Stewardship / Resistance Scan for Aug 09, 2021

News brief

Survey examines caregiver attitudes on antibiotic use

A survey of US caregivers found that more than 1 in 10 either planned or had already administered a nonprescription antibiotic (NPA) to their child, researchers reported last week in the Journal of the Pediatric Infectious Diseases Society.

Among the 396 caregivers of children younger than 18 who answered all the questions in the survey, which was conducted from January 2019 through July 2019, 119 (30%) caregivers requested antibiotics from a clinician, 65 (16%) reported storing antibiotics currently in the home, and 47 (12%) reported intent to use an antibiotic without a clinician's directive or had already done so. Amoxicillin was the most common antibiotic stored in the home, followed by amoxicillin/clavulanate, cephalexin, and ciprofloxacin.

Further analysis of the respondents in the NPA group found that 40% reported requesting antibiotics from a clinician, and those with an annual income of over $75,000 were more than twice as likely as other caregivers (odds ratio, 2.04; 95% confidence interval [CI], 1.01 to 4.14) to store and use antibiotics without a clinician's directive. Nineteen percent of the NPA group agreed with the statement "It's okay to use antibiotics that were given to a friend or family member as long as it was used to treat a similar illness," compared with 3% of other caregivers.

"Our data highlight that the issue of antibiotic misuse by caregivers of children is complex and must be tackled systematically," the study authors wrote. "Future antibiotic stewardship efforts should include education for clinicians, pharmacists, and the public about leftover medication and nonprescription antibiotic use."
Aug 7 J Pediatric Infect Dis Soc abstract

Study finds COVID surges linked to increase in hospital infections

An analysis of US hospital data found that surges in COVID-19 hospitalizations were associated with elevated rates of healthcare-associated infections (HAIs) and drug-resistant pathogens, researchers reported today in Clinical Infectious Diseases.

Using data collected from 148 hospitals in 17 states from March through September 2020, the researchers found that increased relative rates of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia increased as the COVID-19 burden increased.

Over 7 months, there were 60% more CLABSIs, 43% more CAUTIs, and 44% more cases of MRSA bacteremia than expected based on predicted HAIs had there been no COVID-cases.

Microbiology data from a subset of 81 hospitals with microbiology and cluster data through December 2020 confirmed those findings. Over 10 months, COVID-19 surges were temporally associated with a 24% increase in hospital-onset bloodstream infections and multidrug-resistant organisms, including a 30% increase in hospital-onset MRSA infections, a 44% increase in hospital-onset vancomycin-resistant Enterococci infections, and 27% increase in infections caused by multidrug-resistant gram-negative organisms. In addition, clusters of hospital-onset pathogens increased as the COVID-19 burden increased.

The findings support the researchers' hypothesis that routine HAI prevention practices, such as central line and urinary catheter care, may have been negatively impacted by disruptions to infection prevention and control measures during the pandemic.

"Although the per-patient risk of a hospital-onset infection remained very low, HAI rates increased during COVID-19 surges," the study authors write. "Further research is necessary to elucidate the specific ways in which the COVID-19 burden is affecting HAI rates, but our results identify a need to build capacity in infection prevention and control."
Aug 9 Clin Infect Dis abstract

News Scan for Aug 09, 2021

News brief

Guinea confirms its first Marburg case

Guinea's ministry of health (MOH) has confirmed the country's first Marburg virus case, also marking the first in West Africa, the World Health Organization (WHO) African regional office said today in a statement.

A few days ago, Guinea's government said the suspected case was reported from Gueckedou in the N'zerekore region near the borders of Liberia and Sierra Leone. The area—located in southern Guinea—was the epicenter of Guinea's recent Ebola outbreak, which totaled 23 cases and 12 deaths. The event was declared over on Jun 19.

The patient with the confirmed Marburg infection sought care at local clinic in Koundou, where medical experts were sent to explore the man's worsening symptoms. Samples were obtained when the he died and were sent to a field lab in Gueckedou.

Marburg virus is similar to Ebola virus, and both filoviruses can result in fatal viral hemorrhagic fever illnesses. A large Marburg virus outbreak in Angola in 2004 and 2005 resulted in 252 cases, 27 of them fatal.

Though tests were positive at two of Guinea's labs, the ministry said since this would be Guinea's first case, further confirmation testing was planned at Pasteur Institute in Senegal.

Matshidiso Moeti, MBBS, who directs the WHO's African regional office, praised Guinea's quick actions in detecting the case. "The potential for the Marburg virus to spread far and wide means we need to stop it in its tracks."
Aug 9 WHO African regional office statement
Aug 6 Guinea MOH statement

CDC reports 4th US melioidosis case

The US Centers for Disease Control and Prevention (CDC) said Georgia health officials are investigating a fatal Burkholderia pseudomallei case that was identified at the end of July after the patient died in the hospital. Genetic analysis suggests a close match between the Georgia cases and three earlier cases reported from Kansas, Minnesota, and Texas.

None of the patients had traveled outside the country, and the findings so far suggest a common exposure source, such as an imported product or animal, the CDC said today in a health alert network (HAN) update. The CDC said it has collected more than 100 samples from products, soil, and water from patients' homes, but so far, but none were positive for the bacteria.

The CDC said the patients' initial symptoms ranged from cough and shortness of breath to fatigue, nausea, vomiting, intermittent fever, and rash on the trunk, abdomen, and face. Cases include both children and adults. Two patients have died and two had long hospitalizations before discharge to rehabilitation facilities. Two patients, including one of the patients who died, had underlying risk factors.

B pseudomallei is a tier 1 select agent and is most commonly found in tropical and subtropical areas. Most cases from the United States are linked to travel to areas where the disease is endemic. Symptoms are often nonspecific, and human infections are rare. The CDC is urging health workers to consider melioidosis in patients with similar symptoms, even if they don't have a travel history.
Aug 9 CDC HAN update
Aug 9 CDC statement
Jul 1 CIDRAP News scan

Viral COVID-19 detected in singing, talking, breathing

Between breathing, singing, and talking, researchers detected SARS-CoV-2 RNA copies mostly from talking and singing (94%), and 85% of all viral particles were detected in fine aerosols, according to a small study late last week in Clinical Infectious Diseases.

The researchers had 22 COVID-19 patients at Singapore's National Centre for Infectious Diseases breathe for 30 minutes, talk for 15 minutes, or sing for 15 minutes into a G-II exhaled breath collector. Thirteen patients (59%) had detectable SARS-CoV-2 levels, of whom three were asymptomatic and one was presymptomatic. Variables such as age, sex, virus variant, and clinical symptoms were not significantly associated with detectable viral RNA in aerosols, but median day of illness was, with a higher likelihood earlier on in a patient’s illness (median, 3 vs 5 days after illness onset).

Overall, 85.4% of the total viral RNA load in the study was from fine aerosols (up to 5 micrometers) versus the larger coarse aerosols. Six people created detectable RNA levels for all three activities, two only had some from talking, and two only had some from singing. None of the viral samples were able to be cultured.

While more RNA copies were created from singing (53%) than talking (41%) or breathing (6%), the researchers note that seven patients emitted more viruses from talking than singing and that there was large person-to-person variation in total viral loads. For instance, two patients contributed 52.4% of the study's total viral load. N gene copies ranged from 63 to 5,281 per activity per person.

"Our sampling yielded viral RNA loads below 103.8 genome copies per sample, suggesting that increased sampling duration is needed to reach culturable virus levels," the researchers write. "However, critical mutations in certain SARS-CoV-2 variants can augment virus infectivity, eg, some patients infected with the Delta variant demonstrate higher viral loads in their respiratory swabs."

They conclude, "Our study demonstrates that SARS-CoV-2 can be aerosolized in the absence of coughing, sneezing, and aerosol-generating medical procedures."
Aug 6 Clin Infect Dis study