Study finds high antibiotic use in Indian hospitals
A point-prevalence study conducted in five hospitals in India shows high use of antibiotics in admitted patients, with a considerable proportion coming from a category of broad-spectrum drugs with a higher potential for promoting antibiotic resistance, Indian researchers reported in the Journal of Antimicrobial Chemotherapy.
The survey, conducted over 2 weeks in May 2019 at five tertiary care centers in India, aimed to collect data on antibiotic prescribing patterns and practices in the country's hospitals, which are in the nascent stages of developing antimicrobial stewardship programs. The researchers collected data on all admitted patients in wards and intensive care units over the study period to determine indications for antibiotic use and the percentage of patients on antibiotics, receiving more than one antibiotic, and on antibiotics from the Watch and Reserve categories of the World Health Organization's Essential Medicines List.
A total of 3,473 patients were included in the study. Of these patients, 1,747 (50.3%) were on antibiotics, with 46.9% being treated with two or more antibiotics. The most common indications for antibiotic use were community-acquired infections (40.6%), surgical prophylaxis (32.6%), and hospital-acquired infections (13.5%).
Drugs from the Watch category accounted for 80.6% of prescriptions, with third-generation cephalosporins being the most widely used. Carbapenems, considered Reserve antibiotics, accounted for 11.3% of antibiotic use.
The WHO's Access, Watch, and Reserve antibiotic classification framework was introduced in 2017 to provide an indirect indication of the appropriateness of antibiotic use at national and global levels. Watch antibiotics are broader-spectrum drugs that are not recommended for routine use because of their higher potential for promoting resistance, while Reserve antibiotics are considered last-resort antibiotics that should be used only for multidrug-resistant infections. The authors of the study say it is difficult to know whether the use of these antibiotics was appropriate or not.
"The findings of the survey were helpful in generating baseline data for identifying strategies for interventions directed at reducing antimicrobial use and for evaluating the impact of future interventions," the authors of the study wrote.
Jan 11 J Antimicrob Chemother abstract
CDC: US sees nearly half a million Lyme disease cases annually
A Centers for Disease Control and Prevention (CDC) report yesterday based on insurance claims data in Emerging Infectious Diseases shows that Lyme disease was diagnosed in approximately 476,000 US patients annually from 2010 to 2018, an increase from the 329,000 annually diagnosed from 2005 to 2010.
The increase mirrors and confirms cases reported through surveillance, the authors said.
The study was based on commercial claims identified from the IBM Watson Health MarketScan Commercial Claims and Encounters Databases, which includes inpatient, outpatient, and prescription services for more than 25 million privately insured US residents under 65 years of age.
The researchers calculated that about 476,000 Lyme cases occurred each year from 2010 through 2018, with a range of 405,000 to 547,000. Though Lyme patients were identified across the United States, 81% of these diagnoses occurred among residents of 14 high-incidence states in the Northeast, mid-Atlantic, and upper Midwest, the CDC said.
"Our findings underscore the large clinical burden associated with Lyme disease diagnoses in the United States. Evolving electronic medical and laboratory systems should help fill demonstrable data gaps and enable more robust and reliable monitoring of changes in the magnitude and spread of the disease," the authors concluded.
Jan 13 Emerg Infect Dis study
Avian flu strikes again in several country, including H5N1 in Cambodia
Several countries reported more highly pathogenic avian flu outbreaks in poultry, including the reappearance of H5N1 in Cambodia, more H5N6 events in Vietnam, and more H5N8 detections in Europe, according to the latest notifications from the World Organization for Animal Health (OIE).
Cambodia reported an H5N1 outbreak in village birds in Battambang province, its first involving the strain since 2019. The outbreak began on Jan 5 and killed 1,827 of 1,990 susceptible birds. So far, the source of the virus isn't known.
Vietnam reported five H5N6 outbreaks in village poultry in four provinces, including northern Bac Ninh, Ha Noi, and Quang Ninh in the north and Phu Yen in the south. The outbreaks started from Dec 17 to Jan 8, killing 1,509 of 11,830 birds. The country's H5N6 outbreaks are its first since July 2020.
Elsewhere in Asia, Tawian reported three more outbreaks involving H5N5 at commercial farms, two housing ducks and one raising geese. The outbreaks began from Dec 25 to Dec 31 in Pingung and Yunlin counties, killing 293 of 10,141 birds.
European countries, meanwhile, reported more H5N8 outbreaks. Poland reported two outbreaks, one at a duck farm in Kujawsko-Pomorskie province and one at a goose farm in Warminsko-Mazurskie province. The outbreaks started on Jan 5 and Jan 6, and, taken together, the virus killed 77 of 1,964 birds. In a separate report, Poland reported an event at a turkey farm in Lubuskie province that began on Jan 8, killing 123 of 15,600 poultry.
Germany reported eight more outbreaks, one at a layer farm in Mecklenburg-Vorpommern states and seven at mainly turkey farms in Lower Saxony state. The outbreaks began from Jan 1 to Jan 12, and among the events the virus killed about 300 of about 128,000 birds.
Finally, Hungary reported an H5N8 outbreak at a layer farm in Bacs-Kiskun County, which began on Jan 12, leading to the culling of 101,185 birds.
Jan 14 OIE report on H5N1 in Cambodia
Jan 14 OIE report on H5N6 in Vietnam
Jan 13 OIE report on H5N5 in Taiwan
Jan 13 OIE report on H5N8 in Poland
Jan 13 OIE report on H5N8 in Poland's Lubuskie province
Jan 13 OIE report on H5N8 in Germany's Mecklenburg-Valpommern state
Jan 13 OIE report on H5N8 in Germany's Lower Saxony state
Jan 14 OIE report on H5N8 in Hungary