Stewardship / Resistance Scan for Feb 08, 2022

News brief

Procalcitonin testing during COVID tied to initial drop in UK antibiotic use

The introduction of procalcitonin (PCT) testing at UK hospitals during the first wave of the COVID-19 pandemic was associated with an immediate but not sustained decline in antibiotic prescribing, researchers reported today in the Journal of Antimicrobial Chemotherapy.

During the first wave of the pandemic, many National Health Service (NHS) hospitals introduced PCT testing, which looks for an inflammatory biomarker that rises in bacterial respiratory tract infections, to guide antibiotic decision-making, particularly in emergency departments (EDs) and acute medical units (ACUs).

To evaluate the impact of PCT testing on antibiotic use, a team of researchers conducted a retrospective, controlled interrupted time series analysis of antibiotic dispensing, hospital activity, and PCT testing at 105 NHS hospitals/hospital trusts in England and Wales from Feb 24 to Jul 5, 2020.

In the main analysis, there was a statistically significant decrease of –1.08 (95% confidence interval [CI], –1.81 to –0.36) defined daily doses (DDD) per admission per week per trust immediately following the introduction of PCT testing in EDs/ACUs. But that was followed by a statistically significant increase of 0.05 (95% CI, 0.02 to 0.08) DDD per admission per week per trust. Similar results were found specifically for first-line antibiotics for community-acquired pneumonia and for COVID-19 admissions. PCT testing was not associated with any change in antibiotic prescribing in the intensive care unit.

"We found that the initial impact of PCT testing was gradually lost over time," the study authors write. "Of note, this is an absolute effect, not relative to other trusts/hospitals, and is likely related to sustainability, which is a challenge for any antibiotic stewardship intervention."

The authors add, however, that the initial impact of PCT testing represents an 18% reduction from the national median of 5.9 DDD per admission per week per trust, and that further research should be done to determine the patient-level impact and its potential for clinical effectiveness.
Feb 8 J Antimicrob Chemother abstract

Three cases of ceftriaxone-resistant gonorrhea reported in England

The UK Health Security Agency (UKHSA) yesterday reported three new cases of ceftriaxone-resistant gonorrhea.

The recently diagnosed cases involve a woman in London in her 20s and a heterosexual couple from the Midlands in their 20s. There are currently no known connections between the cases.

Ceftriaxone-resistant strains of gonorrhea are most common in the Asia-Pacific region but have been occasionally identified in people who've travelled or moved to the United Kingdom from that region. On Dec 24, 2021, UKHSA reported a case of ceftriaxone-resistant gonorrhea in a man who acquired the infection in London in November.

Since 2019, ceftriaxone has been the primary antibiotic used to treat gonorrhea infections in the United Kingdom. Previous treatment guidelines recommended dual therapy with ceftriaxone and azithromycin, but azithromycin is no longer recommended because of high levels of resistance.

"After a couple of years without any cases of this hard-to-treat form of gonorrhoea, we have now seen 4 cases in the last 2 months," Katy Sinka, PhD, who heads the UKHSA's Sexually Transmitted Infection (STI) section, said in a press release. "It's too soon to say whether this will be the start of a longer-term trend, but we do know that STIs are on the rise in general."

UKHSA officials say they are awaiting follow-up tests in the three cases to see if treatment has been successful.
Feb 7 UKHSA press release
Dec 24 UKHSA press release

News Scan for Feb 08, 2022

News brief

Babies born to COVID-vaccinated moms have antibodies at 6 months

A small Massachusetts General Hospital–based study in JAMA shows more lasting antibodies in infants after COVID-19 vaccination during pregnancy, compared with infants whose mothers had natural COVID-19 infections during pregnancy but were not vaccinated.

The study looked at 77 vaccinated pregnant mothers, and 12 who had symptomatic SARS-CoV-2 infection in pregnancy; all vaccination series with mRNA vaccines were completed between weeks 20 and 32 in pregnancy. The babies of vaccinated women had significantly higher immunoglobulin G (IgG) antibodies in both umbilical cord blood at delivery, and at blood draws at 2 and 6 months postpartum.

After 2 months, 98% of the infants (48 of 49) born to vaccinated mothers had detectable levels of protective IgG; by 6 months, 57% of infants born to vaccinated mothers had detectable antibodies, compared with just 8% of babies born to mothers with natural infections.

"Although the antibody titer known to be protective against COVID-19 in infants is unknown, these findings provide further incentive for pregnant individuals to pursue COVID-19 vaccination," the authors concluded.

In a press release on the study, senior study author Andrea Edlow, MD, said the research helps fill in some knowledge gaps on infant protection from maternal antibodies.

"Many interested parties from parents to pediatricians want to know how long maternal antibodies persist in infants after vaccination, and now we can provide some answers. We hope these findings will provide further incentive for pregnant people to get vaccinated, especially with the emergence of new variants of concern like Omicron," she said.
Feb 7 JAMA study
Feb 7 Massachusetts General Hospital press release

Hospital COVID-19 Omicron clusters contained after universal testing, N95s

A study yesterday in Clinical Infectious Diseases describes how Brigham and Women's Hospital in Boston worked to contain two Omicron COVID-19 variant clusters using daily testing and universal N95 respirators, which the researchers said could be a model for other facilities.

A team led by Harvard researchers analyzed data from 45 patients diagnosed as having COVID-19 on their fifth day of hospitalization or later (median, 11 days) from Nov 1, 2021, to Jan 15, 2022.

Mirroring COVID-19 prevalence in the community, the incidence of hospital-onset cases increased from 0 per 1,000 patient-days in November to 0.5 per 1,000 in December to 3.0 per 1,000 in January.

Among the 45 patients, 22 received care from hospital personnel who had undiagnosed infections, 5 roomed with patients with undiagnosed infections, 1 had a visitor with an undiagnosed infection, and no source was identified for the remaining 17 patients.

The hospital detected the first cluster on Jan 1 in a unit with 10 rooms and 15 patients after 2 patients developed symptoms. Unit-wide testing identified a third infection on Jan 3, leading to universal testing and N95 respirator use. The week before, 7 hospital staff tested positive for COVID-19 during screening.

One staff member worked while symptomatic. No other patient or staff infections were detected in the unit in the next 10 days.

The second cluster was identified on Jan 2 in a surgical unit with 10 rooms with 15 patients when preoperative testing detected a patient with asymptomatic COVID-19. Testing of the entire unit on Jan 3 identified six more cases.

Fifteen unit personnel tested positive for COVID-19 the week before, two of whom worked while symptomatic.

While 16 more hospital-based infections were detected elsewhere in the hospital, no more patient or staff infections were discovered in the unit in the next 10 days.

"Our clusters abated rapidly compared to previous reports of hospital-based SARS-CoV-2 clusters," the researchers wrote. "This may be due to the short incubation period of Omicron as well as the control measures taken."
Feb 7 Clin Infect Dis study

H5N1 avian flu turns up in Maryland wild bird, infects more Russian poultry

The US Department of Agriculture (USDA) reported one more highly pathogenic H5N1 avian flu detection, this time in a wild bird from Maryland.

The virus was found in a live lesser scaup from Kent County, Maryland, during testing conducted by the US Geological Society, the USDA's Animal and Plant Health Inspection Service (APHIS) said on its highly pathogenic avian flu page. Kent County is on the upper eastern shore of the Chesapeake Bay.

Maryland is the fifth state to report the virus, following South Carolina, North Carolina, Virginia, and Florida. The detection marks the 91st recent identification of H5N1 or H5 on the US East Coast. Maryland's detection is also the first from live testing; the others involved sampling in hunter-harvested birds.
USDA APHIS high-path avian flu page

Elsewhere, Russia reported a new H5N1 event, which affected three turkey farms in the same area of Stavropol krai in the country's southwest, according to a notification from the World Organisation for Animal Health (OIE). The outbreaks began on Jan 31, killing 45 of 121,097 birds.
Feb 8 OIE repot on H5N1 in Russia