Stewardship intervention linked to more appropriate ER prescribing

A multifaceted intervention implemented in a Japanese emergency department was associated with reduced antibiotic prescribing at discharge and an increase in appropriate prescribing, Japanese researchers reported today in Infection Control and Hospital Epidemiology.

In a before-and-after study conducted at a tertiary-care center in Tokyo, hospital researchers compared the average monthly proportion of appropriate antimicrobial prescriptions at discharge (APD), and the average rate of monthly APD per 1,000 visits, in the year prior to the intervention (January 2016 to December 2016) and the year following the implementation of intervention (October 2018 to September 2019).

The intervention included an educational session about common infectious diseases encountered in the emergency department, an evidence-base pocket treatment guide, antimicrobial order sets, monthly reports on the proportion of appropriate APD, and post-prescription review and feedback by an infectious diseases (ID) physician.

A total of 70,093 patients visited the emergency department during the study period—36,308 during the preintervention period and 33,785 during the intervention period. The average monthly proportion of appropriate APD increased from 47.2% in the preintervention period to 79.5% in the intervention period. The analysis also found that the number of monthly APD fell by 11.7% overall in the intervention period, despite an increasing trend in the average monthly APD. The number of fluoroquinolones prescribed fell from 5.8 to 2.0 per 1,000 visits, while macrolides fell from 2.3 to 0.9 per 1,000 visits.

The authors say the educational sessions led by an ID physician and the pocket guide on common infectious diseases provided clinicians with a better understanding of antimicrobial stewardship goals, clarified the appropriate indications for antimicrobial use for each type of infectious disease, and likely contributed to a change in prescribing behaviors.
Feb 5 Infect Control Hosp Epidemiol abstract

Poll finds older US adults often use leftover antibiotics

A new poll of US adults aged 50 to 80 years indicates that taking leftover antibiotics without consulting a healthcare professional is a common practice, University of Michigan researchers reported today in Infection Control and Hospital Epidemiology.

Among 2,256 respondents to the University of Michigan National Poll on Healthy Aging, 47.7% reported receiving an antibiotic prescription in the previous 2 years. The most common indications were respiratory (49.7%), dental (17.6%), urinary tract (16.6%), and skin (11.7%) infections.

Among those who filled a prescription, 139 of 1,091 (12.7%) had leftover medication, and 65% of those with leftovers said they kept the medication. Among all respondents, 422 of 2,256 (18.7%) reported ever taking leftover antibiotics without talking to a healthcare professional (16.8% took their own medication and 3.4% took someone else’s).

Of the respondents who had leftover antibiotics in the previous 2 years, 71 of 141 (50.7%) had ever taken antibiotics without talking to a healthcare professional. For those who had a prescription for antibiotics but did not have leftover medication in the previous 2 years, 215 of 948 (22.7%) reported taking antibiotics without talking to a healthcare professional. Respondents aged 50 to 64 were more likely to have taken antibiotics without talking to a provider than respondents aged 65 to 80 (21.0% versus 15.0%), and women were more likely than men to have taken leftover antibiotics (20.7% vs 16.5%).

“The use of leftover antibiotics without supervision could result in serious drug interactions, cause other side effects, and contribute to resistance,” the authors wrote. “In addition to counseling patients to take all antibiotics as prescribed, prescribers should consider the number of pills dispensed and follow guidance supporting shorter treatment durations for common infections.”

The survey also found that many patients still ask for and expect antibiotics when they know they are unlikely to be helpful. While 91.5% agreed that they are cautious about the use of antibiotics and 88.6% agreed that overuse can lead to antibiotics not working the next time they are needed, 41.3% said they expect antibiotic when they have a cold that lasts long enough for them to visit a doctor, and 34% said they believed antibiotics will help them get better sooner if they get a cold or the flu.
Feb 5 Infect Control Hosp Epidemiol abstract

Latest global flu snapshot shows only sporadic activity, mainly flu B

Against the backdrop of COVID-19 measures and other pandemic effects, global flu activity remains at very low levels, with little activity or just sporadic activity reported across the globe, the World Health Organization (WHO) said in its regular update.

In the Northern Hemisphere, some countries reported sporadic activity, and flu stayed at interseasonal levels in temperate Southern Hemisphere nations.

Haiti reported low flu activity, and West Africa continues to report low levels. Some parts of South Asia reported sporadic flu cases, including Bangladesh, India, and Iran. Also, flu detections, mainly involving the H3N2 strain, continue in Laos. Though flu levels in China are low, activity increased slightly in the country’s south, mainly from influenza B.

Other countries reporting sporadic activity include Oman, Saudi Arabia, Armenia, and the United Arab Emirates.

Globally, of respiratory specimens tested at WHO-collaborating labs during the first half of January, only 556 of 233,931 (2.4%) were positive for flu. Of those, 79.3% were influenza B, and of the subtyped influenza A samples, 81.3% were H3N2.
Feb 1 WHO global flu update

Four countries report more polio cases; Liberia declares outbreak

Countries in the Middle East and Africa reported more polio cases last week, mostly involving circulating vaccine-derived poliovirus type 2 (cVDPV2), according to the latest update from the Global Polio Eradication Initiative (GPEI).

Afghanistan reported one more wild poliovirus type 1 (WPV1) case, in Ghazni, marking its first such case for 2021. Also, the country reported 14 more cVDPV2 cases in eight provinces, bringing its total for 2020 to 269. Pakistan reported 8 more cVDPV2 cases in Sindh and Balochistan provinces, marking the first cases for 2021 and pushing the 2020 total to 135.

In Africa, Benin reported a cVDPV2 case in Oueme, lifting its 2020 total to three for 2020, all linked to Nigeria’s Jigawa outbreak. Also, Nigeria reported one more such case, in Bayelsa state, putting its 2020 total at eight.
Feb 4 GPEI update

In other developments, Liberia’s health ministry yesterday declared a polio outbreak after national surveillance identified environmental cVDPV2 positives from two sites in Monrovia, according to a statement. The government said response efforts will include enhanced surveillance and a door-to-door immunization campaign across the country. According to GPEI records, Liberia hasn’t yet confirmed any human cases.
Feb 4 Liberian health ministry statement