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.

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.

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.

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.

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.”