The length of antibiotic therapy for US patients hospitalized with uncomplicated community-acquired pneumonia (CAP) has decreased but remains excessive for too many patients, researchers reported today in Infection Control & Hospital Epidemiology.

Using national data from MarketScan and the Centers for Medicare & Medicaid Services (CMS), researchers with the Centers for Disease Control and Prevention evaluated length of therapy (LOT) annual trends among US adults hospitalized with uncomplicated CAP from 2013 through 2020. A total LOT of 7 days or more was considered likely excessive, since current guidelines suggest 5 days of antibiotic therapy for uncomplicated CAP.

There were 44,976 uncomplicated CAP hospitalizations among patients aged 18 to 64 (MarketScan) and 400,928 among patients 65 and older (CMS). The median hospital stay for both cohorts was 3 days. After adjusting for patient and hospitalization characteristics, the proportion of patients with likely excessive antibiotic therapy decreased significantly in both cohorts. From 2013 through 2020, the proportion of uncomplicated CAP patients with a total LOT of 7 days or more fell from 68% to 51% (a 25% decline) among those ages 18 to 64 and from 68% to 50% (a 26% decline) among those 65 and older.

Excessive postdischarge antibiotics

While the 25% and 26% reductions exceed the recommended 20% reduction target for inappropriate antibiotic use in the 2014 US National Strategy for Combating Antibiotic-Resistant Bacteria, the study authors say the fact that at least half of uncomplicated CAP patients in 2020 received more than 7 days of antibiotics indicates more work needs to be done.

In particular, they point to excessive postdischarge antibiotic therapy for uncomplicated CAP, which has been highlighted in previous studies as a potential focus for antibiotic stewardship programs. The current study found that 62% to 63% of patients in both cohorts received likely excessive postdischarge antibiotic therapy in 2020.

"The high proportion of patients with likely excessive postdischarge LOT demonstrates the need for antibiotic stewardship to optimize prescribing at hospital discharge," they wrote.

A new Centers for Disease Control and Prevention (CDC) report today notes that 38.6% of children age 9 to 17 had received at least one dose of the human papillomavirus (HPV) vaccine in 2022, with rates rising with age from 7% in the youngest kids to 57% in the oldest.

HPV vaccination has been recommended in the United States since 2006 for girls and 2011 for boys. The multiple-dose vaccine, targeted to be initiated for children ages 11 to 12 years, may be started as young as age 9 and prevents against the most common cancer-causing HPV strains.

Overall, girls (42.9%) were more likely than boys (34.6%) to have received one or more HPV vaccine doses.

Children with private insurance were more likely to have received at least one dose of HPV vaccine (41.5%) compared to children without insurance (20.7%) or those on Medicaid (37.0%).

Coverage also increased with parental education levels: 42.1% of children whose parents had a bachelor's degree or higher had received at least one dose, compared to 31.1% of children whose parents had a high school degree.

Urban and rural divide

Urbanization also was a factor in vaccine coverage.

The percentage of children who have received one or more HPV vaccine doses was higher for those living in large central metropolitan areas.

"The percentage of children who have received one or more HPV vaccine doses was higher for those living in large central metropolitan areas (39.4%), large fringe metropolitan areas (41.1%), and medium and small metropolitan areas (39.4%) compared with those living in nonmetropolitan areas (30.0%)," the CDC said.

Hispanic children (34.4%) were less likely than White children (39.9%) to have received at least one HPV vaccine dose. There were no significant differences among Black, Asian, and White children.

• Following a yellow fever outbreak in South Sudan that began in late December, the country's health ministry, the World Health Organization (WHO), and other partners have launched a vaccine campaign targeting 610,000 people in Yambio, Tambura Ezo, Ibba, and Maridi counties, the WHO said yesterday. Vaccine doses were drawn from the international stockpile with support from Gavi, the Vaccine Alliance. As of February 3, South Sudan has reported 2 lab confirmed cases and 48 suspected cases, all in Western Equatoria state.
• Two more US states have reported measles cases, Arizona and Minnesota. In Arizona, the Maricopa County Department of Public Health on February 10 reported a confirmed case in an international visitor. In a follow-up 2 days later, officials said the patient was infectious at two locations, a sports bar in Phoenix and the breakfast buffet at a hotel in Chandler. Meanwhile, the Minnesota Department of Health (MDH) has reported two cases so far this year, an imported case and a local person with links to an imported case. The cases are the state's first since 2022. A local media report, citing the MDH, said the two patients are siblings from the Twin Cities metro area and that the second sibling had not been vaccinated. In late January, the US Centers for Disease Control and Prevention urged healthcare providers to be alert for cases, given a global rise in measles activity.
• Though avian flu outbreaks in US poultry have declined since December, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) continues to report detections poultry. So far this month seven states have reported outbreaks, including commercial facilities in three of them: a turkey farm in North Carolina's Lenoir County, a commercial broiler breeding operation in Colorado's Delta County, and a broiler facility in Nebraska's Gage County. The virus was also confirmed at a live-bird market in Florida's Miami-Dade County. Backyard flock detections occurred in Idaho, Pennsylvania, and Massachusetts. In related developments, APHIS continues to report several H5N1 avian flu detections in wild birds and has confirmed 50 more in February, a mix of waterfowl and raptors across several states.