News Scan for Aug 11, 2021

News brief

Corticosteroid tied to shorter recovery in non-severe COVID-19

Inhaled budesonide, a corticosteroid often used for Crohn's disease, was tied to a shorter recovery time in COVID-19 patients who were at a higher risk of severe infection, according to a study published in The Lancet yesterday.

The researchers used UK residents 65 or older or who were 50 and older with comorbidities who were enrolled in the larger PRINCIPLE trial. Patients were unwell with suspected COVID-19 for up to 14 days (median, 6 days), and were randomized to budesonide from Nov 27, 2020, to Mar 31, 2021. In the primary analysis group, 787 received budesonide and usual care, 1,069 received usual care, and 974 were part of other treatment groups. None were hospitalized prior to assignment.

The budesonide group self-reported a shorter time to recovery (median, 2.94 days; 11.8 vs 14.7 days). And, although hospital admission and death data were too small for the prespecified superiority threshold, the researchers had enough data to model that budesonide may lead to less hospitalization and death (6.8% vs 8.8% model estimate; odds ratio, 0.75).

In a related commentary by Dee Mangin, DPH, MBChB, Michelle Howard, PhD, MSc, they note that this link to improved symptom recovery was not seen in the large RECOVERY trial, which enrolled adults with severe COVID-19. They also note that because no placebos were involved, self-reported recovery could be biased.

Overall, they write, "Various subgroup analyses in PRINCIPLE do not provide any pointers to which particular patient or illness characteristics in the included population might be more likely to predict benefit. These trial data do not support use in younger populations who are at lower risk of complications (<65 years with no comorbidities or anyone <50 years)."
Aug 10 Lancet study and commentary

US COVID testing improved in some ways, stayed stagnant in others

Surveys from 10 US states showed that although COVID-19 testing access and turnaround times has shown improvement, consistent barriers (eg, confusion around where to go) remained, according to a study yesterday in Clinical Infectious Diseases.

More than 8,000 adults from California, Florida, Illinois, Maryland, Massachusetts, Nebraska, North Dakota, South Dakota, Texas, and Wisconsin were surveyed (median age, 45 years; 50% female) from Feb 16 to 28. At the time, 11% of respondents said they had wanted a COVID-19 diagnostic test in the past 2 weeks, of whom 63% got tested. About half (56%) received their results within 2 days, and 97% received results at any time.

Multivariable analysis showed that younger age, working outside the home, non-White race or ethnicity, possible exposure, symptoms, and timing around travel (before or after) were all associated with a greater likelihood to want a COVID-19 test. Those who lived in suburban or rural areas were also associated with less demand than those who lived in the city.

Florida, Illinois, and Maryland also participated in prior survey waves going back to mid-July 2020, and data showed that same-day testing improved (56% vs 28%), as did same-day results (45% vs 17%). However, the researchers note, 42% respondents who wanted a test still had to wait 3 or more days from the initial desire to diagnosis.

Respondents said that logistical challenges were the most frequent barriers to testing, such as where to go, but the researchers also found that 16% of people were turned away because they did not have a doctor's order, which is not required.
Aug 10 Clin Infect Dis study

H5N6 avian flu infects 1 more person in China

China reported one more H5N6 avian influenza infection, which involves a 55-year-old woman from Hunan province in the south, bringing its total for the year to 14, part of an uptick in activity involving the strain.

In a statement yesterday, Hong Kong's Centre for Health Protection (CHP) said the woman lives in Chenzhou City and had been exposed to live poultry at a market before her symptoms began on Jul 26. She was hospitalized on Aug 1 and is listed in serious condition.

China has now reported 38 H5N6 cases since the first human illness was reported in 2014. The virus is known to circulate in poultry, mainly in a handful of Asian countries, but so far only China and Laos have reported human cases. H5N6 infections are often severe or fatal.
Aug 10 CHP statement

Eleven more sick in breaded chicken Salmonella outbreak

In an investigation update on a Salmonella Enteritidis outbreak linked to frozen and breaded stuffed chicken products, the Centers for Disease Control and Prevention (CDC) today reported 11 more illnesses and 2 more affected states. The newly reported infections raise the total to 28 cases from 8 states.

Patient ages range from 3 to 84. Among 24 people with available information, 11 were hospitalized. No deaths were reported. The latest illness onset was Jun 28.

Of 21 people who were interviewed, 13 had prepared and eaten frozen breaded chicken products, which spanned different brands and from multiple stores. The CDC added that the true number of sick people is likely to be much higher, because many recover without medical care and aren't tested.

Since the CDC's initial announcement in early June, Indiana-based Serenade Foods recalled nearly 60,000 pounds of frozen raw breaded chicken products produced at a single facility, which was linked to product samples from an Indiana patient's home that matched the outbreak strain. The products were distributed nationwide. However, the CDC said the company's products may not account for all of the illnesses

Earlier in the investigation, testing in Minnesota found the outbreak strain in two samples of Kirkwood Chicken Cordon Bleu collected from a grocery store where a sick person had bought the product.

The CDC urges people to cook raw chicken products thoroughly to 165 and to never use a microwave or air fryer to cook products that contain raw chicken. The agency warned that those types of chicken products may still be raw, even if they appear ready to eat. Frozen breaded raw chicken entrees have been linked to a number of Salmonella outbreaks over the past several years.
Aug 11 CDC outbreak update
Aug 9 US Department of Agriculture Food Safety and Inspection Service recall

Stewardship / Resistance Scan for Aug 11, 2021

News brief

Canadian surveillance shows rise in multidrug-resistant pathogens

The proportion of multidrug-resistant Escherichia coli and Klebsiella pneumoniae found in Canadian hospital patients increased substantially from 2007 through 2018, according to a surveillance study published today in the Journal of Antimicrobial Chemotherapy.

The findings are from an analysis of bacterial isolates collected through CANWARD, an ongoing national surveillance study that analyzes isolates from hospitals in 8 of Canada's 10 provinces for antibiotic resistance. Researchers conducted antimicrobial susceptibility tests to confirm phenotypic resistance and performed whole-genome sequencing to detect production of extended-spectrum beta-lactamase (ESBL) enzymes, which confer resistance to multiple antibiotic classes.

Of the 9,588 E coli isolates collected from 2007 through 2018, 7.0% (671) were ESBL producers, and the proportion of ESBL-producing E coli climbed from 3.3% in 2007 to 11.2% in 2018. Of the 3,056 K pneumoniae isolates collected, 4.6% (141) were ESBL producers; the proportion of ESBL-producing K pneumoniae rose from 1.3% to 9.3%. Overall, 97.2% of ESBL-producing E coli and K pneumoniae were multidrug-resistant (MDR). The most common ESBL enzyme in E coli (62.3% of isolates) and K pneumoniae (48.9%) was bla_CTX-M-15.

The most frequent sequence types (STs) were ST131 for E coli (62.4%) and ST11 (7.8%) and ST147 (7.8%) for K pneumoniae.

"Increases in the proportion of infections caused by ESBL-producing Enterobacteriaceae, especially specific STs, are detrimental to patient care and public health because they result in increased use of carbapenems, which may in turn drive the emergence and increased isolation of carbapenem-resistant Enterobacteriaceae," the authors write. "Prospective surveillance of these evolving MDR pathogens is imperative."
Aug 11 J Antimicrob Chemother abstract

UN, India team up to boost understanding of AMR in the environment

The United Nations Environmental Programme (UNEP) has launched a collaboration with Indian researchers to address the environmental dimension of antimicrobial resistance (AMR).

The collaboration between UNEP and the Indian Council of Medical Research aims to strengthen the environmental aspects of national- and state-level AMR action strategies and plans, according to a UNEP press release. It will conduct secondary research and stakeholder consultations to better understand the role the environment plays in harboring and transmitting resistant pathogens.

Among the areas the project will likely explore is the effects of discharging antibiotics and other antimicrobial compounds into natural environments, which has the potential to drive the evolution of resistant bacteria. India is a major manufacturer of antibiotics, and studies have found high concentrations of antibiotics and high levels of AMR genes in waterways in and around Hyderabad, the country's pharmaceutical manufacturing hub.

"AMR in the environment is an issue inadequately recognized by the stakeholders," said Lav Aggarwal, a member of India's Ministry of Health and Family Welfare. "It is critical to understand that we have to engage with the environment as a critical part of our AMR response."
Aug 9 UNEP press release