News Scan for Jul 22, 2022

News brief

Survey flags public health worker exodus due in part to COVID-19 impact

Over 40% of the US public health workforce plans to leave their jobs within the next 5 years, and 51% said more staff were needed to respond to COVID-19, according to findings from a 2021 survey published today in Morbidity and Mortality Weekly Report (MMWR).

Researchers from the de Beaumont Foundation and the University of Minnesota collected responses to the online 2021 Public Health Workforce Interests and Needs Survey of state and local governmental public health agency workers participating in the Big Health Cities Coalition and a national sample of local health departments from September 2021 to January 2022.

Participants included 41,890 staff members from 47 state health agency central offices, 190 large local health departments, and 249 medium-sized local health departments.

During the pandemic, 72% of respondents worked fully or partially in a COVID-19 response role. Respondents were predominantly White (54%), women (79%), and older than 40 years (63%), and half had worked at their current agency for less than 5 years. Of all respondents, 37% reported having a master's or doctoral degree, and 14% had a degree in public health.

Forty-four percent of workers said they were thinking about leaving their jobs, including retirement, within the next 5 years, 27% said they were thinking about leaving their jobs for reasons other than retirement, and 76% said they began considering leaving when the pandemic began.

In response to being asked what was needed to respond to COVID-19, in addition to funding, 51% cited more staff, followed by more support from the community (30%) and elected leaders (26%).

"This finding is concerning, given a recent report that found approximately 80,000 additional full-time staff members are needed throughout the nation's public health agencies to provide foundational public health services," the authors wrote. "Purposeful succession planning and focused attention on recruitment and retention that promotes diversity will be critical as the workforce rebuilds while the COVID-19 pandemic evolves."
Jul 22 MMWR study

 

Small pet turtles implicated in multistate Salmonella outbreak

The Centers for Disease Control and Prevention (CDC) yesterday announced that it and health officials in several states are investigating a Salmonella Stanley outbreak linked to small pet turtles.

So far, 15 cases have been reported in 11 states. Five people have been hospitalized, but no deaths have been reported. Sick people range in age from less than 1 to 59 years old, with a median of 7 years old. Illness onsets range from Jan 3 to Jun 24.

Interviews with 9 patients found that 8 reported touching turtles. Of 7 people asked about the size of the turtles, 6 reported contact with a pet turtle with a shell shorter than 4 inches. Six had bought the turtles from online retailers, 3 of them from myturtlestore.com.

Testing on two samples from turtles from a sick person's home in Tennessee found that they were closely related to the strain found in sick people. Whole-genome sequencing on samples from people, turtles, and their environments didn't predict any resistance to antibiotics, but one patient's sample showed resistance to tetracycline.

The CDC said federal law bans the sale and distribution of turtles with shells less than 4 inches long, but they can sometimes be found online or at other outlets. It said pet turtles are not recommended for young children and those with weakened immune systems, due to the disease risk.

Several Salmonella outbreaks have been linked to small pet turtles in the past, most recently in 2021, when outbreaks sickened 87 people, 1 fatally, from 20 states and the District of Columbia.
Jul 21 CDC outbreak announcement

 

Three countries report more polio as Pakistan WPV1 total grows

Aside from the polio case reported from New York yesterday, three other countries reported new cases this week, including another wild poliovirus type 1 (WPV1) case from Pakistan, the Global Polio Eradication Initiative (GPEI) said in its latest weekly update.

Pakistan's latest case is in Khyber Pakhtunkhwa province in the northwest, and the illness lifts the nation's total to 12 for the year.

Elsewhere, two countries reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases. Nigeria reported 3 cases in three states, boosting its total for 2022 to 30. And Yemen reported 5 more cases in four governorates, putting its total this year at 54.
Jul 21 GPEI update

Stewardship / Resistance Scan for Jul 22, 2022

News brief

Groups say McDonald's is 'backtracking' on antibiotic commitment

A coalition of public interest, animal welfare, and environmental groups is criticizing McDonald's for backing away from a commitment to reduce the use of medically important antibiotics in its beef supply chain.

In a statement released yesterday, the Antibiotics Off the Menu coalition noted that the company's updated antibiotic policy for beef and dairy beef moves away from setting any concrete targets for the reduction of medically important antibiotics by suppliers in the 10 countries (Australia, New Zealand, France, Germany, Ireland, Poland, United Kingdom, Canada, United States, and Brazil) that supply most of its beef. In December 2018, McDonald's pledged that it would establish antibiotic reduction targets for beef suppliers in those countries by the end of 2020—a pledge it has yet to meet.  

The company now says that, after conducting pilot tests in those countries, it will collaborate with industry leaders, academics, suppliers, and experts to establish market-appropriate targets for responsible use of medically important antibiotics.

"McDonald's showed leadership in 2018 with a commitment to reduce antibiotics across its massive beef supply chain," the group said. "Disappointingly, it's clear that the company is backtracking on its commitment. By switching from targets for 'reducing use' to targets for 'responsible use,' McDonald's stopped leading and began following, because their latest approach leaves ample room for business as usual practices to continue."

McDonald's says its focus is on refining antibiotic selection and administration, reducing non-therapeutic antibiotic use, and, when possible, replacing antibiotics with "long-term solutions to proactively prevent disease and protect animal health and welfare."
Jul 21 Antibiotics Off the Menu statement

 

Rapid susceptibility test shortens time to oral antibiotics, hospital stay

A randomized clinical trial found that a rapid phenotypic antimicrobial susceptibility test for patients with gram-negative bloodstream infections decreased the time to oral antibiotics and the length of hospitalization, researchers reported today in Open Forum Infectious Diseases.

In the trial, which was conducted at two medical centers in Portland, Oregon, investigators randomly assigned positive blood cultures from 247 patients who had gram-negative bloodstream infections to undergo a rapid antimicrobial susceptibility test (rAST) or a conventional AST (cAST). The primary outcome was time to narrowest effective antibiotic therapy, and secondary outcomes included time to susceptibility results, time to oral therapy, and length of stay (LOS) in the hospital.

Among the 205 patients included in the analysis, time to susceptibility results was 23 hours shorter in the rAST group than in the cAST group (39 hours vs 62 hours), but the median time to the narrowest effective antibiotic therapy was not significantly different between the two groups (64 hours [rAST] vs 73 hours [cAST]), except in a subgroup analysis that excluded patients who were already on the narrowest therapy. But significant decreases were observed in the time to oral therapy (91 hours [rAST] vs 126 hours [cAST]) and median LOS (5 days [rAST] vs 7 days [cAST]). The investigators say the reduction in LOS resulted in an approximate $1.2 million cost-avoidance in the rAST group.

The study authors conclude that faster AST reporting, particularly in the context of an antimicrobial stewardship program, has the potential to facilitate early transitions to oral therapy and early discharge.
Jul 22 Open Forum Infect Dis abstract

ASP Scan (Weekly) for Jul 22, 2022

News brief

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

Groups say McDonald's is 'backtracking' on antibiotic commitment

A coalition of public interest, animal welfare, and environmental groups is criticizing McDonald's for backing away from a commitment to reduce the use of medically important antibiotics in its beef supply chain.

In a statement released yesterday, the Antibiotics Off the Menu coalition noted that the company's updated antibiotic policy for beef and dairy beef moves away from setting any concrete targets for the reduction of medically important antibiotics by suppliers in the 10 countries (Australia, New Zealand, France, Germany, Ireland, Poland, United Kingdom, Canada, United States, and Brazil) that supply most of its beef. In December 2018, McDonald's pledged that it would establish antibiotic reduction targets for beef suppliers in those countries by the end of 2020—a pledge it has yet to meet.  

The company now says that, after conducting pilot tests in those countries, it will collaborate with industry leaders, academics, suppliers, and experts to establish market-appropriate targets for responsible use of medically important antibiotics.

"McDonald's showed leadership in 2018 with a commitment to reduce antibiotics across its massive beef supply chain," the group said. "Disappointingly, it's clear that the company is backtracking on its commitment. By switching from targets for 'reducing use' to targets for 'responsible use,' McDonald's stopped leading and began following, because their latest approach leaves ample room for business as usual practices to continue."

McDonald's says its focus is on refining antibiotic selection and administration, reducing non-therapeutic antibiotic use, and, when possible, replacing antibiotics with "long-term solutions to proactively prevent disease and protect animal health and welfare."
Jul 21 Antibiotics Off the Menu statement

 

Rapid susceptibility test shortens time to oral antibiotics, hospital stay

A randomized clinical trial found that a rapid phenotypic antimicrobial susceptibility test for patients with gram-negative bloodstream infections decreased the time to oral antibiotics and the length of hospitalization, researchers reported today in Open Forum Infectious Diseases.

In the trial, which was conducted at two medical centers in Portland, Oregon, investigators randomly assigned positive blood cultures from 247 patients who had gram-negative bloodstream infections to undergo a rapid antimicrobial susceptibility test (rAST) or a conventional AST (cAST). The primary outcome was time to narrowest effective antibiotic therapy, and secondary outcomes included time to susceptibility results, time to oral therapy, and length of stay (LOS) in the hospital.

Among the 205 patients included in the analysis, time to susceptibility results was 23 hours shorter in the rAST group than in the cAST group (39 hours vs 62 hours), but the median time to the narrowest effective antibiotic therapy was not significantly different between the two groups (64 hours [rAST] vs 73 hours [cAST]), except in a subgroup analysis that excluded patients who were already on the narrowest therapy. But significant decreases were observed in the time to oral therapy (91 hours [rAST] vs 126 hours [cAST]) and median LOS (5 days [rAST] vs 7 days [cAST]). The investigators say the reduction in LOS resulted in an approximate $1.2 million cost-avoidance in the rAST group.

The study authors conclude that faster AST reporting, particularly in the context of an antimicrobial stewardship program, has the potential to facilitate early transitions to oral therapy and early discharge.
Jul 22 Open Forum Infect Dis abstract

 

Study spotlights overuse of broader-spectrum antibiotics in Saudi Arabia

Originally published by CIDRAP News Jul 20

An analysis of dental and pediatric primary care practices in Saudi Arabia found higher prescribing of broader-spectrum antibiotics and poor adherence to antibiotic prescribing guidelines, researchers reported yesterday in the American Journal of Infection Control.

The retrospective cross-sectional study, conducted from May through November 2020 at 24 primary healthcare centers in Saudi Arabia, assessed antibiotic prescribing patterns at family medicine and dental practices using the World Health Organization AWaRe (Access, Watch and Reserve) classification system and relevant clinical guidelines. The researchers also identified factors associated with the choice of Watch-group antibiotics, which are broader-spectrum agents with a higher resistance potential.

Of the 752 antibiotic prescriptions assessed, 84% were prescribed by general practitioners and 16% by dentists, most commonly for urinary tract (12.8%) and acute respiratory tract (12.2%) infections. Compared with Access-group antibiotics, Watch-group antibiotics such as second-generation cephalosporins and macrolides were more likely to be prescribed based on the number of prescriptions (51.1% vs 48.9%) and defined daily doses (DDDs) (52.2% vs 47.8%).

The percentages of Watch-group antibiotics for children and adults were 66.7% and 42.9%, respectively. The overall adherence to clinical prescribing guidelines for children, adults, and total prescribed antibiotics was 27.2%, 64%, and 49.5%, respectively, with dental clinics demonstrating better adherence than general practices.

Multivariable logistic regression analysis found that being a child (adjusted odds ratio, [aOR], 2.89; 95% confidence interval [CI], 1.46 to 5.78), diagnosis with acute respiratory tract infection (aOR, 2.62; 95% CI, 1.03 to 6.69), and urinary tract infection (aOR, 4.69; 95% CI, 2.09 to 10.56) were associated with higher prescribing of Watch-group antibiotics.

The study authors say the findings indicate national guidelines on antibiotic use are needed in Saudi Arabia, along with a surveillance system to track antibiotic use at the national level.

"The higher proportion of prescribing of Watch-group antibiotics in this study for both children and adults is a warning sign that may reflect inappropriate awareness of the optimum antibiotic selection as well as poor adherence to guidelines," they wrote. "This result may lead to a potential increase in bacterial resistance and overuse of broad-spectrum antibiotics, which consequently increases costs and the likelihood of adverse drug reactions or lowered therapy outcomes."
Jul 19 Am J Infect Control abstract

 

International travel linked to spread of multidrug-resistant STIs

Originally published by CIDRAP News Jul 18

International travel may play a critical role in the spread of multidrug-resistant (MDR) sexually transmitted infections (STIs), according to a study published late last week in Travel Medicine and Infectious Disease.

In a systematic review and meta-analysis of studies on gonococcal infection, antibiotic resistance, and international travel that were published from 2010 to 2021, a team of Spanish researchers found that 16 of 18 studies described a probable link between international travel and transmission of MDR Neisseria gonorrhoeae from the country of travel to the country of return, as the index cases reported unprotected sexual intercourse at their place of destination. Travelers mainly visited Southeast Asian countries (66.7%) and returned to the United Kingdom (38.9%).

Half of the studies (9) reported N gonorrhoeae strains with resistance to ciprofloxacin, while 7 described cephalosporin resistant and 4 described decreased sensitivity to penicillin and azithromycin. The most frequently prescribed antibiotic for treatment was ceftriaxone.

The meta-analysis also found that men in their 30s are more likely to be infected by an MDR STI.

"As no vaccinations are currently available for these infections, sexual education should therefore play an important role in the routine pre-travel consultation," the study authors concluded. "Returned travelers who present with gonococcal infection should be screened for antibiotic resistance to avoid transmitting drug-resistant pathogens to other worldwide locations."
Jul 16 Travel Med Infect Dis abstract

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