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Weekly Digest: Remdesivir linked to faster recovery among hospitalized COVID-19 patients; Wedding-related COVID-19 outbreak highlights risks of mass gatherings; A majority of US hospital admissions receive antibiotics.

Weekly Digest: Remdesivir linked to faster recovery among hospitalized COVID-19 patients; Wedding-related COVID-19 outbreak highlights risks of mass gatherings; A majority of US hospital admissions receive antibiotics.

COVID-19

Remdesivir linked to faster recovery among hospitalized COVID-19 patients. In a randomized controlled trial, researchers found that the experimental drug remdesivir was linked to a shorter time to recovery compared to placebo among hospitalized COVID-19 patients. Preliminary results from the study showed that patients randomized to receive intravenous remdesivir had a median time to recovery of 11 days, compared to 15 days among patients randomized to receive placebo. Serious adverse events were more frequently reported in the placebo group, and 14-day mortality was not significantly different between groups. [NEJM]

Wedding-related COVID-19 outbreak highlights risks of mass gatherings. A case investigation into a COVID-19 outbreak at a wedding in Jordan highlights the risk of exponential viral transmission during mass gatherings. Researchers gathered data on 350 wedding guests and found that 76 tested positive for the novel coronavirus; of whom, 47.4 percent were asymptomatic. The index patient is believed to be the bride’s father who traveled to the wedding from Spain. Common symptoms were mild including cough, fever, headache, sore throat, fatigue, and shortness of breath, although two individuals developed serious conditions including pneumonia and respiratory failure. [Emerging Infectious Diseases]

Sunlight inactivates novel coronavirus on surfaces within minutes, study shows. In a simulation, researchers demonstrated that sunlight can inactivate the novel coronavirus (SARS-CoV-2) within minutes on non-porous surfaces. The study found that 90 percent of the novel coronavirus suspended in simulated saliva or culture media was inactivated within 6.8 and 14.3 minutes, respectively on stainless steel surfaces under simulated sunlight. Lower levels of sunlight inactivated the virus at a slower rate. Results suggest that exposure risks may differ between indoor and outdoor environments, and sunlight may be an effective surface disinfectant for the novel coronavirus. [Journal of Infectious Diseases]

Nearly ¼ of hospitalized COVID-19 patients in NYC are critically ill. In a prospective study of 1,150 adults hospitalized for COVID-19 at two NYC hospitals, researchers found that 22 percent were critically ill, and of whom, 39 percent died. Of the critically ill COVID-19 patients, 79 percent received mechanical ventilation for a median of 18 days, 66 percent received vasopressors, drugs that work to raise blood pressure, and the median time to in-hospital deterioration was just three days. The study found that older age, chronic cardiac disease, chronic pulmonary disease, and higher concentrations of interleukin-6 or D-dimer were all significantly linked to increased in-hospital mortality. [The Lancet]

Early COVID-19 testing could prevent nursing home outbreaks. In an outbreak investigation of COVID-19 in a Seattle nursing facility, researchers found that 3.8 percent of residents tested positive for the novel coronavirus, all of whom were asymptomatic, and 3.2 percent of staff tested positive, all of whom were symptomatic. The investigation was conducted after two residents were hospitalized for COVID-19. Results indicate that symptom screening alone failed to identify four asymptomatic cases of COVID-19, and early testing of all residents and staff prevented a facility-wide outbreak. [JAMA Internal Medicine]

C diff and COVID-19 co-infections highlight importance of antimicrobial stewardship and screening during pandemicIn a surveillance review of nine patients co-infected with COVID-19 and Clostridiodes difficile in Detroit, Michigan, researchers note the importance of antimicrobial stewardship and C. diff screening during the COVID-19 pandemic. Two patients tested positive for C. diff at hospital admission, while the remaining seven patients developed diarrheal symptoms and tested positive for C. diff following COVID-19 diagnosis. A majority of the nine patients were elderly, severely ill, and had multiple underlying health conditions. Cefepime, ceftriaxone, meropenem, and azithromycin were the most commonly prescribed antibiotics across the cohort. Other studies have shown that antibiotic overuse is common among COVID-19 patients, which may lead to C. diff co-infections, and some COVID-19 patients (<10 percent) present gastrointestinal symptoms that may hinder C. diff diagnosis. [Emerging Infectious Diseases]

Minnesota sees increasing rates of COVID-19 in both large and small metro areas. [CDDEP]

 

Drug Resistance & Global Health

A majority of US hospital admissions receive antibiotics. Researchers conducted a retrospective study of nearly 12 million hospital admissions in the United States between 2016 and 2017, and found that 65 percent of patients received antibiotics. Beta-lactam/beta-lactamase inhibitor combinations, third- and fourth-generation cephalosporins, and glycopeptides were the most common classes of antibiotics prescribed. Total antibiotic use and class-specific use varied significantly across regions and by hospital type, and identifying the reasons behind these differences is important to inform antibiotic stewardship efforts. [Clinical Infectious Diseases]

ASP linked to improved antimicrobial use and care among patients with Staph. In a retrospective study between 2016 and 2018, researchers found that the implementation of mandatory infectious disease consultations and real-time antimicrobial stewardship review in Illinois hospitals was linked to improvements in antimicrobial use and care among patients with Staphylococcus aureus bacteremia. The outcome of the study was adherence to a bundle of measures including appropriate intravenous antimicrobial therapy, duration of therapy, surveillance cultures, and echocardiography. Bundle adherence increased significantly following the implementation of the mandatory consult and review, from 65 percent pre-implementation to 76 percent post-implementation (p=0.02). [Open Forum Infectious Diseases]

Antimicrobial stewardship intervention reduces fluoroquinolone use in outpatient settings. An antimicrobial stewardship intervention focused on fluoroquinolones, antibiotics with serious side effects, led to a significant reduction in fluoroquinolone prescribing across a Texas health system between 2016 and 2018. The intervention, which consisted of education on fluoroquinolones and warnings on all orders, was tied to a 39 percent reduction in the rate of total fluoroquinolone prescriptions. Inappropriate fluoroquinolone use also decreased from 53 to 34 percent across the study period. [Open Forum Infectious Diseases]

Parental worries about flu shot side effects among children tied to lack of re-vaccination. A prospective cohort study of 270 parents and guardians found that 17.7 percent of children in the United Kingdom who received a flu shot the following season were not re-vaccinated in the 2017/18 season. The study found that parental report of their child experiencing severe side effects and worry about their child experiencing side effects following flu vaccination were significantly linked to lack of re-vaccination. Although the small sample size limits the power of these results, authors note that reducing parental worry about side effects from the flu shot may improve re-vaccination rates. [Vaccine]