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Weekly Digest: OIE reports global reduction in antibiotic use for growth promotion in food animals; US CDC announces interim flu vaccine estimates; Expanding Ebola treatment trials in DRC.

Weekly Digest: OIE reports global reduction in antibiotic use for growth promotion in food animals; US CDC announces interim flu vaccine estimates; Expanding Ebola treatment trials in DRC.

OIE reports reduction in antibiotic use for growth promotion in food animals. As of 2017, 110 of 155 surveyed countries did not report using any antimicrobial drugs for growth promotion in food animals, the World Organization for Animal Health (OIE) reported. These surveys are based on self-reports by countries. In 2016, only 86 of 146 surveyed countries reported abstaining from antibiotic use for growth promotion. Of the remaining 45 countries where antibiotic use for growth promotion occurred in 2017, 18 reported a regulatory framework that provided guidance about which antimicrobials could, or could not, be used as growth promoters. [OIE]

US CDC announces interim flu vaccine estimates. Between November 2018 and February 2019, 3,254 patients aged 6 months or older who sought outpatient medical care at facilities in Michigan, Pennsylvania, Texas, Washington, and Wisconsin for acute respiratory illness were enrolled into the US Influenza Vaccine Effectiveness Network. Of all enrolled patients, 14 percent tested positive for influenza virus; 98 percent of those cases were influenza A. Forty-three percent of patients with influenza had received the seasonal influenza vaccine while 57 percent of influenza-negative participants received the vaccine. Overall vaccine effectiveness against all influenza virus types was 47 percent. Vaccine effectiveness was higher among pediatric patients aged 6 months to 17 years compared to those 50 years or older (61 versus 24 percent). [CDC MMWR ]

Fluoroquinolone stewardship successful in hospitals but not after discharge. At medical facilities with hospital-based stewardship interventions aimed at reducing fluoroquinolone prescribing, there were fewer patients receiving a fluoroquinolone compared to hospitals without stewardship programs (48.2 percent versus 37.1). Fluoroquinolone stewardship programs were also associated with fewer fluoroquinolone treatment days at rates of 3,096 per 1,000 patients compared to 2,282 days/1,000 patients. Following patient discharge, however, hospitals with fluoroquinolone stewardship programs had twice as many new fluoroquinolone prescription starts compared to hospitals without programs (15.6 percent versus 8.4 percent). [CID]

MRSA patients more likely to be readmitted with infection recurrence. Between January 2014 and November 2014, researchers identified 92,089 patients with Staphylococcus aureus bacteremia infections. 48.5 percent of those infections were resistant to methicillin. The all-cause 30-day readmission rate was 22 percent overall, and there was no significant difference between patients with methicillin-resistant (MRSA) and methicillin-susceptible infections. However, those with resistant infections were 17 percent more likely to have 30-day readmission with S. aureus bacteremia recurrence and were 15 percent more likely to die during their hospital stay. [CID]

Post-discharge decolonization and education reduces risk of MRSA infection. Post-discharge hygiene education and decolonization with chlorhexidine and mupirocin reduced the risk of contracting a methicillin-resistant Staphylococcus aureus (MRSA) infection by 30 percent compared to education alone, according to a multicenter, randomized, controlled trial involving 1,063 patients. MRSA infection occurred in 9.2 percent of participants in the education group and 6.3 percent in the education plus decolonization group. [NEJM]

Electronic antibiotic stewardship intervention associated with fewer prescriptions for respiratory infections. Researchers conducted an open label, cluster-randomized trial in 79 general medicine practices throughout the UK to assess the impact of electronically delivered training webinars, automated monthly feedback reports of antibiotic prescribing, and tools to support appropriate prescribing. 41 practices, representing 323,155 patient years, received the electronic antibiotic stewardship intervention, and 38 practices, representing 259,520 patient years, served as controls. Over the 12-month study period, antibiotic prescription rates were 98.7 per 1,000 patient years among practices that received the intervention and 107.6 per 1,000 patient years for control practices. [BMJ]

Cephalosporin resistance may increase risk of recurrent UTI. Patients with community-onset, extended-spectrum cephalosporin resistant Enterobacteriaceae urinary tract infections (ESC-R EB UTIs) were at a significantly increased risk (Hazard ratio: 1.39) of developing a recurrent UTI compared to patients with ESC-susceptible EB UTIs, according to a retrospective cohort study involving 302 patients. Overall, 54 percent of patients experienced a recurrent UTI, and the median time to recurrence was 69 days. History of UTI and use of a urinary catheter also increased risk of recurrence. In multivariate analysis, when researchers adjusted for type of UTI treatment, there was no longer a statistically significant association between resistance and time to UTI recurrence. [BMC Infectious Diseases]

Expanding Ebola treatment trials in DRC. The Democratic Republic of the Congo’s Ministry of Health, US National Institutes of Health, and Médecins Sans Frontières (MSF) are expanding randomized controlled clinical trials of four Ebola treatments to Katwa and Butembo, two current hotspots of the Ebola outbreak which began in late August  2018. The four Ebola treatments are Remdesivir, mAb114, REGN-EB3, and ZMapp. Clinical trials for these treatments began in other regions of the country in November 2018 and are being overseen by a World Health Organization steering committee. [MSF Press Release]

Reporting delays during the ongoing Ebola outbreak in DRC. The ongoing Ebola outbreak in the Democratic Republic of the Congo (DRC) has demonstrated a two-wave pattern with surges in case numbers in early August and in late September 2018. Average delays between symptom onset and reporting disease symptoms have declined 81.1 percent from a mean of 17.4 weeks in May 2018 to 3.3 weeks in September 2018. Between December 3 and January 7, the average reporting delay was 1.7 weeks. [Epidemics]

Organic fertilizers may propagate spread of antibiotic resistance genes. Researchers assessed the environmental fate of antibiotic resistance genes in the soil of a Scottish grassland field that was treated with organic fertilizers. The concentration of resistance genes declined in all soil treatments over time, however, the decline was slower when soil experienced multiple applications of organic fertilizers. Soil with a history of low intensity farming had a higher relative abundance of tetracycline resistance, compared to sulfonamide resistance, both of which declined in concentration over time. Of the different organic fertilizers, compost had the least effect on the reduction in resistance overtime and manure and biosolids, had different effects on the relative abundance of different types of resistance in the soil. These findings indicate that organic fertilizers may aid the spread of antibiotic resistance genes in the soil. [Ecotoxicology and Environmental Safety]

Postnatal growth slower in children exposed but uninfected with HIV compared to children not exposed to HIV. Between June 2013 and April 2016, 884 breastfeeding mothers and their newborn babies were enrolled in a postnatal study in Cape Town, South Africa to compare the growth of children unexposed to HIV with children exposed but uninfected by HIV who were born to women who initiated anti-retroviral therapy during pregnancy. There were 413 children unexposed to HIV and 471 children exposed but uninfected by HIV; birth characteristics including gestational age and size at birth were similar between both groups. Compared to unexposed children, those exposed to but uninfected by HIV had lower mean weight-for-age and length-for-age scores. Children exposed to HIV were also breastfed for shorter durations and were more likely to be stunted. [The Lancet Child & Adolescent Health]

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