Stewardship / Resistance Scan for Nov 15, 2021

News brief

English study finds less antibiotic prescribing amid pandemic

Antibiotic prescribing in general practice in England fell significantly during the first 12 months of the COVID-19 pandemic compared with the previous year, according to data released last week by Antibiotic Research UK (ANTRUK).

Analysis of prescription data from the England's National Health Service showed that from March 2020 through February 2021, antibiotic prescribing by general practitioners (GPs) declined by 17% compared with the previous 12 months, and the decline occurred in almost all areas of the country. The analysis also found that the rise in antibiotic prescribing that typically occurs in the winter in England was considerably lower for the winter of 2020 to 2021.

While antibiotic prescribing has risen by 21% on average from the summer (June to August) to the winter (December to February) in previous years, antibiotic prescribing from December 2020 to February 2021 only rose by 4%.

"The dramatic fall in antibiotic prescribing during the COVID pandemic could be due to many factors including less infection transmission during lockdowns and fewer visits to GPs," ANTRUK Chief Executive Colin Garner, PhD, said in a press release.

"More work is needed to understand the extent to which each of these factors has resulted in this drop in antibiotic prescribing, but the data does tell us that antibiotic prescribing can be reduced to help protect us all from the danger of the growing threat of antibiotic resistance."
Nov 11 ANTRUK press release

Michigan hospital project tied to shorter antibiotic course for pneumonia

Participation in a prospective collaborative quality initiative (CQI) was associated with more appropriate use of short-course antibiotic therapy for pneumonia, according to a study published last week in Clinical Infectious Diseases.

The study looked at data from a 3-year project undertaken by 41 hospitals participating in the Michigan Hospital Medicine Safety Consortium, a statewide collaborative quality initiative. The project targeted appropriate 5-day antibiotic treatment for uncomplicated community-acquired pneumonia (CAP), using benchmarking, sharing of best practices, and pay-for-performance metrics.

To evaluate the impact of the program, researchers assessed appropriate receipt of a 5-day antibiotic duration and 30-day post-discharge composite adverse events (mortality, readmission, urgent visit, antibiotic-associated adverse events) for patients with uncomplicated CAP.

Overall, 6,553 patients with uncomplicated CAP were eligible for 5-day treatment at the 41 hospitals from February 2017 through February 2021. Over the study period, the percentage of patients treated with a 5-day course of antibiotics rose from 22.1% to 45.9%. Each quarter was associated with higher odds of receiving an appropriate 5-day course of antibiotics (adjusted odds ratio, [aOR], 1.10; 95% confidence interval [CI], 1.07 to 1.14), for an annual aOR of 1.49 per year.

Thirty-day composite adverse events occurred in 18.5% of patients over the entire study period and decreased over time (aOR, 0.98 per quarter; 95% CI, 0.96 to 0.99) due mainly to a decrease in antibiotic-associated adverse events (aOR, 0.91; 95% CI, 0.87 to 0.95). Mortality, readmission, urgent visits, and Clostridioides difficile infections did not change over time.

The study authors suggest other states and healthcare systems should consider adopting this three-pronged method for improving antibiotic treatment.

"Participation in a stewardship CQI may not only improve antibiotic use, but also patient outcomes," the study authors wrote. "The observation that all hospitals, including small hospitals, benefited from CQI participation suggests that the CQI model could be one way to advance antibiotic stewardship even in small, rural hospitals with fewer resources."
Nov 13 Clin Infect Dis abstract

News Scan for Nov 15, 2021

News brief

Women, racial minority health workers struggle to find respirators that fit

Most respiratory protective equipment (RPE) used in healthcare is not designed for women or racial minorities amid a dearth of research into how facial dimensions across sex and race affect respirator performance, according to a systematic review and meta-analysis published late last week in BMJ Global Health.

Researchers at the University of Southampton in England led the study, which involved analysis of 32 studies and anthropometric data (measurements and proportions of the human body) from 15 studies.

Studies were included if they evaluated half- or quarter-size filtering facepiece respirators meeting N95/PPF3 standards of any brand, design, model, size, or disposability. The investigators noted that PPE must be "fit-tested," or assessed for a good seal, to reduce inward leaks of aerosolized viruses such as SARS-CoV-2.

They found that most RPE has been developed for men and White people, who don't make up the largest proportions of National Health Service (NHS) staff in England. And 63% of COVID-19 deaths among NHS staff have been of Black and other racial minority staff, although they account for only 20% of the workforce.

The anthropometric analysis showed that women's faces are significantly smaller than men. But while 12 studies reported worse face mask fit for women than for men, 10 reported no difference by sex.

Trends observed in studies that included racial minorities were similar, although few studies focused on fit-testing differences among races. In 12 studies, low or moderate numbers of racial minorities were able to find a respirator that fit them.

The small sample size and lack of justification, inclusion and exclusion criteria, and power calculations was a concern in many studies, the authors noted. "Significant heterogeneity in study designs limited comparisons, particularly relating to respirator selection or availability and defining study outcomes relating to RPE performance," the researchers wrote.

In a University of Southampton press release, lead author Jagrati Chopra called for more research into proper design of face masks and other personal protective equipment: "The high rate of BAME [Black, Asian, and minority ethnic] healthcare workers affected by the pandemic has shown how important it is to have enough respiratory equipment to suit everyone, regardless of gender or background."
Nov 12 BMJ Glob Health study
Nov 12 University of Southampton press release

Depressed patients visited ED more often for anxiety, chest pain in pandemic

Depression and anxiety during the COVID-19 pandemic drove more patients to seek care at an emergency department (ED) for treatment of anxiety and chest pain, according to a news release on a study to be presented tomorrow at the virtual American Heart Association's 2021 Scientific Sessions.

Researchers at Intermountain Healthcare in Salt Lake City examined 4,633 patients who completed a routine depression screening before (Mar 1, 2019, to Feb 29, 2020) and during (Mar 1, 2020, to Apr 20, 2021) the pandemic.

Nearly 40% of patients said they had new or continuing depression symptoms in the first year of the pandemic. Among depressed patients, screening scores were higher during rather than before the pandemic. The odds of visiting an ED for treatment of anxiety was 2.8 times higher for depressed versus nondepressed patients and 1.8 times higher for anxiety accompanied by chest pain.

Principal investigator Heidi May, PhD, said in the release that longer-term follow-up is needed to identify possible long-term effects of the pandemic on mental health, because depression is a strong risk factor for cardiovascular disease.

"If people are becoming more depressed because of the pandemic, in a few years, we could see a higher incidence of cardiovascular disease," she said. "Clinicians should be acutely aware of their patients' mental health so that it can be addressed and treated immediately to improve the overall quality of their lives, and hopefully avoid the development of subsequent health problems in the future. This is vital, because the pandemic is still not over."
Nov 13 Intermountain Health news release

Norway, UK, Japan report more H5N1 avian flu in poultry

Norway reported its first-ever highly pathogenic H5N1 avian flu outbreak in poultry, and United Kingdom and Japan reported more detections of the virus, according to official and media reports.

In Norway, the outbreak began on Nov 10 at a farm in Rogaland County on the country's southwest coast, according to a notification from the World Organisation for Animal Health (OIE). The outbreak also marks the first appearance of H5N1 in Norway.

Elsewhere in Europe, the UK's Department for Environment, Food, and Rural Affairs (DEFRA) reported two more H5N1 outbreaks, one at a facility in North Yorkshire and another at a location in neighboring Lancashire. Both are in northern England.

Meanwhile, Japan reported its second avian flu outbreak in poultry, this time at a farm in Kagoshima prefecture, according to a government statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. A media report quoting an agricultural official said the subtype is H5N1.

In an update from OFFLU, the animal influenza expert network from the OIE and the UN Food and Agriculture Organization, the group said 41 countries in Asia, Europe, and Africa have reported detections in wild birds and poultry since May, with most viruses falling in the 2.3.4.4b HA clade. Genetic sequencing of recent H5N1 viruses from Europe suggests they are related to recent H5N5 and H5N1 strains found in Europe and Africa in late 2020 and early 2021, all of which link back to H5N8 circulating in Eurasia.
Nov 12 OIE report on H5N1 in Norway
Nov 15 DEFRA update
Nov 15 AFD post
Nov 12 ProMED Mail post on OFFLU statement