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Weekly Digest: Broad-spectrum antibiotic use common among COVID-19 patients; COVID-19-related disruptions to increase burden of malaria and HIV in Africa; Social media messages influence vaccination patterns in US.

Weekly Digest: Broad-spectrum antibiotic use common among COVID-19 patients; COVID-19-related disruptions to increase burden of malaria and HIV in Africa; Social media messages influence vaccination patterns in US.


Broad-spectrum antibiotic use common among COVID-19 patients. Findings from a survey administered across 82 hospitals in 23 countries suggest that broad-spectrum antibiotic use is common among COVID-19 patients, and prescribing is often based on clinical presentation rather than laboratory markers. More than half of respondents reported combined use of β-lactams and macrolides or fluoroquinolones, and the most commonly prescribed antibiotic in the COVID-19 intensive care unit was piperacillin/ tazobactam. Approximately 83 percent of respondents reported that local guidelines for antibiotic use in COVID-19 patients were identical to local guidelines for community-acquired pneumonia. Authors emphasized the importance of implementing antimicrobial stewardship guidelines for COVID-19 patients to prevent negative consequences that may arise from widespread use. [Journal of Antimicrobial Chemotherapy]

COVID-19-related disruptions to increase burden of malaria and HIV in Africa. In two modeling studies, researchers estimated that the COVID-19 pandemic could lead to excess infections and deaths related to disruptions in access to malaria and HIV services across Africa. The first study, published in Nature Medicine, found that halting malaria control activities including the distribution of long-lasting insecticidal nets, could lead to more than twice as many malaria infections in sub-Saharan Africa in 2020 compared to 2019. Reducing case management and delaying mosquito net campaigns could lead to more than 80,000 excess deaths in Nigeria alone. The second study, published in The Lancet HIV, found that a six-month disruption in antiretroviral therapy drugs for 50 percent of individuals on the medication may result in nearly 300,000 excess deaths due to HIV in one year. Findings highlight the importance of sustaining access to malaria and HIV services in Africa during the pandemic. [Nature Medicine, The Lancet HIV]

Social distancing measures slowed spread of COVID-19 in US. A modeling study in the US estimated that statewide social distancing measures prevented approximately 600,000 COVID-19 cases after three weeks of implementation. Researchers utilized a pre-test, post-test design to estimate the impact of statewide distancing interventions on the growth of COVID-19 cases and attributable mortality. On average, social distancing measures slowed COVID-19 cases and deaths approximately one and two percent per day, respectively during the first 4 to 21 days following implementation. [PLOS Medicine]

Similar COVID-19 viral loads detected in asymptomatic and symptomatic patients. A retrospective study of 303 COVID-19 patients in Korea detected similar viral loads in asymptomatic and symptomatic patients, suggesting that positive individuals should isolate irrespective of symptoms in an effort to control the spread of the coronavirus. Of the 110 asymptomatic patients included in the analysis, 10.8 percent developed symptoms later on, with an average of 15 days between COVID-19 detection and symptom onset. Authors note that while the detection of a high viral load in asymptomatic patients may indicate risk of novel coronavirus transmission, larger studies are needed to assess this association. [JAMA Internal Medicine]

Children are at risk for serve COVID-19, analysis shows. An analysis of severe COVID-19 in US children between March and July 2020 found that while hospitalization rates were lower among children than adults (8.0 vs. 164.5 per 100,000 population), rates of admission to the intensive care unit (ICU) were similar. Hospitalization rates were highest among children younger than two years old (24.8 per 100,000) as well as Black and Hispanic children (16.4 and 10.5 per 100,000, respectively). The study also found that 42.3 percent of children hospitalized for COVID-19 had at least one underlying medical condition and 10.8 percent had a diagnosis of multisystem inflammatory syndrome in children (MIS-C) at discharge. Approximately one-third of the children were admitted to the ICU, 5.8 percent required ventilation, and one patient died. Findings emphasize that children are at risk for severe COVID-19, and infection prevention and control strategies are essential in settings like schools and daycares. [CDC MMWR]

Bandanas and fleece masks provide suboptimal protection against droplet transmission. In a demonstration study of 14 common masks and face coverings, researchers concluded that fitted N95 and surgical masks prevented the spread of nearly all respiratory droplets during speech, while neck fleece and bandanas were less protective. Relative droplet count and rates of droplet transmission were lowest through N95 and surgical masks, followed by cotton masks and bandanas; All of which prevented more droplets than the control (no mask). The fraction of droplet transmission ranged from <0.01 percent for a fitted N95 mask to 110 percent for a fleece mask, which is thought to split respiratory droplets into smaller particles and may, therefore, be counterproductive. Although the study was small and had several limitations, authors note that it can be a basis for larger studies to test the efficacy of common face masks.  [Science Advances]


Drug Resistance and Global Health

Colistin-resistance genes reported in human Klebsiella isolates from Taiwan. Researchers at the National Institute of Infectious Diseases and Vaccinology in Taiwan detected mobile colistin resistance (mcr) genes in six Klebsiella pneumoniae isolates from elderly hospital patients. The isolates were resistant to multiple antibiotics, including last-resort antibiotic colistin, although they were susceptible to carbapenems and amikacin. MCR genes have been increasingly reported in human Escherichia coli isolates, but detection in K. pneumoniae isolates is rare and warrants heightened surveillance. [Clinical Microbiology and Infection]

Pediatric antibiotic prescribing has dropped significantly in Germany. Researchers in Berlin analyzed health insurance data from Germany and reported a 43 percent reduction in outpatient pediatric antibiotic prescribing over the last decade. Prescribing rates dropped from 746 prescriptions per 1,000 people in 2010 to 428 per 1,000 in 2018, with the largest reductions reported among children 0 to 1 and 2 to 5 years old (50 and 44 percent, respectively). The study also found that the use of second- and third-generation cephalosporins across Germany remains high, accounting for 32 percent of prescribed antibiotics. Findings represent improvements in appropriate antibiotic prescribing among children in Germany, but authors emphasize the need for region-level interventions. [Eurosurveillance]

Previous receipt of antibiotics leads patients to seek future care, prescriptions. An analysis of US insurance data found that patients and their spouses who visited a high-prescribing physician for acute respiratory infection (ARI) were more likely to seek future ARI care and subsequently receive antibiotics. One year following an initial ARI visit, patients seen by the highest-prescribing doctors received 14.6 percent more antibiotic prescriptions than those seen by the lowest-prescribing doctors; This increase was largely attributable to a significant increase in ARI visits among these patients. The researchers explain that patients’ experiences in an initial ARI visit may lead them to seek care and receive antibiotics for subsequent ARIs. [Clinical Infectious Diseases]

Social media messages influence vaccination patterns in US. Researchers from Pennsylvania and Illinois found that vaccine-related social media messages were tied to vaccination attitudes and behaviors in the United States. The analysis found that regional twitter content on vaccine science was positively correlated with vaccine attitudes during the 2018-19 flu season, while content on vaccine fraud and children was negatively correlated with vaccination patterns. However, when individuals discussed the flu vaccine with friends and family, the negative correlations between social media content and vaccination patterns were eliminated. [Vaccine]