News Scan for Jul 15, 2022

News brief

Cancer treatment delays spotlighted in minority groups amid COVID-19

Survey results published yesterday in JAMA Network Open reveal that, amid the COVID-19 pandemic, Black and Latino adults in the United States have experienced more delays in cancer care and more worries about treatment costs than their White peers.

A team led by Stanford University researchers deployed the 74-question online survey of 1,639 cancer patients from 50 US states, the District of Columbia, and five territories from Sep 1, 2020, to Jan 12, 2021.

A total of 1,240 patients (75.7%) responded. Median patient age was 60 years, 60.0% were women, 42.5% were White, 21.5% were Black, 15.0% were Asian, 18.7% were Latino, 2.3% were American Indian or Alaska Native, Native Hawaiian, another race, or multiracial.

A higher proportion of Black (75.6%) and Latino (80.2%) participants and those of other races (75.9%) experienced care modifications, including delayed clinic visits, lab tests, and imaging, as well as a change in care location than White participants (57.1%). A higher proportion of Black (98.0%) than White respondents (84.1%) who had care modifications said their clinic or physician requested the modifications.

Relative to White participants, Black and Latino respondents were more likely to report extreme concerns that the care modifications would worsen their cancer outcomes (odds ratios [ORs], 3.57 and 2.20, respectively).

Black and Latino respondents were more likely to experience involuntary delayed cancer treatments (ORs, 6.13 and 2.77, respectively), and, for Black patients, those delays were more likely to last longer than 4 weeks (OR, 3.13). These respondents also had greater chances of food insecurity (ORs, 4.32 and 6.13, respectively), as well as worries about food insecurity (ORs, 2.02 and 2.94), financial instability (ORs, 3.56 and 4.29), and the affordability of cancer treatment (ORs, 4.27 and 2.81).

"Owing to a combination of structural, economic, and socioenvironmental factors associated with systemic racism, prepandemic disparities persist in access to and timely receipt of cancer care among Black and Latinx adults," the researchers wrote. 
Jul 14 JAMA Netw Open study

 

Pakistan reports new WPV1 case as Algeria has first vaccine-derived polio

Pakistan reported a new wild poliovirus type 1 (WPV1) case, part of an ongoing uptick in activity this year, and Algeria reported its first vaccine-derived poliovirus type 2 (cVDPV2) case.

In Pakistan, the new case—its 12th of the year—involved a 21-month-old boy from North Waziristan province, according to Samaa, a Pakistani news outlet, which cited the Pakistan National Polio Laboratory.

In other global developments, Algeria reported its first cVDPV2 case, according to a weekly update from the Global Polio Eradication Initiative (GPEI). The patient is from Tamanghasset in the south. GPEI said the samples are related to the circulating strain in Zamfara, Nigeria.

Four other African nations reported more cVDPV2 cases. Benin reported its first two cases of the year, one in Atlantique and the other in Oueme. Eritrea also has its first case of the year, which involves a patient from Gashbarka. Likewise, Ghana reported its first 2022 case, in Savannah.

Finally, Niger reported 4 more cases, 1 in Maradi and 3 in Tillaberi, lifting its total for 2022 to 8.
Jul 14 Samaa story
Jul 14 GPEI update

 

California reports H5N1 avian flu in wild birds

California wildlife officials yesterday reported the first highly pathogenic H5N1 avian flu detections in the state's wild birds, two Canada geese and a pelican that were found dead as part of a die-off at the Sacramento National Wildlife Refuge.

The birds were collected and submitted for preliminary testing on Jul 5, and on Jul 13 the US Department of Agriculture (USDA) National Veterinary Services Laboratory confirmed the findings.

The Eurasian H5N1 strain that caused domestic poultry outbreaks in other world regions, especially Europe, turned up in US wild birds in January. Since then, 43 states have reported the virus in wild birds, and the USDA has reported 1,826 detections.

The California Department of Fish and Wildlife (CDFW) said so far the virus hasn't triggered any outbreaks in the state's poultry.

In other avian flu developments, the USDA recently reported another outbreak in poultry, which occurred at a backyard facility in Deschutes County, Oregon. Also, the Canadian Wildlife Health Cooperative this week said H5N1 has been detected in samples from harbor seals that died in Quebec's St. Lawrence Estuary. Earlier this month, Maine officials reported similar findings in seals.
Jul 14 CDFW statement
USDA poultry outbreak updates
Jul 12 Canadian Wildlife Health Cooperative post
Jul 5 CIDRAP News scan

 

Two German airport workers diagnosed as having malaria

Two employees of the Frankfurt International Airport have contracted malaria, despite no history of international travel or blood transfusions.

According to a post on ProMed, the infectious disease message board of the International Society for Infectious Diseases, the two employees both developed symptoms on Jul 5. Though they did not work in overlapping areas of the airport, both worked on Jul 1 and 2.

One of the patients fulfills the criteria for severe malaria and is in critical condition, the ProMed post read.

"The current cases as well as those described in the literature show that these patients affected by airport-associated malaria had a remarkably high disease severity. This is probably due to the relatively late initiation of treatment given the difficulty of diagnosing malaria without an epidemiological link to a malaria-endemic country," the authors said.

In 2020 airport workers in Brussels, Belgium contracted malaria, and Frankfurt had a previous two-case cluster in 2019.
Jul 13 ProMed
post

Stewardship / Resistance Scan for Jul 15, 2022

News brief

Study shows global rise in macrolide-resistant Mycoplasma pneumoniae

Antibiotic resistance, one of the most common causes of community-acquired pneumonia (CAP) in children, has risen dramatically over the past two decades, according to a study published this week in JAMA Network Open.

To analyze global patterns, temporal trends, and regional variations in macrolide-resistant Mycoplasma pneumoniae (MRMP) infections, a team of South Korean researchers conducted a systematic review and meta-analysis of 153 studies from 150 articles published prior to Sep 10, 2021.

They found the worldwide proportion of MRMP infections rose from 18.2% in 2000 to 41% in 2010 to 76.5% in 2019. When the proportion of MRMP infections was classified by World Health Organization (WHO) region, a significant increasing trend was observed in the Western Pacific region (from 17.1% in 2000 to 71.2% in 2011 to 76.5% in 2019), but trends did not change significantly over time in other WHO regions.

The highest proportion of MRMP infections was observed in the Western Pacific region (53.4%), followed by the South East Asian region (9.8%), the region of the Americas (8.4%), the European region (5.1%), and the Eastern Mediterranean region (1.4%). Among the M pneumoniae variants associated with resistance to macrolides, A2063G was the most commonly identified (96.8%), followed by A2064G (4.8%).

When study populations were classified by children, the proportion of MRMP infections was highest in studies that comprised only children (37%).

M pneumoniae causes an estimated 30% to 40% of CAP cases in children globally. Macrolide resistance is one of the possible causes of refractory M pneumoniae infections, which are difficult to treat and have been associated with increased long-term complications and higher medical costs. The study authors say antibiotic overuse, especially of macrolides, may be behind the rise in MRMP infections.

"The results of the present study provide helpful information on the proportion of MRMP infections and may be used to overcome the disease burden of MRMP infections via the establishment of appropriate therapeutic strategies," they wrote.
Jul 11 JAMA Netw Open study

 

Report: Reforms could boost antibiotic access in emerging markets

A new report from the One Health Trust suggests more regulatory flexibility is needed to accelerate the approval of new antibiotics in emerging markets.

In their analysis of the regulatory framework for antibiotic approval in three middle-income countries—South Africa, India, and Brazil—researchers with the One Health Trust (formerly the Center for Disease Dynamics, Economics & Policy) found that the national regulatory bodies in the three countries have taken steps to expedite the registration of medicines, including, in some cases, granting flexibility in clinical trial requirements for drugs targeting unmet public health needs.

In South Africa, for example, a strategy for prioritizing regulatory review of new medicines for HIV, tuberculosis, and cancer has been introduced, and the COVID-19 pandemic has led to expedited assessments of clinical trials for COVID-19 treatments.

Likewise, officials in Brazil have introduced priority pathways for rapid approval of drugs relevant to public health, and Indian authorities have drafted a plan to reduce the time to drug approval. However, antibiotics and multidrug-resistant infections aren't explicitly included in the list of eligible drugs and indications in any of these accelerated approval frameworks.

Going forward, the report recommends that regulatory agencies in emerging markets create a specific category for antibiotics that target serious and life-threatening infections within the framework provided for accelerated approval pathways, leverage existing programs for expedited drug approval, and increase regulatory authorities' capacity to deal with the complexity of antimicrobial resistance (AMR) and novel clinical trials. They also call for more collaboration and harmonization with drug regulatory agencies in high-income nations.

The report argues that while it is crucial to create new financial incentives and reform the antibiotic development market to create a sustainable pipeline of new antibiotics, regulatory reforms to accelerate approval of new antibiotics can also help boost their development and improve access in the parts of the world where they are most needed.

"The growing burden of AMR will need to be addressed with new antibiotics," One Health Trust Director Ramanan Laxminarayan, PhD, MPH, writes in the report. "Unless we significantly rethink and revise current processes for regulatory approvals, the burden of AMR will keep increasing."
Jul 12 One Health Trust report

ASP Scan (Weekly) for Jul 15, 2022

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Study shows global rise in macrolide-resistant Mycoplasma pneumoniae

Antibiotic resistance, one of the most common causes of community-acquired pneumonia (CAP) in children, has risen dramatically over the past two decades, according to a study published this week in JAMA Network Open.

To analyze global patterns, temporal trends, and regional variations in macrolide-resistant Mycoplasma pneumoniae (MRMP) infections, a team of South Korean researchers conducted a systematic review and meta-analysis of 153 studies from 150 articles published prior to Sep 10, 2021.

They found the worldwide proportion of MRMP infections rose from 18.2% in 2000 to 41% in 2010 to 76.5% in 2019. When the proportion of MRMP infections was classified by World Health Organization (WHO) region, a significant increasing trend was observed in the Western Pacific region (from 17.1% in 2000 to 71.2% in 2011 to 76.5% in 2019), but trends did not change significantly over time in other WHO regions.

The highest proportion of MRMP infections was observed in the Western Pacific region (53.4%), followed by the South East Asian region (9.8%), the region of the Americas (8.4%), the European region (5.1%), and the Eastern Mediterranean region (1.4%). Among the M pneumoniae variants associated with resistance to macrolides, A2063G was the most commonly identified (96.8%), followed by A2064G (4.8%).

When study populations were classified by children, the proportion of MRMP infections was highest in studies that comprised only children (37%).

M pneumoniae causes an estimated 30% to 40% of CAP cases in children globally. Macrolide resistance is one of the possible causes of refractory M pneumoniae infections, which are difficult to treat and have been associated with increased long-term complications and higher medical costs. The study authors say antibiotic overuse, especially of macrolides, may be behind the rise in MRMP infections.

"The results of the present study provide helpful information on the proportion of MRMP infections and may be used to overcome the disease burden of MRMP infections via the establishment of appropriate therapeutic strategies," they wrote.
Jul 11 JAMA Netw Open study

 

Report: Reforms could boost antibiotic access in emerging markets

A new report from the One Health Trust suggests more regulatory flexibility is needed to accelerate the approval of new antibiotics in emerging markets.

In their analysis of the regulatory framework for antibiotic approval in three middle-income countries—South Africa, India, and Brazil—researchers with the One Health Trust (formerly the Center for Disease Dynamics, Economics & Policy) found that the national regulatory bodies in the three countries have taken steps to expedite the registration of medicines, including, in some cases, granting flexibility in clinical trial requirements for drugs targeting unmet public health needs.

In South Africa, for example, a strategy for prioritizing regulatory review of new medicines for HIV, tuberculosis, and cancer has been introduced, and the COVID-19 pandemic has led to expedited assessments of clinical trials for COVID-19 treatments.

Likewise, officials in Brazil have introduced priority pathways for rapid approval of drugs relevant to public health, and Indian authorities have drafted a plan to reduce the time to drug approval. However, antibiotics and multidrug-resistant infections aren't explicitly included in the list of eligible drugs and indications in any of these accelerated approval frameworks.

Going forward, the report recommends that regulatory agencies in emerging markets create a specific category for antibiotics that target serious and life-threatening infections within the framework provided for accelerated approval pathways, leverage existing programs for expedited drug approval, and increase regulatory authorities' capacity to deal with the complexity of antimicrobial resistance (AMR) and novel clinical trials. They also call for more collaboration and harmonization with drug regulatory agencies in high-income nations.

The report argues that while it is crucial to create new financial incentives and reform the antibiotic development market to create a sustainable pipeline of new antibiotics, regulatory reforms to accelerate approval of new antibiotics can also help boost their development and improve access in the parts of the world where they are most needed.

"The growing burden of AMR will need to be addressed with new antibiotics," One Health Trust Director Ramanan Laxminarayan, PhD, MPH, writes in the report. "Unless we significantly rethink and revise current processes for regulatory approvals, the burden of AMR will keep increasing."
Jul 12 One Health Trust report

 

Prior antibiotic use, longer hospital stays increase risk of CRE infections

Originally published by CIDRAP News Jul 14

A study of patients at a large tertiary-care medical center found that antibiotic exposure and length of stay were associated with an increased risk of developing a carbapenem-resistant Enterobacterales (CRE) infection, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

To identify risk factors for CRE infection, Ohio State researchers conducted a retrospective case-case-control study, comparing patients who had been diagnosed as having a CRE infection at the hospital from 2011 through 2016 with patients diagnosed as having carbapenem-susceptible Enterobacterales (CSE) infections and a random selection of control patients. Data collected from patient medical records included age at admission, sex, length of hospital stay, and prescription for antibiotics in the 90 days prior to admission.

A total of 81 unique CRE patients were identified during the study period, and they were compared with 87 CSE patients and 89 control patients. In the unadjusted analysis, CRE patients were more than 18 times more likely to have been prescribed any antibiotic in the previous 90 days than CSE patients (odds ratio [OR], 18.35; 95% confidence interval [CI], 5.37 to 62.8) and 51 times more likely than control patients (OR, 51.1; 95% CI, 14.9 to 176.0).

In multivariable models, prescription of a beta-lactam antibiotic was associated with a fivefold increase in odds for CRE infection (OR, 5.43; 95% CI, 1.95 to 15.1) and a more than twofold increase in odds for CSE infection (OR, 2.65; 95% CI, 1.18 to 5.95). Each additional day of hospital admission was associated with an increased odds of infection of about 13% for CRE patients (OR, 1.14; 95% CI, 1.08 to 1.19) and CSE patients (OR, 1.13; 95% CI, 1.08 to 1.18).

"Future studies of this type may consider conducting more thorough reviews of medical records to determine specific residence type prior to admission and whether patients are coming from common locations that have seen patients previously diagnosed with either CRE or CSE," the study authors wrote. "Long-term and other group care facilities may have increased incidence of infection in general and of resistant organisms specifically and determining where patients are being admitted from can be important factors in determining how to care for these patients upon admission to a medical facility." 
Jul 14 Antimicrob Stewardship Healthc Epidemiol study

 

Stewardship interventions linked to reduce antibiotics in urgent care

Originally published by CIDRAP News Jul 14

A multifaceted quality-improvement program implemented at urgent care clinics in an integrated academic health system was associated with reductions in inappropriate and overall antibiotic prescribing, without negatively affecting patient satisfaction, researchers reported yesterday in Infection Control & Hospital Epidemiology.

The program implemented in 2019 at Northwestern Medicine was developed by an ambulatory antibiotic stewardship committee and focused on improving antibiotic prescribing for "stewardship target visits," which included non–antibiotic-appropriate conditions like upper respiratory tract infections. The program also targeted "diagnosis shifting visits," in which clinicians add antibiotic-appropriate diagnoses to evade stewardship measures, overall antibiotic prescribing, and patient satisfaction for acute respiratory infections (ARI) visits. Interventions included comparative feedback and clinician and patient education.

From 2019 through 2021, 576,609 patients made 1,358,816 visits to 17 urgent care clinics, including 105,781 visits for which stewardship measures were applied and 149,691 visits for which diagnosis shifting measures were applied.

The antibiotic prescribing rate decreased for stewardship-measure visits from 34% in 2019 to 12% in 2021 (absolute change, −22 percentage points; 95% CI, −23 to −22), for diagnosis-shifting visits from 63% to 35% (−28 percentage points; 95% CI, −28 to −27). The overall antibiotic prescribing rate declined from 30% to 10% (−20 percentage points; 95% CI, −20 to −20). The patient satisfaction rate increased from 83% in 2019 to 89% in 2020 and 2021. There was no significant association between antibiotic prescribing rates of individual clinicians and ARI visit patient satisfaction.

"In conclusion, it is possible to decrease antibiotic prescribing for presumed viral illnesses in the urgent-care setting and maintain patient satisfaction," the study authors wrote. "Key elements of success may have included an ambulatory antimicrobial stewardship committee, physician champions, having data for analysis and reporting, and educational resources for patients and prescribers."

They added that reducing antibiotic prescribing for non–antibiotic-appropriate diagnoses has the potential to start a "virtuous cycle" for patients, as non-receipt of antibiotics may be associated with less antibiotic seeking in the future.
Jul 13 Infect Control Hosp Epidemiol abstract

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