September 21, 2020
COVID-19
COVID-19 could reverse decades of progress toward eliminating preventable child deaths, agencies warn. The World Health Organization warned that disruptions in child and maternal health services due to the COVID-19 pandemic are putting millions of additional lives at risk. The number of under-five deaths worldwide was at an all-time low in 2019 with 5.2 million cases; however, disruption in services such as health checkups, vaccinations and prenatal and post-natal care, due to resource constraints or fear of infection, are threatening the progress made so far. According to UNICEF and WHO surveys, more than half of the countries reported disruptions in health services for children or systems for management of malnutrition, warranting for resource allocations and an urgent response to re-start disrupted health systems and services. [WHO]
Projected health-care resource needs for an effective response to COVID-19 in 73 low-income and middle-income countries. Experts estimated the projected costs involved in maintaining essential components of the strategic preparedness and response plan (SPRP), in 73 low-income and middle-income countries (LMICs), revealing significant increases in costs with increasing transmission. Overall, case management (54%) and maintaining essential services (21%) were deemed to be the two largest cost drivers. For LMICs, the total projected costs for a 4 week period (starting from June 26, 2020), increased from US$24.74 billion at status quo to US$28.54 billion if transmission were to increase by 50%. However, costs were estimated to reduce to US$14.18 billion if transmission were to decrease by 50%, emphasizing the potential cost saving opportunities from early implementation of mitigating measures to limit spread. [Lancet Global Health]
Associations between phone mobility data and COVID-19 cases. In response to a recent study revealing a strong correlation between phone mobility data and decreased COVID-19 case growth rates in select US counties, implying that phone mobility data could serve as a proxy for social distancing, researchers at CDDEP expanded the analysis to include longer time frames during which broad public health measures were being implemented across the US. The analysis revealed that while there was a strong positive correlation between phone mobility data and COVID-19 growth rates in the time period around initial state-level shutdowns, this correlation weakened at later stages, leading the authors to suggest that phone mobility data captured only one of the many components of behaviors associated with social distancing. [Lancet Infectious Disease]
Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children. Researchers at the Children’s National Hospital in the District of Columbia conducted a prospective cohort study comparing clinical features between COVID-19 and seasonal influenza in children admitted to the hospital with diagnosed influenza or confirmed COVID-19. No statistically significant differences were found in the rates of hospitalization, admission to the intensive care unit, and mechanical ventilator use between the two groups; however, children hospitalized with COVID-19 were more likely to have at least one medical condition (neurologic, cardiac, hematologic), than those hospitalized with influenza (OR, 2.6; 95% CI, 1.4-4.7; P = .002). Furthermore, a greater proportion of children hospitalized with COVID-19 reported fever, diarrhea or vomiting, headache, body ache or myalgia, and chest pain, leading the authors to conclude that more children hospitalized with COVID-19 than with seasonal influenza reported clinical symptoms at the time of diagnosis. [JAMA]
Antibiotic Resistance
Antibiotic Overuse after Hospital Discharge. A retrospective multi-center cohort study investigating antibiotic overuse (defined as unnecessary use, excess duration, or suboptimal fluoroquinolone use) in hospitalized patients treated for pneumonia or urinary tract infection (UTI), revealed that nearly half of the patients had antibiotic overuse after discharge. For pneumonia, 63.1% of overuse days after discharge were due to excess duration, whereas for UTI, 43.9% were due to treatment of asymptomatic bacteriuria. Antibiotic overuse varied greatly between hospitals and conditions, suggesting that prescribing culture, physician behavior and organizational processes may drive overprescribing of antibiotics stressing the need for antibiotic stewardship programs monitoring antibiotic use after discharge. [Clinical Infectious Diseases]
Inappropriate empirical antibiotic therapy for bloodstream infections based on discordant in-vitro susceptibilities. Researchers conducted a retrospective cohort analysis of electronic health record data from 131 hospitals in the USA, including 21,608 patients with suspected—and subsequently confirmed—bloodstream infections empirically treated with systemic antibiotics. The study revealed that 4,165 (19%) patients received discordant empirical antibiotic therapy, and that this was independently associated with increased risk of mortality (adjusted OR 1.46; 95% CI, 1.28–1.66), even in patients without sepsis. Furthermore, infection with antibiotic-resistant species strongly predicted receiving discordant empirical therapy (adjusted OR 9.09; 95% CI, 7.68–10.76). Early identification of bloodstream pathogens and resistance is necessary to improve population-level outcome. [The Lancet Infectious Diseases]
Management of Gram-negative bloodstream infections in the era of rapid diagnostic testing. Researchers at the University of Maryland conducted a retrospective quasi-experimental (non-randomized) study of adult patients with at least one positive blood culture with a Gram-negative organism routinely identified by rapid diagnostic testing (RDT), to evaluate the impact of RDT and antimicrobial stewardship program (AMS) on optimal antibiotic therapy. The proportion of patients on optimal antibiotic therapy increased with each intervention, pre-RDT/AMS versus post-RDT/pre-AMS versus post-RDT/AMS (66.5% vs 78.9% vs 83.2%, P < 0.0001), and time to optimal therapy decreased with introduction of RDT, highlighting the beneficial role of RDTs in Gram-negative bloodstream infections. [Open Forum Infectious Diseases]
Antimicrobial stewardship in a pandemic: picking up the pieces. A study reviewing antibiotic utilization and rates of bacterial co-infection in 1,705 patients hospitalized with COVID-19 at 38 hospitals in Michigan revealed that 56.6% of the patients received empiric antibiotic therapy, despite only 3.5% having a documented community-onset bacterial co-infection. These and other findings demonstrating high rates of inpatient utilization of overall, broad-spectrum, and narrow-spectrum antibiotics during the COVID-19 pandemic period, warrant for antimicrobial stewardship strategies aimed at ensuring judicious use of antibacterials and at providing guidance during the different phases of inpatient management of COVID-19 disease. [Clinical Infectious Diseases]
Empowerment of nurses in antibiotic stewardship: A social-ecological qualitative analysis. Researchers in Singapore conducted an exploratory qualitative study in three public hospitals, in order to understand the facilitators and barriers that impact nurses’ engagement in antibiotic stewardship programs (ASP). The study revealed that, while nurses felt empowered in their roles in antibiotic administration, they lacked the knowledge and expertise in antibiotic use and AMR prevention, and this impacted how they were perceived by patients, caregivers and primary care team. This perception was especially important when nurses had patient-safety concerns and antibiotic-administration suggestions, leading the researchers to suggest that it is imperative to formally acknowledge and expand the nurses’ roles in ASPs. [J Hosp Infect]
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