News Scan for Oct 26, 2020

News brief

CDC report highlights COVID-19 prevalence in US healthcare workers

New data from the Centers for Disease Control and Prevention (CDC) show that US healthcare workers accounted for 6% of COVID-19 hospitalizations from March through May.

The data, published today in the CDC's Morbidity and Mortality Weekly Report (MMWR), show that, of 6,760 patients hospitalized with COVID-19 from 13 states from Mar 1 through May 31, 5.9% (95% confidence interval [CI], 5.1% to 6.8%) were healthcare personnel (HCP). More than two thirds (67.4%) of HCP hospitalized with COVID-19 were in occupations in which they were generally expected to have direct patient contact, and 36.3% worked in nursing-related occupations, including nurses (27.8%) and certified nursing assistants (8.5%).

The median age of HCP hospitalized with COVID-19 was 49 years, and 71.9% were female. More than half (52%) were black, 27.4% were white, and 8.6% were Hispanic or Latino.

Further analysis of the data shows that 89.8% of HCP hospitalized with COVID-19 had at least one underlying condition, with obesity (72.5%), hypertension (40.6%), and diabetes (30.9%) the most common. Overall, 27.5% of HCP were admitted to an intensive care unit for a median of 6 days, 15.8% required invasive mechanical ventilation, and 4.2% died during hospitalization.

The authors of the study say the data highlight the prevalence of severe COVID-19 and potential for virus transmission among HCP, and the subsequent implications for healthcare capacity as COVID-19 cases increase in the community.

"Continued surveillance of hospitalized HCP is necessary to document the prevalence and characteristics of COVID-19 among this population," they write. "Further understanding of exposure risks for SARS-CoV-2 infection among HCP is important to inform additional prevention strategies for these essential workers."
Oct 26 CDC MMWR study

Genetic analysis points to late February start for NYC COVID-19 outbreak

A study last week in Genome Research used gene sequencing to trace the COVID-19 outbreak in the New York City region last spring, pointing to a late-February introduction seeded by multiple individuals, with most of the viral strains matching those from Europe or other US states rather than those from China.

The study collected viral samples from 864 nasal swabs taken from New Yorkers who tested positive from Mar 12 to May 10, compared viral gene sequences to viral samples worldwide, and analyzed phylogenetic relationships. The genetic analysis process used "flags"—small portions of the genetic code—to identify mutations found only in particular viral strains to compare viral samples and construct a viral "family tree."

The authors found that most New York viral strains closely matched those from Europe or other US states, with at least 109 different individuals seeding the outbreak via infection chains at least 50 people long. The researchers also found that more than 95% of infected New Yorkers carried a viral strain with a mutation that may make it easier to transmit.

The numerous infection sources and early dates of introduction point to a prolonged period of unrecognized community spread. The predominance of European strains confirms that most of the early spread in the region was at the community level, with more than 40% of SARS-CoV-2–positive individuals having no known contact with another infected person.

The study represents just 10% of the COVID-19 patients within a single hospital system in New York City, suggesting a much higher community infection level and an earlier introduction than currently recognized.

"Our findings show that New York's early screening test methods missed the onset and roots of the outbreak by several days at the minimum," co-lead author Matthew Maurano, PhD, of New York University said in a university news release today. "The work strongly suggests that to nip future outbreaks in the bud, we need a system of rapid, plentiful real-time genetic surveillance as well as traditional epidemiologic indicators," Maurano added.
Oct 22 Genome Res study
Oct 26 New York University news release

Multistate Listeria outbreak linked to deli meats sickens 10, kills 1

Ten people in three states have been hospitalized and one has died in a Listeria monocytogenes outbreak tied to deli meats, the CDC said late last week.

Whole-genomic sequencing indicated that the 10 cases thus far are related, and interviews with 9 of the ill people revealed they all had eaten Italian-style meats including salami, mortadella, and prosciutto. No common supplier or type of meat has been identified yet.

Cases have been found in Massachusetts (7), New York (2), and Florida (1 which was fatal), with samples collected from Aug 6 through Oct 3. Patients are between 40 and 89 years old, with a median age of 81. Eight of the patients are women.

The CDC recommends that people who are at high risk of getting sick from Listeria infection—such as pregnant women, seniors, and those with weakened immune systems—should avoid eating deli meats unless they are heated to internal temperatures of 165°F. The agency also says to clean all surfaces and supplies that deli meat and its juices may have come into contact with.

Listeriosis symptoms include headache, stiff neck, confusion, loss of balance, convulsions, fever, and muscle aches, and it can cause complications in pregnant women. Symptoms generally start 1 to 4 weeks after exposure.
Oct 23 CDC outbreak notice

Probing possible urban spread in French Guiana Mayaro virus outbreak

An outbreak of the mosquito-borne Mayaro virus disease in French Guiana has resulted in 13 lab-confirmed cases within 3 months of each other and mainly in people from urban areas, unusual developments given that the country usually records 1 to 3 cases each year from forested areas, the World Health Organization (WHO) said yesterday.

The first few cases were confirmed in September in patients who had symptoms similar to dengue, but tested negative for that disease. A retrospective analysis of blood samples collected from July through September in the Cayenne area in patients who had similar symptoms turned up 11 more cases. Eleven of the patients live in urban coastal areas, another feature of the outbreak that is atypical, given that the virus is usually transmitted through a sylvatic cycle.

An investigation is underway to document patients' travel histories to determine if they contracted the virus in forest settings or if transmission is occurring in urban areas. The WHO said the risk of international spread is small, but a bigger threat can't be excluded if the investigation confirms that urban transmission is occurring.
Oct 25 WHO statement

Stewardship / Resistance Scan for Oct 26, 2020

News brief

Survey: Few outpatient clinics have fully functional stewardship programs

A multicenter survey found that only 7% of ambulatory healthcare settings in the United States have fully functional antimicrobial stewardship programs (ASPs), researchers reported late last week in Open Forum Infectious Diseases.

The cross-sectional survey, sent to hospitals and healthcare systems in the Vizient network, asked respondents 51 questions about the presence of an outpatient ASP, the components of their ASP, compliance with the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship, and ASP effectiveness. Respondents were asked to characterize ASPs as either fully functional, in development, no program but considering a small project, or no program with no plans to develop one.

ASP effectiveness was defined as self-reported achievement in at least one of the following areas within the past 2 years: cost savings or avoidance related to antibiotics, decreases in antibiotic use, decreased Clostridioides difficile infection, or decreased rate of drug-resistant organisms. Survey respondents were also asked to compare their ambulatory ASPs to their inpatient ASPs, where applicable.

Overall, 129 survey responses were received from institutions across 44 states, with 9 of 129 respondents (7%) reporting a fully functional ASP in their ambulatory practice compared with 114 of 129 (88%) inpatient practices. Effectiveness in at least one antibiotic use-related outcome in the past 2 years was reported in 18 of 100 (18%) ambulatory ASPs compared with 103 of 123 (84%) inpatient ASPs. The characteristics most commonly reported in ambulatory ASPs that demonstrated effectiveness were use of institutional guidelines (89%), rapid diagnostic testing for respiratory viruses or group A Streptococcus (89%), and outpatient antibiograms (78%).

Ambulatory ASP effectiveness was shown to increase as programs met more of the CDC Core Elements of Outpatient Antibiotic Stewardship; zero reported effectiveness when meeting only one core element, compared with 59% of those that met all four core elements.

The authors say the findings should serve as a benchmark and provide areas of focus for ambulatory ASPs currently in development.
Oct 24 Open Forum Infect Dis abstract

Roadblocks, priorities noted for sustainable ASPs in nursing homes

Interviews with staff at nine non-profit nursing homes with active ASPs identified three critical areas needed for sustainability, researchers reported today in Infection Control and Hospital Epidemiology.

The interviews were conducted by researchers with the University of Rochester 5 years after a collaborative project in which staff at nine nursing homes in Monroe County, New York, formed ASPs and implemented stewardship activities to optimize antibiotic use and reduce C difficile infection. The purpose of the interviews was to examine the experiences and perceptions of staff at the nursing homes and understand the factors that influence the sustainability of ASPs.

Interviews with 48 clinical and administrative staff members at the nursing home identified seven themes that threaten sustainability. These included the belief that ASPs are resource intensive for nursing homes with limited resources and high turnover rates, that a single champion cannot sustain an ASP even when fully committed, that an ASP requires access to and interpretation of data that are not readily available at nursing homes, and that ASPs require explicit support from nursing home leadership and partnerships with external consultants.

Staff members also reported that it was hard to make progress beyond ASP implementation because urgent resident care needs always take precedence over ASP tasks, that prescribing patterns of external providers (like emergency departments) often impede stewardship efforts, and that ongoing and consistent ASP education is necessary for sustainability.

Based on these interviews, the authors of the study recommend that nursing homes with ASPs prioritize three critical areas: (1) explicit, ongoing leadership support; (2) partnerships with external stewardship experts; and (3) consistent education and training for staff.

"We believe that sustainability cannot be an afterthought and needs to be integrated into the design of ASPs," the authors write. "Future research should target how ASPs in nursing homes with limited resources can be both implemented and sustained over time."
Oct 26 Infect Control Hosp Epidemiol abstract