Italian study finds daily ID consults linked to reduced hospital antibiotics
Daily infectious disease (ID) consultation in an Italian hospital was associated with reduced antibiotic consumption compared with weekly ID consultation, Italian researchers reported late last week in BMC Infectious Diseases.
The 2-year retrospective observational analysis of all ID consults at a large tertiary hospital in Milan, conducted by researchers at the University of Milan, compared a year of weekly ID consults (September 2016 through August 2017) with a year of ID consults provided on a daily basis (September 2017 through September 2018). The process outcomes included the number of ID consults per 100 bed-days, the time from admission to first ID consults, and the type of antibiotic intervention. The primary outcomes were the reduction of overall antibiotic consumption and the reduction of antibiotic consumption by department and antibiotic class, as expressed by defined daily dose (DDD) per 100 bed-days.
Overall, 2,552 ID consults were performed in 1,111 patients (18.6% weekly vs 81.4% daily). In the daily service, compared with the weekly service, patients were seen by the ID consultant earlier (6 days vs 10 days), and the number of ID consults increased from 0.4 per 100 bed-days to 1.5 per 100 bed-days, with the greatest increase seen in the emergency department. Total antibiotic consumption decreased from 64 to 60 DDD/100 bed-days, with the greatest reduction observed in the emergency department (132 DDD/100 bed-days with weekly consults vs 107 DDD/100 bed-days with daily consults).
According to antibiotic classes, glycopeptides consumption declined from 3.1 to 2.1 DDD/100 bed-days, while carbapenem use decreased from 3.7 to 3.1 DDD/100 bed-days. No changes in overall mortality (5.2% in 2017 vs 5.2% in 2018) and sepsis-related mortality (19.3% in 2017 vs 20.9% in 2018) were observed among the two periods.
"In our study, the availability of daily ID-consultations was associated with a global reduction in antibiotic consumption in the whole hospital in spite of a similar distribution of infections among the two time periods," the authors wrote. "This reduction was not accompanied by a worsening of clinical outcomes."
Nov 7 BMC Infect Dis study
MERS sickens Saudi man in Riyadh
Marking the first known MERS-CoV since May, Saudi Arabia's ministry of health (MOH) yesterday reported an infection in a man from Riyadh who had contact with camels.
The man is 51 years old, but few other details were available, other than the is case is classified as primary, meaning it likely didn't contract MERS-CoV (Middle East respiratory syndrome coronavirus) from another patient, and he is not a healthcare worker.
The country's last cases were reported in April and May, six of which were part of a hospital outbreak in Riyadh. Its latest infection would lift the global total reported to the World Health Organization since 2012 to 2,562 cases, 881 of them fatal. The vast majority of the cases have been reported in Saudi Arabia.
Nov 8 Saudi MOH update
Jul 6 CIDRAP News scan on earlier Saudi cases
Parental flu vaccine hesitancy leads to less coverage, study finds
In a national survey about child flu vaccinations, one in five children had a parent who had vaccine hesitancy (VH), which is tied to lower flu vaccination coverage.
The study, published today in Pediatrics, found that, among parents with VH, flu vaccination coverage for their children was 25.8 percentage points lower than other children's coverage during the 2017-18 flu season and 25.6 percentage points lower in the 2018-19 flu season.
Parents were contacted April through June of 2018 and 2019 as part of the National Immunization Survey-Flu and asked about their hesitancy toward childhood shots, concerns about side effects and the amount of shots at one time, and trust in their health provider. In 2018, 36,184 people responded, reporting 25.8% at least somewhat hesitant, and in 2019, 39,617 responded, with 19.5% identifying as at least somewhat hesitant.
Some of the larger opinion differences lay between parents of black children and parents of white children. VH differed from 29.4% for parents of black children to 17.5% for parents of white children; concern about the number of vaccines per one appointment was 22.1% vs 18.0%, concerns about serious long-term side effects was 29.8% vs 19.9%, and relative mistrust in their health provider was 15.5% vs 14.1%, respectively.
Despite this, only 5.5% of parents with black children chose nonstandard flu vaccine schedules (eg the Sears schedule), compared with 5.9% of parents with white children. Hispanics, while self-reporting the highest non-standard vaccine schedule (7.1%), had the lowest mistrust in their healthcare providers regarding vaccine information (13.1%).
Higher VH was also correlated with parents living in rural areas, lower education, and having a lower income than the highest bracket. Concern declined as children grew older, with 20.3% of parents with children 6 to 23 months old being hesitant compared with 17.7% of parents with children 13 to 17 years old. The data suggested that geographical pockets of VH existed, but further research is needed for more conclusive results.
Nov 9 Pediatrics study
Three European countries report avian flu detections in wild birds
In the latest highly pathogenic avian flu developments, Denmark reported an H5N5 outbreak in wild birds, and Germany and the Netherlands reported more events involving both H5N8 and H5N5 in wild birds, according to the latest notifications from the World Organization for Animal Health (OIE).
In Denmark, animal health officials found H5N5 in a peregrine falcon found on Oct 30 near the city of Guldborgsund in the southernmost region of the country.
Meanwhile, in five different OIE reports, Germany reported H5N8 in wild birds in Brandenburg state in an event that began on Nov 6, one that began on Nov 3 in Hamburg state, and four that began on Nov 4 in Mecklenburg-Vorpommern state. It also reported H5N5 outbreaks that began on Nov 3 in Schleswig-Holstein state and on Nov 4 in Mecklenburg-Vorpommern state.
Nov 6 OIE report on H5N5 in Denmark
Nov 9 report on H5N8 in Germany
Nov 6 OIE report on H5N8 in Germany (Hamburg)
Nov 6 OIE report on H5N5 in Germany (Schleswig-Holstein)
Nov 6 OIE report on H5N5 in Germany (Mecklenburg-Vorpommern)
Nov 6 OIE report on H5N8 in Germany (Mecklenburg-Vorpommern)
In other developments, the OIE added virus subtypes on outbreaks reported earlier by the Netherlands and Japan. In the Netherlands, a recent suspected H5 outbreaks at a poultry farm in Puiflijk was confirmed as H5N8, and an outbreak at a farm in Japan's Kagawa prefecture was confirmed as H5N8.
Nov 7 OIE report on H5N8 in the Netherlands
Nov 6 OIE report on H5N8 in Japan
Nov 5 CIDRAP News scan