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Center For Disease Dynamics, Economics & Policy

Weekly Digest: Strategies to improve antibiotic utilization in low-resource settings; Clarifying antibiotic prescription decision-making in the ICU; MMR vaccine may be effective against COVID-19

Strategies to improve antibiotic utilization in low-resource settings. In a narrative review, experts evaluate strategies to address the emergence of antimicrobial resistance (AMR) across the world while keeping a particular focus on low- and middle-income countries (LMICs). The review focuses on antimicrobial stewardship programs targeting ambulatory care physicians and pharmacists, which dispense 93% to 100% of the antibiotics used in LMICs. Recommendations are also made for patient-targeting campaigns, given existing evidence that community awareness campaigns can significantly reduce antibiotic use. [Life]

NCBI expands the AMR gene database to investigate novel mechanisms of resistance. The National Center for Biotechnology Information released a new gene detection tool called AMRFinderPlus and an expanded Reference Gene Catalog to enable the investigation of links between AMR and other mechanisms such as stress response or virulence. AMRFinderPlus utilizes both protein and nucleotide databases, increasing the tool’s accuracy and enabling the link between AMR genotypes and phenotypes. [Nature]

Clarifying antibiotic prescription decision-making in the ICU. A recent study employing focus groups and semi-structured interviews explored contextual factors influencing the process of antibiotic prescriptions in the intensive care unit (ICU) setting in the United Kingdom. ICU clinicians often prescribed antibiotics in high stake situations and were more concerned with the immediacy and severity of the consequences of undertreatment rather than overtreatment. AMR was a concern, but often not great enough to end the course of antibiotics for a patient; protecting the individual patient was prioritized over societal concerns related to antimicrobial resistance. [BMJ Quality & Safety]

High concentrations of antimicrobial residues in Nigerian freshwater fish farm products. Researchers in Nigeria surveyed 151 freshwater fish farmers in North-central Nigeria to investigate the extent of antimicrobial use as prophylactic and metaphylactic measures. Additionally, they assessed antimicrobial residue in fish and pond water samples. The majority of the farmers (78.1% ) used antimicrobials, with 94.1% practicing self-prescription and 56.1% using arbitrary doses. Antimicrobial residues were found in 60% and 38.8% of fish and pond samples, respectively, highlighting the vast impact of antimicrobial misuse. [Food Control]

High levels of antibiotic resistance found in hospitals in Sierra Leone. A study conducted in Sierra Leone revealed high levels of antibiotic resistance in a maternity (94%) and pediatric (85%) hospital. Resistance was highest with penicillin (84% and 100%) and lowest with nitrofurantoin (13%) and novobiocin (0%) for gram-positive and gram-negative bacteria, respectively. The findings demonstrate the need for continuous surveillance, urgent antimicrobial stewardship, and access to reserve antibiotics in Sierra Leone. [Trop. Med. Infect. Dis]

MMR vaccine may be effective against COVID-19. A recent study from researchers in Sweden suggests that the measles, mumps, and rubella (MMR) vaccine may protect against COVID-19. The odds ratio (OR) for testing positive for COVID-19 among those with recent MMR vaccination compared to those not recently vaccinated was 0.91 (95% CI 0.76 to 1.09); however, when stratified by sex, recent MMR vaccination (within 2.5 years) lowered the odds of testing positive for COVID-19 among males (OR 0.43, 95% CI 0.24 to 0.79). [Vaccine]

Race can affect COVID-19 outcomes. A recent study investigated the association between race and COVID-19 outcomes in more than 2.5 million children in the United Kingdom. White children had a greater number of tests than Asian, Black, and mixed-race children. However, the number of positive test results was greater for Asian, Black, and mixed-race individuals. When compared to white children, Asian children were hospitalized at a higher rate (adjusted OR 1.62; 95% CI, 1.12 to 2.36) and were more likely to get admitted to the intensive care unit (2.11; 1.07 to 4.14). [JAMA Pediatrics]

NIH funds a research initiative on Long COVID. The National Institutes of Health announced a $1.15 billion research initiative on long COVID, a complex and persistent chronic condition experienced by an increasing number of patients. One growing theory is that the virus may trigger post infectious processes. However, many of the side effects are not specific to long COVID and the condition itself lacks objective and reliable markers, leading to frustrations among patients that feel unheard or neglected. [The Lancet]

Preliminary findings of mRNA Covid-19 vaccine safety in pregnant persons. A recent study using data from the V-safe Surveillance System and Pregnancy Registry investigated COVID-19 vaccine safety among 35,691 pregnant persons between December 2020 and February 2021 in the United States. Participants reported very general symptoms, such as fatigue, headache, and myalgia. Adverse pregnancy or neonatal outcomes were observed, however, the incidence was not higher than what has been reported in studies involving pregnant persons before the COVID-19 pandemic. [NEJM]

COVID-19 transmission among children is low, rendering school closure a potentially ineffective pandemic response. A recent study quantified the degree of COVID-19 community spread in different schools and revealed that 73% of the cases among children were secondary to an adult and only 5% were secondary to another child. Overall, most pediatric cases arose at home, suggesting that children may transmit COVID-19 at lesser rates than adults and more so at home than at school. Findings from this study, combined with the negative impact school closure had on many children, provide a compelling argument for a reconsideration of school closure as a public health measure. [Clinical Infectious Diseases]

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