A mass media campaign in England helped improve knowledge about antimicrobial resistance (AMR) and attitudes regarding inappropriate antibiotic use, according to a study published last week in Eurosurveillance.

The Keep Antibiotics Working campaign was England's first multi-channel, integrated social marketing and communications campaign promoting prudent antibiotic prescribing for the public and general practitioners (GPs). The messaging aimed to reduce patient expectations for an antibiotic prescription and help GPs feel confident about declining antibiotic prescription requests when they are inappropriate.

To evaluate the impact of the campaign, researchers analyzed responses to interviews given before and after each wave of advertising in 2017, 2018, and 2019.

Improved understanding of appropriate antibiotic use

The interviews showed that prompted recognition of the campaign (where the respondent is shown campaign material and asked if they recognize it) was high, increasing from 68% in 2018 to 74% in 2019, and was significantly higher post-2019 in mothers of children ages 0 to 16 years old—a subgroup identified as one of the key targets of the campaign. The level of recognition was higher than found for previous national antibiotic awareness campaigns.

More important, respondents' knowledge and understanding of appropriate antibiotic use increased following the campaign. The percentage of respondents who answered "true" when responding to the statement "Antibiotics will stop working for you if taken for the wrong things" rose from 69.1% pre-2017 to 77.6% post-2019, while those who recognized that taking antibiotics when you don't need them puts you and your family at risk of antibiotic-resistant infections rose from 80.5% to 86.1%. In addition, the proportion of people reporting concern for themselves or for their children about AMR increased by 11.2% and 6.0%, respectively, pre- to post-campaign. 

Most GPs agreed that the campaign supported them in saying no to patients asking for inappropriate antibiotics and will make patients less likely to ask for antibiotics.

"Overall, the campaign evaluation showed the key aims of the campaign were met with several significant changes in knowledge, attitudes, concern about AMR, and intentions to alter behaviour which would improve appropriate antibiotic usage and reduce pressure on GPs to prescribe unnecessary antibiotics," the study authors wrote.

A molecular survey of Greek hospitals shows the emergence and rapid spread of two new high-risk Klebsiella pneumoniae strains, researchers reported last week in Eurosurveillance.

For the study, a team led by researchers from Greece's National Public Health Organization and the European Centre for Disease Prevention and Control analyzed whole-genome sequences and epidemiologic data of 310 carbapenemase-producing K pneumoniae (CPKP) isolates collected from 15 Greek hospitals from 2013 to 2022. The purpose of the study was to determine the distribution of K pneumoniae sequence type (ST) 39, a highly drug-resistant clade that was detected in 12 of 15 Greek hospitals that participated in a European Union/European Economic Area (EU/EEA) genomic surveillance project on carbapenemase-producing Enterobacterales in 2019.

Five STs accounted for more than 90% of the CPKP isolates in the dataset: ST258/512 (101 isolates), ST11 (93), ST39 (56), ST147 (21), and ST323 (13). Even though the number of ST39 isolates found in 2022 was lower than in the same hospitals in 2019, the study showed it had spread to all 15 hospitals by 2022, marking it as a high-risk clone that can now be considered endemic in Greek hospitals. In addition, ST323, another highly drug-resistant clone that was not detected in the 2019 survey, was detected in 6 of the 15 hospitals.

"Even in a country with long-standing endemicity for CPKP such as Greece, the emergence of new high-risk clones is relevant as this is the starting point for further spread of these clones which usually have additional antimicrobial resistance mechanisms and/or are better adapted to transmission in healthcare settings," the study authors wrote.

Within-hospital transmission drives rapid emergence

Analysis of isolates collected in 2022 identified 44 within-hospital CPKP transmission events, a finding the authors say is likely responsible for the rapid emergence of ST39 and ST323 and needs to be urgently addressed.

"This situation is of concern and highlights the need for molecular surveillance and enhanced IPC [infection prevention and control] measures in hospitals in Greece and in other EU/EEA countries, and more generally increased efforts to control antimicrobial resistance in the EU/EEA and beyond," they concluded.

People who were able to have steady and stable coping mechanisms throughout the first year of the COVID-19 pandemic were less likely to experience depression and anxiety, according to a new study in The Annals of Family Medicine.

The study, conducted via Veterans Affairs health services, was based on more than 2,000 participants who completed three online surveys during the period when COVID-19 vaccines were widely available but restrictions were still in place across much of the United States (December 2 to 27, 2020; January 21 to February 6, 2021; and March 8 to 23, 2021).

The questionnaire asked participants about their use of 11 coping strategies and symptoms of anxiety and depression. Coping strategies ranged from using humor and distraction to denial and planning.

Most people changed coping strategies

The authors said a total of 2,085 participants (50.8% veterans) completed the questionnaire at one or more time points, and 930 participants (62.8% veterans) completed it at all three time points. In responses, researchers identified three coping strategies: adaptive, distressed, and disengaged.

Seventy-one percent of participants changed their coping strategy across the three different survey periods, the authors said. The most common coping style during the first two questionnaires was the disengagement (used by 50.3% and 59.6% of participants, respectively), whereas the most common style during the final survey was adaptive coping (used by 46.0%).

Over our study’s time window, 4 months of a rapidly evolving context for the COVID-19 pandemic, changes in coping style were common.

"Over our study’s time window, 4 months of a rapidly evolving context for the COVID-19 pandemic, changes in coping style were common," the authors wrote. "Participants who did not change coping style across time (the stable group) were less depressed and anxious than those who did change styles."

The protection against anxiety and depression existed even if the coping strategies were not adaptive, the authors said.

A study from Israel finds that adult solid-cancer patients had a higher risk of death and hospitalization after COVID-19 infection than infected patients without cancer during a period of Omicron variant predominance and that vaccination lowered that risk. A 

Researchers from Beilinson Hospital and Tel Aviv University analyzed the electronic health records of 7,432 Clalit Health Services patients diagnosed as having solid cancer and COVID-19 and 14,864 matched, infected control patients without cancer from December 2021 to September 2022. The results were published late last week in JAMA Oncology.

"The SARS-CoV-2 Omicron variant, which is associated with milder disease than prior strains, became the dominant SARS-CoV-2 variant in November 2021," the study authors wrote. "Research conducted before it became dominant demonstrated that patients with cancer had increased fatality rates from COVID-19 compared with patients without cancer; however, corresponding data on the Omicron variant are sparse."

Older age, comorbidities increased risk

The 30-day death rate after COVID-19 diagnosis was twice as high in the cancer group than in controls (1.6% vs 0.8%; odds ratio [OR], 2.12). The 90-day death rate and 30-day hospitalization rates were similarly higher in people with cancer (2.7% vs 1.3%; OR, 2.09 and 2.8% vs 1.2%; OR, 2.44).

Our study showed that during the Omicron-dominant period, patients with solid cancer and COVID-19 had higher mortality and hospitalization risks following COVID-19 infection vs patients without solid cancer with COVID-19, and that COVID-19 vaccination in the patients with cancer mitigated this risk.

Greater 30- and 90-day death risks and 30-day hospitalization risk were tied to older age, higher Charlson Comorbidity Index scores, and unvaccinated status. The risk of death by 30 days was also linked to a lack of previous COVID-19 infection, the 90-day death risk was also associated with male sex and lower body mass index (BMI), and the 30-day hospitalization risk was linked to smoking.

"Our study showed that during the Omicron-dominant period, patients with solid cancer and COVID-19 had higher mortality and hospitalization risks following COVID-19 infection vs patients without solid cancer with COVID-19, and that COVID-19 vaccination in the patients with cancer mitigated this risk," the study authors wrote.

"Study limitations include its retrospective design, the heterogenous cancer population, and the absence of genotyping data that could have confirmed infection with the Omicron variant," they added.

• Senior White House officials met yesterday with respiratory syncytial virus (RSV) vaccine suppliers to discuss manufacturing, distribution, and accessibility through the private market. In a statement, the White House said administration officials underscored the urgency of meeting demand heading into the winter season. The meeting came amid reports of a high demand for Beyfortus (nirsevimab-alip), the new long-acting monoclonal antibody injection to help prevent RSV in newborns. The White House recently announced the release of 77,000 more doses.
• Novavax announced today that the World Health Organization (WHO) has listed its updated COVID vaccine for emergency use, which paves the way for quicker regulatory approval for 194 member states and procurement by groups such as UNICEF. John Jacobs, the company's president and chief executive officer, said in a statement, "Rural or hard-to-reach areas can benefit from our vaccine's ease of transport and storage profile. As part of a diversified vaccine portfolio, our vaccine can play an important role in helping to protect people around the globe against the latest variants."
• The UK Health Security Agency yesterday announced the detection of the country's first human infection involving variant H1N2 (H1N2v) influenza, a virus that is similar to a strain circulating in UK pigs. The case was found during routine flu surveillance. The patient had a mild illness and has fully recovered. The source of the virus is under investigation, and health officials are closely monitoring the patient's contacts.