News Scan for Oct 21, 2021

News brief

Data show low antibiotic prescribing, UTI misdiagnosis on mental health units

A review of antibiotic prescribing at Veterans' Health Administration (VHA) mental health units found that only 1 in 10 patients were exposed to antibiotics, but urinary tract infections (UTIs) appeared to be frequently misdiagnosed, researchers reported today in Infection Control & Hospital Epidemiology.

In the study, researchers from the Iowa City VA Health Care System looked at data on inpatient and post-discharge antibiotics at 111 VHA mental health units from 2016 through 2018. They also conducted chart reviews for a subset of patients to assess adherence to standard recommended practices and professional guidelines for UTIs, cystitis, skin and other soft-tissue infections (SSTIs), and acute respiratory infections (ARIs).

During the study period, 27,401 (10.9%) of 252,588 admitted patients had an antibiotic administered while hospitalized on the mental health unit. The median inpatient antibiotics days of therapy across all 111 units was 73.5 per 1,000 days present. The infections most commonly associated with an antibiotic prescription were UTIs (18.3%), SSTIs (10.9%), and ARIs (7.1%).

Chart review found that, among 111 UTI cases, 63 (56.8%) were not supported by patient history or laboratory findings, and in 24.3% of UTI cases, the presence of altered mental status appeared to be the driver of antibiotic therapy, even though antibiotics are not recommended for bacteriuria in the context of cognitive impairment alone.

"Overall, these findings suggest that UTI is commonly misdiagnosed and therefore represent an optimal target for stewardship efforts," the study authors wrote.

The study also found that 25.3% of the antibiotic recommendations were made by emergency department physicians, and 27.8% by internal medicine physicians, a finding the authors say suggests that these specialties should be included in any efforts to improve antibiotic prescribing at VHA mental health units.
Oct 21 Infect Control Hosp Epidemiol abstract

Large US Salmonella outbreak linked to onions; 652 cases confirmed

The Centers for Disease Control and Prevention (CDC) first reported a Salmonella Oranienburg outbreak in mid-September, and now the rapidly growing outbreak has been linked to fresh yellow, red, and white onions from Chihuahua, Mexico, distributed by ProSource, Inc. Investigators are still seeing if other onions or suppliers have been affected.

As of Oct 18, 652 illnesses, 129 known hospitalizations, and zero deaths have been reported. Thirty-seven states have been affected, with the most cases in Texas (158), Oklahoma (98), and Virginia (59).

Investigators were able to connect the outbreak to the onions after 75% of 193 interviewed people reported consuming raw onions or dishes likely containing raw onions. From that information, 20 illness clusters from restaurants were identified, and one of the clusters was at a restaurant where Salmonella Oranienburg was identified in a condiment container.

No food recalls have been issued, but the CDC recommends that people throw away their onions if they were from ProSource or Chihuahua or if they do not know their onions' origins. They should also wash contaminated surfaces. ProSource says the last import was Aug 27, but the onions, which were distributed to grocers and restaurants, can last up to 3 months in storage.

Whole-genome sequencing from 609 people's bacteria samples did not predict any antibiotic resistance to Salmonella-related treatment.
Oct 20 CDC update
Oct 1 CIDRAP News scan on previous update

COVID-19 Scan for Oct 21, 2021

News brief

COVID-19 vaccine appears safe in first-trimester pregnancy

COVID-19 vaccination does not increase the risk of miscarriage during the first trimester of pregnancy, according to a Norwegian case-control study that involved 13,956 women, 5.5% of whom were vaccinated against the virus. The results were published yesterday as a letter to the editor in the New England Journal of Medicine.

The study consisted of 13,956 pregnant women, 5.5% of whom were vaccinated. In total, 4,521 women had miscarriages, and 5.1% of those were vaccinated. A median of 19 days occurred between vaccination and either miscarriage or confirmation of ongoing pregnancy. (In Norway, pregnant women are not recommended to receive any vaccinations during their first trimester, but the researchers reason that some women may have gotten vaccinated against COVID-19 before they knew they were pregnant.)

Women vaccinated against COVID-19 did not show increased odds of miscarriage (adjusted odds ratios, 0.91 at 3 weeks and 0.81 at 5 weeks post-vaccination). Even after the researchers analyzed data via available vaccine types, number of doses, and conducted a sensitivity analysis limited to healthcare professionals or women with at least 8 weeks of follow-up after confirmed pregnancy, the results remained similar.

In a podcast involving the journal's top editors, Lindsey Baden, MD, deputy editor, says that this study, in conjunction with the other observational studies on pregnancy and vaccination, becomes "yet again" a risk-benefit analysis. "Pregnancy will require ongoing careful surveillance, but thus far, the emerging data support the use in pregnancy to prevent significant complications," he says.
Oct 20 N Engl J Med study and podcast

COVID occupational risks may be second to socioeconomic inequities

While Swedish workers' occupations were not linked to increased COVID-19 mortality risk, older people who lived with these adults had an increased risk, according to a study published yesterday in the Scandinavian Journal of Work, Environment, and Health.

The researchers looked at 4,620,395 adults 20 to 66 years old who were registered with an occupation in December 2018 and at 209,229 adults 67 years and older who lived in a household with at least one person who lived with a working-age adult. Population-wide data was collected from Mar 12, 2020, to Feb 23, 2021. While Sweden never mandated a lockdown, mobility trends for workplaces decreased 25% in March and April 2020.

At face value, frontline and essential occupations were linked to higher associated risks than other occupations—taxi and bus drivers had more than four times the COVID-19 mortality risk of skilled workers. However, after adjusting for socioeconomic status (SES), all occupation differences become nonsignificant.

Instead, data showed that older people who lived with adults of working age who could not work from home were at increased COVID mortality risk. "This relationship persisted when we adjust for the older person’s own SES (RR [relative risk] 1.005, P=0.001)," the researchers write. "This RR is for an increase in being able to work from home of only one percentage point, whereas the RR is 1.73 if we consider instead 100% versus 0% of an occupation not being able to work from home."

Post-SES adjustment, delivery and postal workers were the only occupational group that posed a higher risk for older co-residents (aRR, 2.16, P = 0.015).

"The finding that socioeconomic status better explained the risk of dying from COVID-19 than the work situation points to health inequalities playing a major role," said first author Sunnee Billingsley, PhD, MPhil, in a Stockholm University press release.
Oct 20 Scand J Work Environ Health study
Oct 20 Stockholm University press release