News Scan for May 19, 2021

News brief

Study finds long-haul COVID-19 common, in even those with mild disease

Long-haul COVID-19 was associated with severe or very severe symptoms, low income, and some age-groups, but was common even in those with mild symptoms, with a quarter of patients in that group having symptoms after 60 days, according to a Clinical Infectious Diseases study today that looked at adult Michigan patients.

The researchers surveyed 593 Michigan adults who had a symptomatic COVID-19 diagnosis through mid-April 2020. Most were female (56.1%), older than 45 years (68.2%), and either White (46.3%) or Black (34.8%). More than half reported 30-day COVID-19 symptoms (52.5%), and 35.0% said they had symptoms 60 days post-diagnosis. The most common symptoms among 60-day COVID-19 patients were fatigue (52.9%) and shortness of breath (43.9%).

Respondents with very severe symptoms were 2.25 and 1.71 times more likely to have 30- and 60-day COVID-19 symptoms, respectively, than those who had mild cases. Similarly, those who were hospitalized had about 40% higher crude increased odds of 30- or 60-day COVID-19 symptoms (crude odds ratio [OR], 1.37 and 1.40, respectively). Still, long-term COVID-19 also occurred in non-hospitalized patients (43.7% at 30 days and 26.9% at 60 days) and those with mild symptoms (29.2% at 30 days and 24.5% at 60 days).

While associations with race, some comorbidities, and multiple age-groups were found using unadjusted models, the researchers' adjusted models showed significant links only for psychological disorders (OR, 1.42 for 60-day symptoms), low household income (OR, 1.38 to 1.40 for income below $75,000 for 30-day symptoms), and people 35 to 44 years of age versus those 18 to 34 (OR not given).

The researchers add that although Hispanic adults had a 48% higher prevalence of 30-day COVID-19 and 67% higher prevalence of 60-day COVID-19 compared with non-hospitalized White adults, the adjusted models showed no statistical significance for any race or ethnicities.
May 19 Clin Infect Dis study

COVID racial disparities may persist independent of socioeconomic status

Non-White COVID-19 patients were more likely to be hospitalized compared with White people regardless of socioeconomic status, according to a study yesterday in the Journal of General Internal Medicine. The researchers also found that non-English speakers were more likely to require hospital care.

University of Minnesota researchers looked at 5,577 COVID-19 patient records from the M Fairview health system in Minnesota from Mar 4 to Aug 19, 2020. Of these, 15.5% were hospitalized within 45 days of diagnosis. Hospitalized patients were more likely to be male (49.1% vs 43.5%) and had more comorbidities (5.0 vs 1.0 on the Elixhauser Comorbidity Index).

Compared with White patients, Black, Asian, and Hispanic people were more likely to need hospitalization (odds ratios [ORs], 1.50, 2.39, and 3.80, respectively). The researchers also found that, while hospitalized patients were older than their outpatient counterparts in general (median 60.9 vs 40.4 years), racial differences in hospital patient age were noted: White patients were a median 69.6 years old; whereas Black patients were 55.4, Asians 58.9, and Hispanics 48.5.

Using the Area Deprivation Index for each patient's ZIP code, the researchers did not find any association between hospitalization outcomes and socioeconomic status, a common factor that is brought up when looking at COVID-19 racial disparities. "It supports concerns that other unidentified confounders (i.e., structural racism, testing, etc.) drive the association," the researchers write.

Conversely, language was independently associated. Regardless of race or ethnicity, the likelihood of hospitalization increased 1.91 times for patients who didn't speak English.

"Seeing an increased risk of severe COVID-19 disease in people of color and non-English speaking, independent of other known risk factors, these populations should be considered high priority for the continued vaccination rollout," lead author Nicholas Ingraham, MD, said in a University of Minnesota press release. The team also advocates for more multilingual COVID-19 information and implicit bias remediation among healthcare providers.
May 18 J Gen Intern Med study
May 18 University of Minnesota press release

Rapid test finds CWD at Minnesota deer carcass dump site

Using rapid testing technology, Minnesota investigators have detected evidence of chronic wasting disease (CWD) prions at a remote dumping site that a Minnesota deer farm used to dispose of white-tail deer carcasses, the University of Minnesota said yesterday in a press release.

Working at a site in Beltrami County in the northwestern part of the state, scientists from the Minnesota Center for Prion Research (MNPRO) used the RT-QuIC test on samples of bone, hides, soil, and plants that were collected on May 2. Their investigation, which focused on materials known to retain prions, turned up portions of at least 10 deer. One bone marrow sample was positive for CWD.

Peter Larsen, PhD, who led the team, said the rapidly evolving situation is concerning, because the area is frequented by wild white-tailed deer.

A herd at a nearby deer farm was depopulated last week and the US Department of Agriculture and MNPRO are testing samples from the depopulated animals. Scientists at MNPRO recently developed an assay for use in the field that is designed to reduce bottlenecks during deer hunting season. Called MN-QuIC, it generates a result within 24 hours, showing red for positive and blue for negative.

CWD is a fatal prion disease that affects deer, elk, reindeer, and moose, and has been confirmed in 26 US states and three Canadian provinces. No cases have yet been reported in people.
May 18 University of Minnesota press release

Stewardship / Resistance Scan for May 19, 2021

News brief

CARB-X funds development of novel antibiotic for gram-negative infections

CARB-X announced today that it is awarding Swiss drug maker Basilea Pharmaceutica International up to $2.7 million to develop a novel class of antibiotics to treat gram-negative bacterial infections.

The award from CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator) will help Basilea develop small-molecule inhibitors of the DXR enzyme, which is essential for the survival of many gram-negative pathogens, including carbapenem-resistant Enterobacterales and Acinetobacter baumannii and multidrug-resistant Pseudomonas aeruginosa.

"The Basilea project is in the early stages of development, with a novel chemical class working with a novel mechanism of inhibition of bacterial growth," CARB-X Research and Development Chief Erin Duffy, PhD, said in a CARB-X press release.

"Together, these offer a potential advantage where the development of resistance is concerned and—as such—offer great promise for a new therapy to treat serious hospital infections."
May 19 CARB-X press release

Hospital stewardship linked to reduced MDR pathogen colonization

A systematic review and meta-analysis of more than 60 studies found that antimicrobial stewardship programs (ASPs) were associated with reduced multidrug-resistant Enterobacterales (MDR-E) colonization in hospital patients, researchers reported last week in the Journal of Infection.

The aim of the study, conducted by scientists from Israel, Germany, and Spain, was to evaluate the comparative effectiveness and safety of different interventions for the prevention of MDR-E colonization and infections in hospitalized patients. The co-primary outcomes were reduction in mortality and infections caused by MDR-E, and secondary outcomes included colonization with MDR-E.

A total of 63 studies were included, with 23 that assessed ASPs as the main intervention. Meta-analysis of those studies found no significant difference between ASPs and control groups for all-cause mortality (relative risk [RR], 1.o; 95% confidence interval [CI], 0.95 to 1.07), intensive care unit mortality (RR, 1.01; 95% CI, 0.93 to 1.10), or MDR-E infection (incidence ratio [IR], 0.88; 95% CI, 0.71 to 1.10). But significantly reduced MDR-E colonization was observed with ASPs (IR, 0.69; 95% CI, 0.57 to 0.82).

Seventeen studies examining decolonization strategies found no significant differences in any outcomes. Few other intervention strategies were studied.

The authors say that the finding of reduced colonization is noteworthy, since roughly one-third of patients with MDR-E colonization will develop an infection.

"Though effect on infection was not demonstrated in our meta-analysis, it is possible that additional future studies and a larger sample size would demonstrate a significant difference," they wrote.
May 14 J Infect abstract

VHA survey finds stewardship programs reliant on pharmacists

Interviews conducted at Veterans Health Administration (VHA) hospitals without on-site infectious diseases (ID) support found that ASPs are largely a pharmacy-driven process, researchers reported this week in Infection Control & Hospital Epidemiology.

A team led by researchers with the Iowa City Veterans' Affairs Health Care System found that four themes emerged from site visits (two conducted virtually because of the pandemic) and interviews with 42 ASP team members at seven VHA hospitals lacking on-site ID support.

The first was that the ASP pharmacy champion wears many hats and fills many roles, and was consistently recognized as the leader of the ASP. The second was that ASP pharmacy champions had to build rapport with clinicians in order to get support for stewardship recommendations, a task that was difficult at hospitals that relied heavily on contract physicians.

The third theme that emerged was that access to an off-site ID specialist via electronic consultation helped give credibility to both the ASP pharmacists' recommendations and to any stewardship initiatives the ASP team was trying to move forward. Finally, most ASP pharmacy champions spoke of the difficulty of gaining institutional buy-in and funding for their efforts.

The authors say the findings have broader implications, since a large proportion of US hospitals lack an on-site ID support but are still required to have an ASP.

"Given the ongoing need to improve antibiotic use and expand the implementation of ASPs across the spectrum of healthcare, our findings could inform future work on ASP implementation in these settings," they wrote.
May 17 Infect Control Hosp Epidemiol abstract