High antibiotic prescribing rates found in COVID-19 patients
A rapid review and meta-analysis of studies involving more than 35,000 COVID-19 patients has found that three-quarters received antibiotics even though fewer than 10% had a bacterial co-infection, Canadian researchers reported today in Clinical Microbiology and Infection.
A total of 35,263 patients with laboratory-confirmed COVID-19 were included across 154 studies published from Jan 1 through Jun 9, 2020. Random effects meta-analysis of all combined studies estimated an antibiotic prescribing prevalence of 74.6% (95% confidence interval [CI], 68.3% to 80.0%). The prevalence of antibiotic use was highest in east/southeast Asia (87.5%), followed by the Middle East (86%), China (76.2%), North America (64.8%), and Europe (63.1%). Across healthcare provider settings, antibiotic use was highest in the intensive care unit (86.4%).
On univariable meta-regression, antibiotic prescribing was lower in children compared with adults (prescribing prevalence odds ratio [OR], 0.10; 95% CI, 0.03 to 0.33), higher with increasing patient age (OR, 1.45 per 10-year increase; 95% CI, 1.18 to 1.77), and higher with increasing proportion of patients requiring mechanical ventilation (OR, 1.33 per 10% increase; 95% CI, 1.15 to 1.54).
Among the 31 studies that reported on concomitant bacterial infection, pooled data indicated 8.6% prevalence (95% CI, 4.7% to 15.2%).
"As such, antibiotic prescribing is significantly higher than the prevalence of bacterial co-infection suggesting a large number of antibiotic prescriptions are unnecessary, increasing the risk of preventable harm including adverse events, C. difficile infection, and antimicrobial resistance," the authors wrote.
They concluded that antimicrobial stewardship efforts are urgently needed to help mitigate the impact of COVID-19 on antimicrobial resistance.
Jan 5 Clin Microbiol Infect abstract
Dutch study on excess deaths finds 1% COVID-19 case-fatality rate
The overall infection-fatality rate for the SARS-CoV-2 virus is 1% in the Netherlands, according to a study assessing excess COVID-19 versus flu deaths yesterday in Emerging Infectious Diseases.
While COVID-related excess deaths in the Netherlands are comparable to those during the decade's most severe flu seasons, the researchers point out that COVID-related deaths occurred over a much shorter time and were mitigated by nonpharmaceutical control measures such as school, bar, and restaurant closures; stay-at-home orders; and mask usage.
The researchers looked at national COVID-19 data from March through May 2020, and compared it with excess flu deaths from the previous 10 flu seasons.
Excess deaths numbered 9,554 during the COVID-19 epidemic from Mar 12 through May 6, 1.8-fold higher than the 5,449 lab-confirmed COVID-19 deaths recorded. Although the researchers concede that attributing the difference to COVID is a slight oversimplification, they also point out ways the disease indirectly affected healthcare, such as medical postponements, possible fluctuations in accidents and suicides, and the omission of the first 2 weeks of data that overlapped the flu season.
The 9,554 deaths during the spring COVID epidemic were 41% over the baseline, and they are well above the 4,000 average excess deaths per flu season. Flu-related excess deaths fluctuate wildly, too; during the 2013-14 flu season, no excess deaths were recorded.
By early May, preliminary serologic tests found that 5.5% of the Netherland's 17.3 million people had been exposed to COVID-19, about 14 times lower than the estimated 75% to 80% that might have occurred if the country had not enforced any COVID-19 safety measures. Using the same case-fatality rate, the researchers say that those measures may have helped prevent 124,202 deaths, or 0.72% of the population.
The researchers say that excess deaths returned to baseline levels after May 6 even as COVID-related deaths still occurred.
Jan 4 Emerg Infect Dis study
Widespread jail COVID-19 outbreak involved many asymptomatic cases
Yesterday in a separate Emerging Infectious Diseases study, the authors describe the prevalence of COVID-19 at a Louisiana correctional facility and find that the virus spread quickly and thoroughly in quarantined dormitories, and many prisoners were asymptomatically infected with the novel coronavirus.
The study was based on serial testing of prisoners beginning in May 2020. The facility had capacity to hold 800 detainees, but was operating at 85% capacity following infections detected in prisoners and staff in March. A total of 143 prisoners in six dormitories were tested for the virus, and only one dorm remained free of COVID-19.
On the first day of serial testing, 54% of detainees in the five dormitories tested positive for the virus. Within 1 month, the overall cumulative incidence rose to 78%, or 111 of 143 prisoners.
None of the prisoners required hospitalization. Among the 111 inmates with positive tests, only 21 (19%) were symptomatic at the time of their first positive test result, and 27 (24%) reported symptoms that had resolved before their first positive test result, the authors said. Forty-nine detainees with positive tests (44%) were asymptomatic.
Prisons have hosted large outbreaks of COVID-19 during the pandemic; as of Oct 20, 2020, at least 146,472 cases and 1,122 deaths in this population were reported in the United States.
"In correctional and detention facilities, prevention and mitigation of SARS-CoV-2 transmission requires a combination of measures," the authors concluded. "Testing is necessary to identify asymptomatic and presymptomatic persons who can silently transmit the infection. Although symptom screening alone was not sufficient to identify SARS-CoV-2 infections, it could serve as a signal for SARS-CoV-2 introduction and initiation of widespread testing."
Jan 4 Emerg Infect Dis study
Worries over violence tied to COVID bump in gun ownership in California
In a 2,870-person survey representative of the adult population of California, 43.0% of people who acquired a firearm during the pandemic were new gun owners, according to a study published yesterday in JAMA Network Open. While the most common reason for any pandemic firearm purchase was concern about lawlessness (75.9%), the researchers write that these fears can cause unsafe storage practices, leading to more instances of gun violence.
In all, 748 respondents (23.5%, due to nonanswers) were firearm owners or shared households with a firearm owner. During the pandemic, 2.4% acquired a gun and 8.5% acquired ammunition.
While 62.7% of firearm owners reported storing their firearms securely (ie, unloaded and locked up), 18.0% said at least one firearm is stored loaded and not locked up, with 1.2% citing the pandemic as the direct cause. Fifty-three percent of those who practice unsafe firearm storage live in a household with children or teenagers.
Across the general population, survey data collected from Jul 14 through 27 show increasing concerns across seven of eight categories, from robbery (+2.8 percentage points, 68.2%) to stray bullet shootings (+5.6, 50.0%). Because of pandemic-related losses such as loved ones, jobs, and housing, 1.8% said they know someone who might hurt others, and 7.5% said they know someone who might purposefully hurt themselves. Of those who might hurt themselves, respondents said 6.0% had access to a firearm.
"A harm reduction approach creates opportunities for engagement to increase the adoption of programs that may lower risk," write Katelin Hoskins, PhD, MBE, and Rinad Beidas, PhD, in an accompanying editorial. "For example, creative design of virtual firearm safety courses that maintain core components (ie, safe handling and storage) may better reach the new owners who have fewer training options amid COVID-19 mitigation measures."
They add that safe storage practices are imperative to prevent incidents such as suicides. They write, "Evidence-based interventions that create time and space between at-risk individuals and lethal means are critical, particularly within the context of increased firearm acquisition and increased psychological distress nationally."
Jan 4 JAMA Netw Open study
Jan 4 JAMA Netw Open editorial
H5N8 avian flu strikes more poultry in Asia and Europe
Countries in Asia and Europe reported more highly pathogenic H5N8 avian flu outbreaks in poultry, according to the latest notifications from the World Organization for Animal Health (OIE).
In Asia, where a virus related to last year's European strain is circulating, Japan reported four more outbreaks in four prefectures: Kagawa, Chiba, Miyazaki, and Gifu. The outbreaks started from Dec 22 to Jan 1, affecting commercial broiler and layer farms. Between the four events, the virus killed 222 of 1,160,000 susceptible birds.
South Korea reported nine more outbreaks in five provinces: North Jeolla, South Jeolla, South Chungcheong, Gyeonggi, and North Gyeongsang. They began from Dec 28 to Jan 1, striking a variety of commercial locations, affecting chickens, ducks, and quail. Taken together, the outbreaks killed 1,698 of 589,794 birds.
In Europe, where a subtype that emerged recently in southwest Russia is circulating, Germany reported three more outbreaks in Lower Saxony state. The events all involved turkey farms and began on Jan 1 and Jan 2. Among the three events, the virus killed 53 of 30,146 birds.
Finally, Sweden reported an outbreak at a broiler breeding farm in Skane County in the far south that began on Jan 2, killing 200 of 18,563 poultry.
Jan 4 OIE report on H5N8 in Japan
Jan 4 OIE report on H5N8 in South Korea
Jan 4 OIE report on H5N8 in Germany
Jan 4 OIE report on H5N8 in Sweden
