Guidelines aim to reduce surgical-site infections in lower-resource nations
An international team of surgeons this week released a set of recommendations for preventing surgical-site infections (SSIs) that aim to improve patient outcomes, reduce unnecessary antibiotic exposure, and curb antibiotic resistance in low- and middle-income countries (LMICs).
Published in the British Journal of Surgery, the guidelines identify nine essential recommendations for reducing SSIs that focus on patients undergoing abdominal surgery and can be feasibly implemented in low-resource settings. The recommendations include selecting antibiotic prophylaxis according to published local, regional, or national guidelines and taking into account local resistance patterns; administering antibiotic prophylaxis for all patients undergoing clean-contaminated, contaminated, or dirty surgery; administering antibiotic prophylaxis within 1 hour before surgery; and not routinely continuing prophylactic antibiotics beyond 24 hours after surgery.
SSIs are among the most common post-operative complications from abdominal surgery, particularly in LMICs, where an estimated 14.7 million patients develop an infection after gastrointestinal surgery. In addition, LMICs have significantly higher rates of antibiotic resistance.
"High rates of SSI and antimicrobial resistance are a real worry for surgeons, particularly in LMICs. Although guidelines for prevention of SSI have previously been published, they were developed in high income countries with little thought for the specific needs of LMIC patients," co-lead author Adewale Adisa, MBChB, of Obafemi Awolowo University in Nigeria said in a press release from the University of Birmingham, which led the collaboration. "This is the first guideline to have been led by LMIC surgeons and I believe our recommendations can be implemented immediately to benefit all patients across the world."
The collaboration was commissioned by the UK National Institute for Health Research.
Mar 24 Br J Surg paper
Mar 25 University of Birmingham press release
Canadian study links fewer early antibiotics to reduced childhood asthma
A new study by Canadian scientists provides further support for the link between early antibiotic use and childhood asthma.
The study, led by researchers from the University of British Columbia and published in The Lancet Respiratory Medicine, included both a population-level analyses of children born in British Columbia from 2000 to 2014 and an individual-level analysis of a cohort of children enrolled in the Canadian Healthy Infant Longitudinal Development (CHILD) study, which includes children recruited prenatally in four Canadian cities from 2008 to 2012.
The researchers also analyzed 16S rRNA gene sequencing data from fecal samples of children in the CHILD study to assess how composition of the gut microbiota relates to antibiotic exposure and asthma incidence.
The researchers found that, at the population level, a 26% decrease in asthma incidence in children ages 1 to 4 from 2000 to 2014 (from 27.3 diagnoses per 1,000 children to 20.2 per 1,000 children) was correlated with a 61% decrease in antibiotic use in children under the age of 1 during the same period (from 1,253 prescriptions per 1,000 infants to 489.1 per 1,000 infants). Further analysis revealed that asthma incidence increased 24% with each 10% increase in antibiotic prescribing (adjusted incidence rate ratio, 1.24; 95% confidence interval [CI], 1.20 to 1.28, P < 0.0001).
Analysis of 2,644 children in the CHILD study, after excluding children who received antibiotics for respiratory symptoms, found that outpatient antibiotic use in the first year of life was significantly associated with asthma diagnosis by age 5 (adjusted odds ratio [aOR], 2.15; 95% CI, 1.37 to 3.39, P = 0.0009), with a significant dose response; the aOR for diagnosis of asthma rose from 1.93 in children exposed to one course of antibiotics to 3.25 in children exposed to three or more courses.
Examination of 16s rRNA gene sequences from children in the CHILD cohort found that the gut microbiota of children who received antibiotics showed reductions in six key bacterial taxa, with two of the bacterial species having mechanistic links to asthma, a finding that suggests that gut bacteria may play a mediating role in asthma development.
The authors conclude, "Our findings suggest that the reduction in the incidence of paediatric asthma observed in recent years might be an unexpected benefit of prudent antibiotic use during infancy, acting via preservation of the gut microbial community."
Mar 24 Lancet Respir Med abstract
Study finds varying vaccine protection from H3N2 flu strain
A separate study by Canadian researchers that looked at flu vaccine effectiveness (VE) against the H3N2 strain during different flu seasons found that protection was similar among people with and without prior vaccination in the 2016-17 season, but lower in those with prior vaccination during the 2017-18 season.
The team published its findings today in the Journal of Infectious Diseases. The probe is part of ongoing research at several labs to tease out the reasons flu VE for H3N2—a strain typically associated with more severe disease—is often lower than for other strains.
The investigators used a test-negative design to look at flu VE in those two seasons from data in the Canadian Sentinel Practitioner Surveillance Network, looking at the subcluster and participants' prior-season vaccine history. The flu vaccine's H3N2 strain was updated following the 2015-16 season to account for a new clade, which showed diversity in the hemagglutinin glycoprotein, and the egg-adapted version also showed mutations.
For, 2016-17, VE for the H3N2 strain was 36%, compared to 43% with or 33% without prior vaccination the previous year. And for 2017-18, VE was 14% and was lower (9%) with previous vaccination and higher (45%) in those without previous vaccination in 2016-17.
Among the other findings, for 2016-17, VE against the predominant clade was 33%, compared with 18% against the mutated egg-based strain, and was 60% and 31% against other variants. "Pivotal mutations conferring loss-of glycosylation, and repeat vaccination with unchanged antigen, may be associated with reduced VE," the authors wrote.
Mar 26 J Infect Dis abstract
