ESCMID releases guidance on antimicrobial stewardship in emergency departments

News brief

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) today published guidelines for antimicrobial stewardship in emergency departments (EDs), which are endorsed by the European Association of Hospital Pharmacists. The guidelines appear in Clinical Microbiology and Infection.

emergency department — *EyeMark / iStockphoto*

In the document, the group said the ED has increasingly become a rapid diagnostic health center for healthcare systems and is often a setting for acute ambulatory cases, as well as the primary source for hospital admissions.

ESCMID convened an expert panel to craft the guidelines, and work began in 2021 with extensive literature searches on clinical outcomes and antimicrobial stewardship outcomes related to antibiotic use. The experts then graded the quality of the evidence.

The group was tasked with answering four questions: if biomarkers or pathogen tests improve prescribing or clinical outcomes, if blood cultures in common infectious infections improve outcomes, the role of watchful waiting or delayed prescribing, and whether culture follow-up programs after patients are discharged from the ED improve antibiotic prescribing.

Best practice statements for low-evidence recommendations

Most recommendations were based on very low or low certainty of evidence, leading to weak recommendations or best practice statements when no evidence was available.

Some topics, however, received strong recommendations. They include withholding antibiotics in patients who have lower respiratory tract infection with no suspicion of pneumonia and immunocompetent patients presenting to the ED with uncomplicated diverticulitis. The group also strongly recommended a structured follow-up process after ED discharge.

The experts said implementation of the recommendations should depend on specific ED settings and circumstances. They also said the lack of high-quality studies on antimicrobial stewardship in ED settings spotlights the need for more and better research.

COVID-19 lockdowns, quarantines linked to mental distress in teens

News brief

Mary Van Beusekom, MS

Sad teenage girl — *Joice Kelly / Unsplash*

A study of 7,800 teens aged 16 to 18 years in Norway ties stringent COVID-19 public health protocols and quarantine with mental distress, particularly among 16-year-olds and those with less-educated parents and a lower genetic susceptibility to depression.

Led by researchers from the Norwegian Institute of Public Health, the study collected data on 7,787 teens from the Norwegian Mother, Father, and Child Cohort Study (MoBa), national health registries, and a national lockdown-stringency index from April 2020 to February 2021.

MoBa recruited pregnant women from 1999 to 2008, consenting to provide umbilical-cord blood samples for genotyping at delivery. The team measured mental distress with the Hopkins Symptom Checklist in six COVID-19 surveys. A total of 57% of the adolescents were girls, and 22% had experienced quarantine.

On March 12, 2020, the Norwegian government closed schools and issued stay-at-home mandates, ordered 14-day quarantines for those who had traveled abroad or had contact with infected people, and initiated travel restrictions to reduce the spread of SARS-CoV-2.

"Adolescence is a critical developmental phase when mental health disorders, such as anxiety and depression, often emerge," the study authors wrote. "Stringent public health measures and quarantine mandates during the COVID-19 pandemic could threaten adolescent mental health."

Targeted teen support needed in future crises

Strict COVID-19 public health measures, recent quarantine, and frequent quarantines were linked to greater mental distress, and the association wasn't changed by sex, age, prepandemic anxiety or depression, or genetic liability for mental illness in general. The effects were especially apparent among 16-year-olds, those with parents with lower educational attainment, and those with lower genetic susceptibility to depression.

Adolescents who experienced increased mental distress during the COVID-19 pandemic may be at risk of continued mental health problems and in need of ongoing support.

"These findings emphasize the need for targeted support strategies to better protect adolescent well-being during future crises," the researchers wrote. "For instance, considering the varying risks and impacts across different people, quarantine measures might be adjusted so that they are not mandatory for vulnerable groups."

"Adolescents who experienced increased mental distress during the COVID-19 pandemic may be at risk of continued mental health problems and in need of ongoing support," they added.

CDC analysis shows high rate of parental hesitation toward kids' vaccinations

News brief

Jim Wappes

girl getting vaccine bandaid — *Drazen Zigic / iStock*

Analysis of US national survey data reveal that the percentage of children with a vaccine-hesitant parent varies by vaccine, ranging from 56% for the COVID-19 vaccine to 12% for routine childhood vaccines, according to a study yesterday in Vaccine.

Researchers from the Centers for Disease Control and Prevention (CDC) wrote, "Some public health professionals have expressed concern that the COVID-19 pandemic has increased vaccine hesitancy about routine childhood vaccines."

They analyzed data from the National Immunization Survey-Child COVID-19 Module from October 2022 through April 2023 to quantify the potential impact on children 6 months to 17 years old. They assessed their parents' hesitancy toward COVID-19, flu, and human papillomavirus (HPV) vaccines, as well as "all other childhood shots."

About 30% of parents hesitant about flu, HPV vaccines

The percentage of children with a parent who was somewhat or very hesitant varied widely by vaccine, with hesitancy toward COVID vaccines, at 55.9%, far outpacing the others. The percentage of children who had a parent hesitant about the flu vaccine was 30.9%, for the HPV vaccine it was 30.1%, and for other vaccines, such as those protecting against measles, polio, and tetanus, it was 12.2%. The percentage that was very hesitant was 37.6%, 15.0%, 14.4%, and 4.1%, respectively, for COVID, flu, HPV, and childhood vaccines.

Differences in hesitation among racial and ethnic groups also varied by vaccine. For example, for COVID-19, a lower percentage of Asian (38.1%) and Hispanic (51.5%) children had a hesitant parent than White children (58.4%). For flu, 20.3% of Asian and 27.9% of Hispanic children were in that category, compared with 30.2% of White children, 39.8% of Black children, and 35.3% of children of other or multiple races.

The CDC researchers conclude, "The study findings of large differences in vaccine hesitancy across vaccines suggest the usefulness of developing vaccine-specific hesitancy interventions and communications for parents to educate about COVID-19, influenza, HPV, and other routine childhood vaccinations."