Stewardship / Resistance Scan for Sep 21, 2022

News brief

Scottish report shows no increase in healthcare-associated infections

A new report from Scotland's national health service shows that three key healthcare-associated infections remained stable or declined from 2020 to 2021.

Surveillance data compiled by Antimicrobial Resistance and Healthcare Associated Infection Scotland (ARHAIS) showed that despite an increase in the number of patients admitted to Scottish acute care hospitals in 2021 compared with 2020 and an increase in total occupied bed days, incidence of Clostridioides difficile infection (CDI) and Staphylococcus aureus bacteremia (SAB) remained stable, at 20.8 and 29.1 per 100,000 population, respectively.

Incidence of healthcare-associated Escherichia coli bacteremia (ECB)—the most common cause of gram-negative bacteremia—fell by 6.4% from 2020 to 2021, to 37.1 per 100,000 bed-days.

Overall, non–COVID-19 healthcare outbreaks and incidents declined, from 136 in 2020 to 118 in 2021. The annual incidence of community-associated CDI, SAB, and ECB remained stable from 2020 to 2021.

ARHAIS also reports that it continues to review and develop guidance documents for the prevention and control of infections across all care settings. Surveillance priorities for 2022 include further investigation into the impact of the COVID-19 pandemic on healthcare-associated infections and the development of wider gram-negative bacteremia surveillance.
Sep 20 ARHAIS 2021 annual report

Survey finds physician empathy linked to lower antibiotic prescribing

A survey of general practitioners (GPs) in Denmark found that those who exhibited high levels of empathy had different antibiotic prescribing habits than low-empathy GPs, particularly when it comes to prescribing penicillins, researchers reported yesterday in BMC Primary Care.

The survey, sent to a stratified sample of 1,196 Danish GPs in 2016, included questions about demographic, professional, and antibiotic prescribing characteristics and used the Jefferson Scale of Empathy for Health Professionals to assess self-reported physician empathy. The high-empathy group was defined as GPs who had empathy scores above the 90th percentile, and the low-empathy group were those with scores below the 90th percentile. The response rate was 39%.

The results showed that 61% of GPs in the top decile of the empathy score were women. GPs in this decile reported the following person-centered factors as more important for their job satisfaction than the bottom decile: the patient-physician relationship, interaction with colleagues, and intellectual stimulation.

Overall, high-empathy scoring GPs had 19% fewer antibiotic prescriptions per year than the low-empathy group and prescribed significantly less penicillin (34% less) than the low-empathy GPs. This was true for most penicillin subcategories. The intra-profile variation index and confidence intervals showed less prescribing uncertainty among GPs with high empathy.

There were no significant differences in age, practice setting (urban vs rural), practice type (partnership vs solo), overall job satisfaction, or GP’s value of prestige and economic profit for their job satisfaction.

The authors say the findings suggest that high-empathy GPs may be more likely to spend time explaining to patients why they don't need an antibiotic rather than simply comply with the patient's request.

"Practitioners with a degree of empathy may prescribe less penicillin as they take better time to explain, meet the patient's fears and expectations, and evaluate antibiotic choice in their community with reference to local resistance patterns," the authors wrote. "A likely explanation may be that high empathy GPs better identify patient’s concerns and expectations and are able to contextualize the patient’s infection in the community."
Sep 20 BMC Prim Care study

News Scan for Sep 21, 2022

News brief

COVID pandemic worsened all-cause death inequities for non-White races

The COVID-19 pandemic dramatically worsened disparities in all-cause death rates for American Indian and Alaska Native (AIAN), Native Hawaiian, other Pacific Islander (NHOPI), and Black Americans and eroded mortality advantages for Asian and Hispanic groups, finds a study published yesterday in PNAS.

A team led by researchers at the University of California and Stanford University estimated monthly all-cause US death rates for the six racial and ethnic groups and compared them with those of White Americans using Centers for Disease Control and Prevention data from January 2018 to February 2022.

Rises in all-cause death rates were larger among Black and Hispanic populations than among their White peers in the first year of the pandemic. The disparities were greatest during the summer 2021 and winter 2021-22 COVID-19 surges.

Relative to White people, AIAN and NHOPI Americans younger than 65 years saw the steepest increases in disparities (AIAN rate ratio [RR], 2.25 in October 2021 vs a prepandemic average of 1.74; NHOPI RR, 2.12 vs 1.31 in August 2021). The inequities were still heightened 2 years into the pandemic.

The authors noted the long history of structural racism in the United States and the pandemic conditions that predisposed minorities to infection, including more exposure during work and lower access to quality healthcare.

"Preexisting inequities associated with mortality, including lack of health care, financial hardship, and housing instability, were likely exacerbated during the pandemic," they wrote.

Assessing racial death disparities throughout the pandemic is important, the researchers said, because if inequalities vary dramatically over time, it suggests they are changeable and responsive to both pandemic dynamics and social responses.

"Our results highlight the dynamic nature of racial/ethnic disparities in mortality and raise alarm about the exacerbation of mortality inequities for Indigenous groups due to the pandemic," they wrote.
Sep 20 PNAS study

COVID-19 tied to elevated risk of serious blood clots for almost a year

COVID-19 increases the risk of potentially life-threatening blood clots for at least 49 weeks, according to a new study of health records of 48 million unvaccinated UK adults from the first wave of the pandemic in 2020. The study is published in the journal Circulation.

The study was based on electronic health records from England and Wales from Jan 1 to Dec 7, 2020. Among 48 million adults, 125,985 were hospitalized within 28 days of COVID-19 diagnosis. The adjusted hazard ratios for first arterial thrombosis after COVID-19 diagnosis compared with no COVID-19 diagnosis declined from 21.7 (95% confidence interval [CI], 21.0 to 22.4) in week 1 after COVID-19 diagnosis to 1.34 (95% CI, 1.21 to 1.48) during weeks 27 to 49.

The adjusted hazard ratios for venous thromboembolic events (VTEs) were 33.2 (95% CI, 31.3 to 35.2) in week 1 to 1.80 (95% CI, 1.50 to 2.17) during weeks 27 to 49.

"Adjusted hazard ratios were higher, for longer after diagnosis, after hospitalized versus nonhospitalized COVID-19, among Black or Asian versus White people, and among people without versus with a previous event," the authors said.

The authors estimate that the first phase of the COVID-19 pandemic led to 10,500 excess arterial thromboses and VTEs in England and Wales. And incidence was markedly increased in the first 2 weeks following infection.

Co-lead author Jonathan Sterne, PhD, at the University of Bristol, said in a Health Data Research UK news release, "We are reassured that the risk drops quite quickly—particularly for heart attacks and strokes—but the finding that it remains elevated for some time highlights the longer-term effects of COVID-19 that we are only beginning to understand."

The other co-lead author, Angela Wood, PhD, with the University of Cambridge, added, "While the risk to individuals remains small, the effect on the public's health could be substantial, and strategies to prevent vascular events will be important as we continue through the pandemic."

The authors conclude, "These results support continued policies to prevent severe COVID-19 with effective COVID-19 vaccines, early review and management of vascular risks in patients with COVID-19, and use of secondary preventive agents in patients at high risk of vascular diseases."
Sep 19 Circulation study
Sep 20 Health Data Research UK news release

Monkeypox cases decline in 20 European countries, rise in 4

Twenty countries in the European Union are reporting monkeypox decreases, according to the latest update from the European Centre for Disease Prevention and Control (ECDC).

Only four countries—Bulgaria, Finland, Slovakia, and Slovenia—reported increases, and over the past week the notification rates were highest in Spain, Ireland, and France.

Cases are still largely seen in men who have sex with men, aged 18 to 50 years.

Yesterday the US Centers for Disease Control and Prevention (CDC) reported 310 more monkeypox cases, raising the total to 24,203. The country has by far the most cases in the world.

In research news, a new German study suggests monkeypox patients who had received a smallpox vaccine earlier in life had a milder course of illness. In a study of more than 500 German monkeypox patients, acute systemic symptoms such as fever, headache, or body aches were lower in vaccinated people, the authors said.
Sep 21 ECDC update
Sep 20 CDC update
Sep 20 Infection study

Flu remains low in most countries, but a few report rises

In a flu update that covers the last week of August and the first days of September, the World Health Organization (WHO) said activity remained low in most countries.

In the Southern Hemisphere, which is nearing the end of its flu season, levels declined in most countries, except for South Africa, which is seeing a spike in influenza B detections. In temperate South America, flu increased above epidemic levels in Argentina.

In the Northern Hemisphere, flu activity rose in El Salvador, with a few European countries reporting increases, such as Spain, Portugal, Scotland, Luxembourg, and Slovenia. In Asia, the United Arab Emirates (UAE) reported a slight increase in flu detections.

Globally, of respiratory specimens that tested positive during the reporting period, 92.4% were influenza A. Of subtyped influenza A samples, 87.7% were the H3N2 strain. Of the subtyped influenza B samples, all belonged to the Victoria lineage.
Sep 19 WHO global flu update

H5N1 in Mississippi waterfowl as 10 states report more poultry outbreaks

In its latest update, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) reported the first three highly pathogenic H5N1 avian flu detections in Mississippi. All involved the detection of the virus in hunter harvested blue-wing teals from Issaquena County, located in the west central part of the state on the Mississippi River shore. So far, the virus hasn't been found in the state's poultry.

The reports were among 194 additional H5N1 detections in wild birds reported by APHIS, raising the total to 2,470. States in multiple regions reported more detections, with several from Washington state, Vermont, Rhode Island, the West, and the Midwest. So far, the only states that haven't reported the virus in wild birds are New Mexico, Louisiana, Arkansas, West Virginia, and Hawaii.

Meanwhile, 10 states reported more highly pathogenic avian flu outbreaks in poultry, mostly involving backyard birds. However, four states reported more outbreaks in commercial poultry, including California (broiler breeders), Minnesota (turkeys), South Dakota (turkeys), and Utah (turkeys).

The states reporting backyard bird detections are Ohio, Massachusetts, Michigan, Montana, Nebraska, and Washington. So far, the virus has led to the loss of 45.1 million birds across 40 states.
USDA APHIS poultry avian flu updates
USDA APHIS wild bird avian flu updates

In international developments, Poland reported a new H5N1 outbreak in poultry, according to a notification from the World Organization for Animal Health (WOAH). The outbreak began on Sep 19 at a farm in the village of Grabow in central Poland, killing 590 of 1,677 susceptible birds.
Sep 21 WOAH report on H5N1 in Poland