January 18, 2019
Mozambique approves AMR National Action Plan. In Mozambique, the National Action Plan for Antimicrobial Resistance was approved by the Ministry of Health and the Ministry of Agriculture and Food Security. CDDEP will work with researchers at the Manhica Health Research Center to disseminate and implement the national action plan country-wide.
Late-career physicians prescribe longer antibiotic courses. Between March 2016 and February 2017, a cohort of 10,616 family physicians in Ontario, Canada collectively prescribed a total of 5.6 million antibiotic courses, 35.4 percent of which were for prolonged durations exceeding eight days. Late-, mid-, and early-career physicians prescribed prolonged antibiotic courses at rates of 38.6, 34.4, 30.6 percent, respectively. Physicians practicing in rural areas and those who saw more children were more likely to prescribe prolonged antibiotic courses. [Clinical Infectious Diseases, Commentary]
Patient-related determinants of antibiotic use. Demographic and socioeconomic characteristics were the most commonly described determinants of antibiotic use with thirty studies describing associations between age, gender, income, and use, according to a literature review. Factors associated with low antibiotic treatment adherence included young age, low income, and low educational level. Twenty-five studies, including one from a low-income country, assessed determinants related to patient-doctor interactions and characteristics of the medical visit. Receiving written instructions for antibiotic consumption, understanding the purpose of a treatment, and tracking antibiotic consumption improved adherence to prescribed treatments. [Clinical Microbiology and Infection]
“Smart Use of Antibiotics” program reduced antibiotic use in a neonatal ICU in China. The total antibiotic days of therapy per 1,000 patient-days dropped from 543 to 380 following the implementation of a Smart Use of Antibiotics Program in a 150-bed neonatal intensive and intermediate care unit in Shanghai, China. Patient length of stay was reduced during the intervention period, and the rate of infections that were multidrug-resistant fell from 1.4 percent to 1.0 percent following program implementation. The overall readmission rate and patient safety outcomes did not change during program intervention. [Critical Care Medicine]
Vaccine-derived polio outbreak in Mozambique. In Molumbo district, Mozambique, a circulating vaccine-derived poliovirus (cVDPV) type 2 isolate was identified in a six-year old girl experiencing acute flaccid paralysis with no history of poliovirus vaccination, the Global Polio Eradication Initiative reported. A second case was also reported in the community. The cases are the first for the country since early 2017. [GPEI]
Time and cost of vaccinations at family medicine, internal medicine, and OBGYN practices. Between March and October 2017, researchers conducted vaccine practice management surveys and vaccination time-motion studies, which measure time spent on vaccination-related health care services, at 19 family medicine, internal medicine, and obstetrician-gynecology (OBGYN) practices in nine US states. Family and internal medicine practices spent a median of five minutes conducting vaccination activities per vaccination while OBGYN practices spent 29 minutes. When considering time spent per vaccination, the median cost per vaccination was $7 for family medicine practices, $8 for internal medicine practices, and $43 at OBGYN practices. Higher costs among OBGYN practices resulted from increased time spent counseling patients, administering vaccines, and managing vaccine supplies. Sixty-eight percent of OBGYN patients offered a vaccine declined to receive it, compared to 32 percent in family practices and 49 percent in internal medicine practices. [Vaccine]
US CDC releases in-season flu incidence estimates. The US Centers for Disease Control and Prevention (CDC) estimates that up to 7.28 million Americans had the flu between October 1, 2018 and January 5, 2019. Between 2.92 and 3.51 million Americans sought medical care for the flu during this time and between 69,300 and 83,500 were hospitalized. This is the first season CDC has reported in-season flu burden estimates, however; hospitalizations estimated so far are lower than end-of-season total hospitalizations estimated for any season since CDC began providing estimates. [CDC]
Overprescribing of antibiotics for kids in emergency departments. In the US, children aged 0 to 17 years accounted for about 30 million emergency room visits per year between 2009 and 2014. Fourteen percent of those visits occurred at pediatric emergency departments, according to a review of the National Hospital Ambulatory Medical Care Survey. Antibiotics were prescribed to 24 percent of children seeking care at non-pediatric emergency departments compared to 20 percent of those at pediatric units. Forty-four percent of all antibiotics prescribed were broad spectrum. Compared to pediatric emergency departments, non-pediatric units had higher rates of prescribing macrolides (8 versus 18 percent) and lower rates of prescribing guideline-concordant antibiotics for the treatment of respiratory conditions (87 versus 77 percent). Overall, 2.1 million or 32 percent of antibiotics prescribed every year were not indicated. [Pediatrics, Commentary]
Community-acquired MRSA in Orthodox Jewish children in Brooklyn, New York. Between May 2015 and December 2016, there were more than 4,000 pediatric cases of antibiotic-resistant community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) at NYU Langone Health. An epidemiological investigation revealed that children residing in a predominantly Orthodox Jewish community in Brooklyn were 10 times more likely to be infected and twice as likely to be colonized by CA-MRSA than children living in other New York City zip codes. The CA-MRSA strain that caused the infections was closely related to USA300 but was determined to belong to its own sub-clade named USA300-BKV. Genetic analysis of isolates from 92 infected community members identified several mutations that enhanced the bacterial strain’s fitness and virulence. [PNAS]
Antibiotics during early childhood associated with obesity. Of 333,353 pediatric beneficiaries of the US Department of Defense TRICARE program who were born between October 2006 and September 2013, 72.4 percent were prescribed an antibiotic in the first two years of life. Antibiotic prescription during the first two years of life increased the risk of developing childhood obesity (Hazard ratio: 1.26) regardless of type or strength of antibiotic prescribed. [BMJ]
Transmission of drug-resistant tuberculosis in HIV-endemic settings. Tuberculosis (TB) and HIV coinfection can accelerate the rate of TB progression and the development of drug resistance. In a new Lancet series, experts and researchers outline research priorities needed to develop more effective interventions for the treatment of multi- and extensively-drug resistant TB (MDR, XDR) in settings with high burdens of HIV. The introduction and use of effective treatment regimens including prophylactic regimens, rapid molecular diagnostics and TB screening, and improved infection control are needed to reduce TB transmission in HIV-endemic settings. Population-based studies, improved surveillance of MDR and XDR TB, and the application of modern molecular epidemiology techniques to better understand the transmission dynamics of drug-resistant TB are needed to assist in the development of new and effective interventions. [The Lancet Infectious Diseases]
Vaccination uptake and the hysteresis effect. Vaccination rates are often unstable over time despite their well-known net public health benefit. Researchers used a mathematical model to explore the impact of the public perception of personal costs associated with vaccination. Even when a vaccine has only marginal adverse effects, an inflated public perception of these costs can cause uptake rates to plunge. Subsequent to a scare, rates of vaccination re-uptake are likely to lag behind, even as public perception becomes more positive. This can delay the recovery of vaccination coverage in many countries. [Proceedings of the Royal Society]
Nose and throat microbiome linked to flu susceptibility. Researchers analyzed nasal and oropharyngeal microbiomes of 717 children and adults from 144 households in Nicaragua and identified five distinct microbiome community types. One of those microbiome types was associated with reduced susceptibility to the flu. This microbiome type was found in 5 percent of study participants aged 0-5 years, 12 percent in children aged 6 to 17 years, and 20 percent in adults. The study did not demonstrate a causal link between the microbiome community and flu susceptibility, but researchers noted that nose and throat microbiomes may be a potential target to reduce influenza burden worldwide. [PLOS]
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