Incorporating COVID-19–specific elements into an existing antimicrobial stewardship program (ASP) framework was associated with reduced antibiotic use and resistance at a safety-net hospital in Chicago, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

COVID-19 posed a significant diagnostic challenge for clinicians in the early months of the pandemic, because symptoms often appeared indistinguishable from lower respiratory tract infections caused by bacteria or other viruses. That, along with a lack of specific treatments, resulted in a surge of antibiotic use (AU) in hospitals, which in turn led to an increase in antimicrobial resistance (AMR). To address this issue, clinicians and pharmacists at Saint Anthony Hospital in Chicago added guidelines that discouraged the routine use of antibiotics for COVID-19 and advised against broad-spectrum antipseudomonal use to a previously established syndrome-based ASP.

To assess the impact of the guidelines, researchers from Saint Anthony and the University of Illinois at Chicago examined data on AU and AMR from 2018 through 2021. They found that the average quarterly antibiotic days of therapy (DOT) per 1,000 patient-days increased by 8.7% (from 359 to 391 DOT) from 2019 to 2020, but then declined by 18.6% (from 391 to 318 DOT) in 2021. Quarterly antibiotic DOT peaked at 440 DOT during the initial COVID-19 surge, but the peaks were smaller with each subsequent surge, falling by 29% from the initial surge to the Omicron surge.

Potential strategy for future pandemics

Meanwhile, the incidence rate per 1,000 patient-days for extended-spectrum beta-lactamase (ESBL)-producing organisms increased from 2.13 in 2019 to 3.58 in 2020, before decreasing to 1.84 in 2021. For carbapenem-resistant Enterobacterales, the incidence increased from 0 in 2018 to .43 in 2019 and further to 1.79 in 2020, before returning to 0 in 2021.

"This suggests that ASP not only guided AU but also may have contributed to the mitigation of AMR," the study authors wrote. "By adapting this intervention to include COVID-19-specific elements, we successfully managed the challenges posed by the pandemic."

They add that leveraging ASP interventions and infrastructure could be a crucial strategy for future pandemics.

The US Centers for Disease Control and Prevention (CDC) yesterday reported 22 more imported Oropouche virus cases, raising the national total to 74 in five states. So far, 1 case of the neuroinvasive form of the disease has been reported.

Most of the illnesses are in Florida, which has reported 70 cases. The Florida Department of Health (Florida Health) said in its latest weekly arbovirus report that all of the state's cases involve travel to Cuba, one of the newly affected countries in the Americas experiencing an outbreak. Florida has reported cases in 11 counties, but most have been in Miami-Dade County.

Oropouche virus isn't a nationally notifiable condition, but in the middle of August the CDC issued an alert about the rise in imported cases and encouraged jurisdictions to voluntarily report cases to its ArboNET surveillance system.

The virus, most commonly transmitted by biting midges, has recently spread beyond endemic areas in South America, with outbreaks in Brazil and Cuba leading to travel-associated cases. Another alarming aspect of the outbreak are sporadic reports of severe fetal outcomes, including deaths and congenital abnormalities. Initial symptoms are similar to dengue, Zika, and chikungunya infections and include acute fever onset, chills, headache, and myalgia. 

Analysis of Campylobacter isolates in East Africa found that multidrug resistance (MDR) was significantly higher in poultry than in people, researchers reported yesterday in Emerging Infectious Diseases.

For the study, an international team of researchers collected and explored the population structure of 178 Campylobacter isolates from Kenya and Tanzania, including 81 from patients with diarrhea and 97 from poultry samples. Africa has the world's highest incidence of campylobacteriosis, and previous studies have found a high prevalence of antimicrobial resistance (AMR) in Campylobacter isolated from humans and poultry in Africa. The researchers conducted antimicrobial susceptibility testing and used whole genome sequencing (WGS) to explore the differences and similarities between the human and poultry isolates.

MDR Campylobacter identified in 41% of poultry isolates

AMR was detected in 75.3% and MDR (defined as resistance to three or more antibiotic classes) in 2.5% of the 81 patient isolates. In the 97 poultry isolates, the estimated AMR prevalence was 85.7%, but MDR prevalence was 40.9%. Five poultry isolates were resistant to five of the six antibiotics tested. WGS identified 57 Campylobacter sequence types (STs) from patients and 29 STs in poultry samples, including many previously unreported STs. Common STs included Campylobacter jejuni ST353 (4 human and 10 poultry isolates from 6 farms), ST2122 (10 poultry isolates from 4 farms), and ST1932 (9 poultry isolates from 5 farms) and Campylobacter coli ST8043 (11 poultry isolates from 5 farms).

The researchers say the study, which is one of the largest using WGS to characterize Campylobacter in East Africa, provides several valuable insights.

"The high prevalence of MDR and the identification of previously undescribed STs highlights the need for ongoing investigation of enteric pathogens, such as Campylobacter spp., in low-resource settings," they wrote. "That effort would require genomic tools to be embedded within formal and transparent surveillance systems, in addition to a greater understanding of the role of antimicrobial use and biosecurity measures as drivers of the emergence of resistance in human health and food production and improved governance of antimicrobial use in both sectors."