk of spread to Kinshasa and bordering countries. "It's still a very active outbreak," he said.
In an update today, the DRC's multisectoral Ebola technical committee (CMRE) said as of Jul 10, 10,916 people in the outbreak region have been vaccinated with VSV-EBOV.
The DRC's latest outbreak, its 11th, is occurring in the same area where its 9th outbreak unfolded in 2018, which resulted in 54 cases, 33 of them fatal.
Jul 13 CMRE update
Canadian report shows worrisome rise in drug-resistant infections
A new report from the Public Health Agency of Canada (PHAC) indicates antimicrobial resistance (AMR) is worsening in the country, highlighted by dramatic increases in drug-resistant bloodstream infections (BSIs).
The 2020 Canadian Antimicrobial Resistance Surveillance System Report, released late last week, shows that from 2014 through 2018, the rate of healthcare-associated vancomycin-resistant Enterococcus (VRE) BSI more than doubled, while the rate of community-associated methicillin-resistant Staphylococcus aureus (MRSA) BSI rose by 140%. Approximately 30% of VRE-BSI and 20% of MRSA-BSI patients died within 30 days of diagnosis.
The report also showed a nine-fold increase in the number of patients testing positive for carbapenem-resistant organisms without signs of infection, detection of carbapenemase genes in Acinetobacter isolated from hospital patients, a 78% increase in the proportion of multidrug-resistant gonorrhea isolates (including the first Canadian reports of ceftriaxone-resistant gonorrhea), and rising ceftriaxone resistance in Salmonella Typhi (typhoid fever) infections.
The frequency of highly drug-resistant Salmonella enterica isolated from animals, humans, and the food chain reached new highs (132 isolates in 2018).
Antimicrobial use in the country increased as well, with rising prescription rates for Canadians over age 65 and a 30% uptick in antimicrobial purchasing by hospitals. In addition, the use of antibiotics that should be reserved for treating multidrug-resistant infections rose by 10%, and the use of carbapenems increased by more than 120% in the community setting. Kilograms of antimicrobials distributed for use in animals dropped overall by 11% but saw a 6% increase from 2017 to 2018.
The reported also highlighted several new surveillance initiatives, including a pilot project to track AMR in the community sector by looking at patterns of resistance in urinary tract infections, and the implementation of whole-genome sequencing to help identify factors associated with food production and AMR.
"No one country, level of government or single sector can slow the growing problem of AMR on its own," the report said. "Preserving the effectiveness of existing antimicrobial drugs will be achieved through collaboration among governments and partners in healthcare, animal health, agri-food, industry, academia, professional associations and the general public."
Jul 9 PHAC report
International study finds low rate of antibiotic prescribing for kids' bronchiolitis
A large international study of infants evaluated in the emergency department (ED) for bronchiolitis found that the overall rate of antibiotic therapy was low, but the use of laboratory testing was substantial, researchers reported today in Pediatrics.
To address the knowledge gap in the understanding of antibiotic use and laboratory testing in infants with bronchiolitis—both of which are discouraged unless bacterial infections are suspected—researchers with the Pediatric Emergency Research Networks conducted a secondary analysis of a retrospective cohort study of previously healthy infants with bronchiolitis treated at 38 EDs in eight countries (United States, Canada, United Kingdom, Ireland, Spain, Portugal, Australia, and New Zealand).
The primary outcome was administration of at least one antibiotic in the ED or a prescription for an antibiotic at discharge, and the secondary outcome was performance of at least one non-recommended laboratory test.
In total, 180 of 2,359 infants (7.6%) received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. Chest x-rays (adjusted odds ratio [aOR], 2.3; 95% confidence interval [CI], 1.6 to 3.2), apnea (aOR, 2.2; 95% CI, 1.1 to 3.5), and fever (aOR, 2.4; 95% confidence interval [CI], 1.7 to 3.4) were associated with antibiotic use.
Antibiotic use did not vary across networks. A total of 768 of 2,359 infants (32.6%) had at least one non-indicated test, with rates of testing ranging from 14.9% in the United Kingdom and Ireland to 50% in Spain and Portugal. Testing was associated with the network, indicators of respiratory distress, fever, and suspected bacterial infection.
The authors said that while the rate of antibiotic use for bronchiolitis is close to the published achievable benchmarks of care, the rate of unnecessary testing observed needs to come down.
"In view of the high global prevalence of bronchiolitis and the cost of bronchiolitis care, our results highlight the need for development of international bronchiolitis benchmarks, guidelines, and quality initiatives to optimize the global management of bronchiolitis," they concluded.
Jul 13 Pediatrics abstract
National stewardship campaign in China tied to fewer primary care antibiotics
A study of community health centers in China found that strict enforcement of a national antimicrobial stewardship campaign had a strong effect on antibiotic prescribing, Chinese researchers reported last week in Clinical Infectious Diseases.
The study used an interrupted time series (ITS) analysis to evaluate the impact of local interventions, based on China's long-term national antimicrobial stewardship campaign, on antibiotic prescribing for primary care in Shenzhen, China, a city of 13 million. Previous studies have shown that the campaign, launched in 2011, has been associated with declines in antibiotic use in Chinese general hospitals, but no studies have assessed the impact on primary care.
The ITS analysis lasted 72 months, including 24 months before the intervention (January 2010 to December 2011) and 48 months after the intervention (January 2012 to December 2015).
Overall, 1,482,223 outpatient prescriptions were obtained from 11 community health centers in Shenzhen. The results of the ITS analysis showed that intervention was associated with an immediate decline of 5.2% and a monthly decline of 3.1% in the percentage of prescriptions with antibiotics, with a cumulative decline of 74% at the end of the study, representing 420,057 antibiotic prescriptions avoided during the 48 post-intervention months.
The percentage of prescriptions for acute upper respiratory infection containing antibiotics fell by 76.2%. In addition, the percentage of prescriptions with broad-spectrum and parenteral antibiotics fell by 36.7% and 77.3%, respectively, immediately after the intervention. But no significant decline in broad-spectrum and parenteral antibiotic use was observed over the course of the study.
The authors of the study said the decline in the percentage of prescriptions with antibiotics was attributed to the multidimensional interventions implemented at the community health centers.
"Additionally, achieving such a good intervention effect was attributed to the strict enforcement of this stewardship campaign," they wrote. "The Chinese government should embed the multidimensional interventions into the routine management of antibiotic prescribing in primary care to optimize antibiotic prescribing and prevent AMR."
Jul 10 Clin Infect Dis abstract