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Weekly Digest: Early antibiotics lack benefits for severe COVID-19 patients; A majority of US adults support COVID-19 mitigation measures; Gonorrhea becomes increasingly resistant to common antibiotics in Vietnam.

Weekly Digest: Early antibiotics lack benefits for severe COVID-19 patients; A majority of US adults support COVID-19 mitigation measures; Gonorrhea becomes increasingly resistant to common antibiotics in Vietnam.

COVID-19

Early antibiotics lack benefits for severe COVID-19 patients. In a retrospective analysis of 48 COVID-19 patients in a Switzerland intensive care unit, researchers found that early administration of antibiotics did not have a significant effect on mortality or hospital-acquired infections. Mortality was similar across groups who were administered antibiotics prior to ICU admission compared to those who were not (24 vs. 26 percent, respectively), and the number of nosocomial infections during ICU stay did not differ between groups. Although the study was small, results question the benefits of early antibiotic use among critically ill COVID-19 patients.  [Journal of Infection]

A majority of US adults support COVID-19 mitigation measures. A survey of nearly 2,500 adults in New York City, Los Angeles, and nationwide in early May 2020 found that a majority of respondents supported COVID-19 mitigation measures and adhered to public health guidelines. Widespread support of stay-at-home orders and non-essential business closures, working from home, social distancing, and limitations on gatherings was documented in all areas (67-87 percent), and most respondents reported self-isolating, keeping at least 6-feet distance from others, avoiding groups of 10 or more, and wearing face coverings in public (77-90 percent). At the time of the survey, 74.3 percent of respondents across the US said they would not feel safe if restrictions were lifted nationwide, with individuals 65+ feeling less safe than younger adults. [CDC MMWR]

Dexamethasone significantly reduces deaths among severe COVID-19 patients. According to a news release on results from the RECOVERY trial, a low-cost steroid, dexamethasone, reduced deaths by one-third among COVID-19 patients on ventilation, and by one-fifth among patients receiving oxygen (p=0.0003; 0.0021, respectively). The drug did not have a significant benefit among patients who did not require respiratory support (p=0.14). Complete results of the randomized trial including over 11,500 patients across the UK have yet to be published and should be interpreted with caution. [RECOVERY]

Study finds 22% of people worldwide may be at increased risk of severe COVID-19. In a modelling study across 188 countries, researchers estimated that 22 percent of the world’s population, or 1.7 billion people, have at least one underlying health condition that would put them at increased risk of severe COVID-19 if infected. The proportion of the population at increased risk ranged from <5 percent among individuals less than 20 years old to >66 percent among individuals 70 years or older, and was highest in countries with older populations, African countries with high HIV/AIDS prevalence, and small islands with high diabetes prevalence. Chronic kidney disease, cardiovascular disease, chronic respiratory disease, and diabetes were the most prevalent health conditions among individuals 50 years or older. [The Lancet Global Health]

COVID-19 household spread and coinfections prevalent among children. In a study of 68 children hospitalized for COVID-19 in China, researchers found that a majority were exposed to the virus through household contacts (96 percent), and more than half were co-infected with another pathogen (51 percent). Co-infections included Mycoplasma pneumoniae, respiratory syncytial virus, and influenza, among others. Among symptomatic patients, mild pneumonia (39 percent), acute respiratory tract infections (32 percent), cough (32 percent), and fever (27 percent) were common. Eight of ten children showed prolonged fecal shedding of the novel coronavirus. Authors note that because the clinical and epidemiological characteristics of COVID-19 differ between children and adults, specialized screening among pediatric populations is necessary. [Pediatrics]

Nearly 11% of Geneva’s population has antibodies against novel coronavirus. According to findings from a population-based study of nearly 3,000 individuals, approximately 11 percent of Geneva, Switzerland’s population had antibodies against SARS-CoV2 in May 2020. The seroprevalence of SARS-CoV2 IgG antibodies increased from 4.8 percent in the first week of the study to 10.8 percent in the fifth week, and individuals aged 5-9 or 65+ years old had a significantly lower risk of testing positive for the antibodies compared to individuals 20-49 years old (RR: 0.32; 0.50, respectively). The study found that for every reported case of COVID-19, 11.6 additional cases exist in the community unreported. [The Lancet]

Drug Resistance and Global Health

Gonorrhea becomes increasingly resistant to common antibiotics in Vietnam. Findings from an analysis of 229 gonococcal isolates show that resistance to current and previous gonorrhea treatments, including ciprofloxacin, benzylpenicillin, and cefixime, increased between 2011 and 2015-16 in Vietnam. All 2015-16 gonococcal samples were resistant to ciprofloxacin, 79 percent were resistant to tetracycline, 50 percent to benzylpenicillin, 15 percent to cefixime, and 1 percent to ceftriaxone. Approximately 15 percent of isolates were multidrug-resistant. Authors suggest the need for increased surveillance, antimicrobial stewardship, and whole genome sequencing for gonococcal isolates in Vietnam and other Asian countries. [Journal of Antimicrobial Chemotherapy]

Inappropriate antibiotic prescribing common among patients with sinusitis. A cross-sectional studyfound that a majority of sinusitis patients received antibiotics despite only 50 percent meeting the criteria for antibiotic prescribing, which is defined as persistent, severe, or worsening symptoms. Of the 425 sinusitis visits at Northwestern Medicine in Chicago included in the study, antibiotics were prescribed to 96 percent of patients who met the criteria for prescribing and 92 percent of those who did not. [Clinical Infectious Diseases]

Shorter course of antibiotics effective among infants hospitalized with pneumonia. In a study of 439 infants hospitalized forcommunity-acquired pneumonia between 2012 and 2018, researchers found that a shorter duration of antibiotic therapy did not have a significant impact on treatment failure. Odds of 30-day treatment failure did not differ significantly between patients who received 5-7 days of antibiotics compared to those who received 8-14 days of antibiotics (OR: 0.48 [95% CI 0.18, 1.30]).  [Journal of the Pediatric Infectious Diseases Society]

One in four US parents hesitant about flu vaccine. A nationally representative survey in February 2019 found that 6.1 percent of US parents sampled were hesitant about routine childhood vaccines, and 26 percent were hesitant about flu vaccines. Only 26 percent of respondents agreed that the influenza vaccine was effective, compared to 70 percent in agreement with the effectiveness of routine childhood vaccines. The study also found that lower education level and household income were significantly associated with vaccine hesitancy among US parents. [Pediatrics]