Giving docs feedback reports tied to improved antibiotic prescribing in kids with pneumonia

News brief
Topics
Antimicrobial Stewardship
Child in hospital
Sasiistock / iStock

Use of clinician audit and feedback reports at two children's hospitals boosted adherence to antibiotic choice and duration recommendations for children hospitalized with community-acquired pneumonia (CAP), researchers reported yesterday in Clinical Infectious Diseases.

The study, led by researchers with Children's Hospital of Philadelphia, evaluated the impact of electronically delivered audit and feedback reports on antibiotic prescribing for CAP at the hospital's two locations from December 2021 through November 2023. While electronic feedback reports have been shown to improve adherence to evidence-based recommendations for antibiotic use in outpatient settings, their use has not been well-explored in inpatient settings.

The reports, which contained information on adherence to the recommended first-line antibiotic choice (ampicillin) and duration (5 days) for CAP, were distributed by email to all general pediatrics attendings, fellows, and advanced practice providers at the hospitals and reviewed in monthly meetings. The primary outcome of the study was the proportion of all CAP encounters that involved both the appropriate antibiotic choice and duration before and after the intervention.

32% increase in rate of appropriate prescribing

A total of 800 CAP encounters occurred during the study period (413 preintervention and 387 postintervention). Adherence to appropriate antibiotic choice and duration increased from 52% of encounters preintervention to 80% postintervention. An interrupted time series analysis demonstrated an immediate 18% increase in the proportion of CAP encounters receiving both the appropriate antibiotic choice and duration (95% confidence interval [CI], 3% to 33%), with no further change over time (-0.3% per month, 95% CI, -2% to 2%). 

Using a Poisson model adjusted for age, sex, race, season, site, and intensive care unit admission, the researchers found the intervention was associated with a 32% increase in the rate of appropriate antibiotic choice and duration (rate ratio, 1.32; 95% CI, 1.12 to 1.56).

"These findings support the use of clinician feedback reports as a stewardship tool for inpatient ASPs [antibiotic stewardship programs], an approach made more feasible through use of electronically derived measures of antibiotic appropriateness," the study authors wrote.

DR Congo probes outbreak of deadly, mysterious flu-like illness

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Misc Emerging Topics

The Democratic Republic of Congo (DRC) is investigating the cause of an outbreak of an unknown disease centered in Kwango province that has so far sickened at least 376 people, with death counts ranging from 67 to 143, since late October. 

The main symptoms are fever, headache, runny nose, breathing problems, and anemia, according to the infectious disease tracking blog FluTrackers, which has been following reports of cases for the past week.

Death count as high as 143

Reuters has reported 143 deaths, while the Associated Press reported yesterday there have been from 67 to 143 fatalities.

Reuters says women and children are the most seriously affected by the disease, and the DRC statement says the illness has been most lethal in children over the age of 15.

The DRC notified the World Health Organization of the outbreak last week. The case-patients live in rural areas with limited access to medications, sources told Reuters. 

Vietnam reports human H5 avian flu case

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Topics
Avian Influenza (Bird Flu)

Health officials in Vietnam's Long An province today reported a human H5 case involving an 18-year-old man who is hospitalized in Ho Chi Minh City with pneumonia and other severe symptoms, according to foreign language media reports translated and posted by FluTrackers, an infectious disease news message board. 

backyard poultry
Alesia Davydava/iStock

Long An province is in the Mekong Delta region of southern Vietnam. The patient is from Tan An, the provincial capital.

Dead poultry found near family's home

Authorities were first notified about the case on November 14, and officials are waiting on further sequencing results to characterize the N gene. 

An investigation revealed hundreds of dead poultry at the patient's family home. 

The country reported its last human H5N1 case in March. Different H5N1 clades circulate in Vietnam and other parts of Asia and have been linked to sporadic human cases, but none involving human-to-human transmission. 

In April scientists warned of an H5N1 reassortant circulating across the Greater Mekong subregion that has infected both birds and people. It contains surface proteins of an older H5N1 clade (2.3.2.1c) that has circulated in parts of Asia with a newer clade (2.3.4.4b) that has circulated globally since 2022.

With fourth CWD case in British Columbia, officials urged to do more to contain spread

News brief
Topics
Chronic Wasting Disease
White-tailed buck in British Columbia
Tidewater Teddy / Flickr cc

Yesterday, officials in British Columbia (BC) reported a fourth case of chronic wasting disease (CWD) in the Kootenay region as the BC Wildlife Federation (BCWF) urged the province to take immediate steps to stem transmission of the fatal neurodegenerative disease.

The Canadian Food Inspection Agency confirmed the latest case last week in a white-tailed deer harvested in October.

The first two BC cases were confirmed in January 2024, with a third discovered last month. They included a mule deer and two white-tailed deer near Cranbrook. CWD surveillance efforts have resulted in the collection of 3,000 samples from the Kootenay region, in the southeastern part of the province.

"The Province is gathering data to help guide decisions and reduce the risk of the disease spreading," officials said in the news release. "These measures are supported by First Nations, stakeholders and the broader hunting community."

Calls for culling, testing, funding

But the BCWF said more action is needed. "The BCWF is concerned that chronic underfunding and a backlog of samples submitted by hunters will hamper efforts to detect and contain this fatal disease," it said in a news release. "No additional dedicated funding was allocated for CWD in the last provincial budget."

City deer have a small range and relatively high density, living in close quarters with frequent contact, which makes them a perfect vector for disease.

Jesse Zeman, MA

Jesse Zeman, MA, executive director of the BCWF, called for the culling of urban deer populations like those in Cranbrook, additional CWD testing, and dedicated funding.

"City deer have a small range and relatively high density, living in close quarters with frequent contact, which makes them a perfect vector for disease," he said. "Because deer may contract the disease but remain symptom-free for months or years, urban deer pose a high risk of dispersing the pathogen."

Caused by misfolded infectious proteins called prions, CWD affects cervids such as deer, elk, and moose. CWD can spread from animal to animal and through environmental contamination. The disease isn't known to infect humans, but authorities advise against eating meat from sick animals and recommend using precautions when handling carcasses.

This week's top reads

  1. DR Congo probes outbreak of deadly, mysterious flu-like illness

    The main symptoms are fever, headache, runny nose, breathing problems, and anemia.

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  2. Lab results expected soon in DR Congo's mystery outbreak

    Children younger than 5 years are the most affected group and account for the largest portion of deaths.

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  3. Initial samples in DR Congo unexplained outbreak positive for malaria

    Of 12 samples, 10 were malaria-positive, but officials continue to investigate other contributing factors.

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  4. Officials continue probe on DR Congo mystery illness

    31 people have died and 406 people have been sickened by the illness, which causes fever, headache, cough, runny nose, and body aches.

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  5. WHO deploys expert team to DR Congo to assist with undiagnosed outbreak probe

    As DRC officials await test results, WHO experts are also bringing medicine and test equipment to help local responders.

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  6. California reports H5N1 in more retail raw milk as virus infects 2 more dairy workers

    Meanwhile, federal officials confirmed more detections on California dairy farms and at commercial poultry farms in 6 states.

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  7. Arizona confirms 2 avian flu infections as California probes second potential case in a child

    Arizona's patients were exposed to sick poultry at a large commercial farm in Pinal County.

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  8. Ferret study suggests connection between H5N1 shedding in air and transmissibility

    The authors say it's crucial to better understand how the virus is spreading, amid the ongoing risk of exposure to farm workers and transmission among animal species.

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  9. Almost a third of preteens, teens with long COVID still not recovered at 2 years, study shows

    Those who reported COVID reinfections during the study period had the most symptoms through 24 months. 

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  10. Avian flu infects another California dairy worker as more raw milk positives prompt wider recall

    State health officials said multiple positive results in recent days came from Raw Farm's retail milk, its storage tanks, and its bottling facility.

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