Study: Prolonged antibiotics common in COVID patients with and without sepsis

News brief

Prolonged antibiotics were common in hospitalized COVID-19 patients with and without sepsis during the first 33 months of the pandemic, despite low rates of proven bacterial infection, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

For the study, researchers from Harvard Medical School and Brigham and Women's Hospital analyzed electronic health record data for patients hospitalized for community-onset SARS-CoV-2 infections at five Massachusetts hospitals from March 2020 through November 2022. Their primary aim was to describe prolonged antibiotic use (4 or more days of antibiotics within the first week following admission) in COVID-19 patients presenting with sepsis, which is primarily caused by bacterial infections and typically treated with antibiotics but can be triggered by viral pathogens, including SARS-CoV-2.

Prolonged antibiotic use remains elevated

Of the 431,017 hospitalizations during the study period, 21,563 (5%) had COVID-19, and 4,769/21,563 (20.5%) presented with sepsis. Prolonged antibiotics were prescribed for 48.7% of COVID-19 patients with sepsis and 17.1% without sepsis, despite low rates of positive bacterial cultures on admission (15.0% vs 6.3%, respectively).

While quarterly rates of prolonged antibiotics declined between the first and second pandemic quarters for both sepsis (66.8% to 43.9%) and no-sepsis (31.8% to 24.4%) groups, there was no significant change in prolonged antibiotic use from the second quarter through November 2022 in either group, with quarterly adjusted odds ratios of 1.02 (95% confidence interval [CI], 0.99 to 1.05) and 1.01 (95% CI, 0.99 to 1.03), respectively.

The study authors say the elevated ongoing rates of prolonged antibiotic prescribing for COVID-19 patients likely reflects concerns about possible bacterial co-infections.

"Our findings highlight an ongoing opportunity to improve antibiotic use in patients presenting with severe respiratory viral infections," they wrote.

California reports likely H5N1 infection in dairy worker

News brief

Lisa Schnirring

The California Department of Public Health (CDPH) today announced that a dairy worker with mild symptoms who had contact with infected cows in the Central Valley has tested positive for H5N1 avian influenza in preliminary tests at a public health laboratory.

milking parlor worker — *U. J. Alexander / iStock*

The local health department was notified after the patient experienced conjunctivitis, which was the only symptom. In its emailed press release, the CDPH said the patient’s specimen will be sent to the US Centers for Disease Control and Prevention (CDC) for confirmatory testing.

If confirmed, the illness would bring the nation’s number of H5N1 infections since the first of the year to 15. Four earlier illnesses occurred in dairy workers, nine occurred in poultry cullers, and one was found in a Missouri patient who had no known animal exposure.

The patient is being treated with antiviral medication and is isolating at home.

Tomás J. Aragón, MD, DrPH, CDPH director and state public health officer, said, "Ongoing health checks of individuals who interact with potentially infected animals helped us quickly detect and respond to this possible human case. Fortunately, as we've seen in other states with human infections, the individual has experienced mild symptoms."

H5N1 strikes 11 more California dairy herds

In related developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has confirmed 11 more H5N1 outbreaks in California dairy herds, boosting the national total to 255 across 14 states.

California, the nation’s largest dairy producer, has now reported 55 infected farms since September.

APHIS gives $12 million to states, tribes for fight against chronic wasting disease

News brief

Mary Van Beusekom, MS

Today, the US Department of Agriculture's (USDA's) Animal and Plant Health Inspection Service (APHIS) announced that it's giving about $12 million to state and tribal governments to implement and enhance chronic wasting disease (CWD) management efforts in wild and farmed cervids such as deer and elk.

CWD is a fatal neurologic disease in cervids caused by misfolded infectious proteins called prions, which are extremely resilient and can persist in the environment for years. CWD poses an ongoing threat to cervids, because it can spread from animal to animal and through environmental contamination.

This funding will help APHIS and our state and Tribal partners find and implement new solutions to this challenging disease while protecting the health of animals and the livelihoods of our farmers.

Jenny Lester Moffitt

Priorities for funding

APHIS said it worked with state agricultural, wildlife, and tribal officials and the cervid industry to establish priorities for funding to:

Improve CWD management of affected farmed and wild cervids
Enhance CWD management of affected areas or premises
Research amplification assays and other new testing methods
Study the application or implementation of a whole-genome predictive genetics CWD management plan for farmed or wild cervids, and
Develop and/or deliver educational outreach materials or programs

APHIS prioritized jurisdictions that have detected CWD or that border CWD-endemic areas and have either launched surveillance programs or plan to do so. More details on the individual projects are available in the 2024 APHIS spending plans for farmed, wild, and tribal nation wild cervids.

"Deer, elk, moose, and other cervids are important wildlife resources that continue to be at risk of contracting chronic wasting disease," Jenny Lester Moffitt, USDA Under Secretary for Marketing and Regulatory Programs, said in a news release. "This funding will help APHIS and our state and Tribal partners find and implement new solutions to this challenging disease while protecting the health of animals and the livelihoods of our farmers."

Officials probe fifth local dengue case in LA County

News brief

Lisa Schnirring

The Los Angeles County Department of Public Health yesterday announced that it is investigating a fifth local dengue case, which doesn’t appear to be related to the four earlier cases.

Aedes mosquito — *Sanofi Pasteur / Flickr cc*

The latest patient is a resident of El Monte, which is located about 14 miles east of the city of Los Angeles.

Officials said local dengue cases in LA County are extremely rare. Last year, two cases were reported.

Of the four cases reported over the past few weeks, three are part of a cluster in Baldwin Park and one involves a resident of Panorama City.

Muntu Davis, MD, MPH, Los Angeles County health officer, said mosquitoes thrive in hot weather, increasing the risk of bites and mosquito-borne illnesses. “This case further indicates that dengue can spread in our community. Preventing mosquito bites and mosquito breeding is the best way stop local transmission of dengue.”