Use of clinician audit and feedback reports at two children's hospitals boosted adherence to antibiotic choice and duration recommendations for children hospitalized with community-acquired pneumonia (CAP), researchers reported yesterday in Clinical Infectious Diseases.

The study, led by researchers with Children's Hospital of Philadelphia, evaluated the impact of electronically delivered audit and feedback reports on antibiotic prescribing for CAP at the hospital's two locations from December 2021 through November 2023. While electronic feedback reports have been shown to improve adherence to evidence-based recommendations for antibiotic use in outpatient settings, their use has not been well-explored in inpatient settings.

The reports, which contained information on adherence to the recommended first-line antibiotic choice (ampicillin) and duration (5 days) for CAP, were distributed by email to all general pediatrics attendings, fellows, and advanced practice providers at the hospitals and reviewed in monthly meetings. The primary outcome of the study was the proportion of all CAP encounters that involved both the appropriate antibiotic choice and duration before and after the intervention.

32% increase in rate of appropriate prescribing

A total of 800 CAP encounters occurred during the study period (413 preintervention and 387 postintervention). Adherence to appropriate antibiotic choice and duration increased from 52% of encounters preintervention to 80% postintervention. An interrupted time series analysis demonstrated an immediate 18% increase in the proportion of CAP encounters receiving both the appropriate antibiotic choice and duration (95% confidence interval [CI], 3% to 33%), with no further change over time (-0.3% per month, 95% CI, -2% to 2%). 

Using a Poisson model adjusted for age, sex, race, season, site, and intensive care unit admission, the researchers found the intervention was associated with a 32% increase in the rate of appropriate antibiotic choice and duration (rate ratio, 1.32; 95% CI, 1.12 to 1.56).

"These findings support the use of clinician feedback reports as a stewardship tool for inpatient ASPs [antibiotic stewardship programs], an approach made more feasible through use of electronically derived measures of antibiotic appropriateness," the study authors wrote.

The Democratic Republic of Congo (DRC) is investigating the cause of an outbreak of an unknown disease centered in Kwango province that has so far sickened at least 376 people, with death counts ranging from 67 to 143, since late October. 

The main symptoms are fever, headache, runny nose, breathing problems, and anemia, according to the infectious disease tracking blog FluTrackers, which has been following reports of cases for the past week.

Death count as high as 143

Reuters has reported 143 deaths, while the Associated Press reported yesterday there have been from 67 to 143 fatalities.

Reuters says women and children are the most seriously affected by the disease, and the DRC statement says the illness has been most lethal in children over the age of 15.

The DRC notified the World Health Organization of the outbreak last week. The case-patients live in rural areas with limited access to medications, sources told Reuters. 

Health officials in Vietnam's Long An province today reported a human H5 case involving an 18-year-old man who is hospitalized in Ho Chi Minh City with pneumonia and other severe symptoms, according to foreign language media reports translated and posted by FluTrackers, an infectious disease news message board. 

Long An province is in the Mekong Delta region of southern Vietnam. The patient is from Tan An, the provincial capital.

Dead poultry found near family's home

Authorities were first notified about the case on November 14, and officials are waiting on further sequencing results to characterize the N gene. 

An investigation revealed hundreds of dead poultry at the patient's family home. 

The country reported its last human H5N1 case in March. Different H5N1 clades circulate in Vietnam and other parts of Asia and have been linked to sporadic human cases, but none involving human-to-human transmission. 

In April scientists warned of an H5N1 reassortant circulating across the Greater Mekong subregion that has infected both birds and people. It contains surface proteins of an older H5N1 clade (2.3.2.1c) that has circulated in parts of Asia with a newer clade (2.3.4.4b) that has circulated globally since 2022.