Study touts revised antimicrobial prophylaxis protocol for ECMO patients

A revised antimicrobial prophylaxis protocol for patients on extracorporeal membrane oxygenation (ECMO) was associated with reduced broad-spectrum antimicrobial use in those patients, without increased risk of infection or poor outcomes, researchers from the Mayo Clinic reported today in Clinical Infectious Diseases.

In the quasi-experimental study, the researchers first compared prophylactic antimicrobial use and nosocomial infection rates in ECMO patients in the 3 years prior to the introduction of the protocol in July 2014 and the 3 years after. Under the protocol, antimicrobials with a broader spectrum of activity were selected for prophylaxis (prevention) in patients with prosthetic valves or cardiovascular devices. Antibiotic prophylaxis is common in ECMO patients because of their high risk of infection.

After initial analysis of the data and feedback colleagues, the researchers revised the protocol to recommend narrower-spectrum agents and included active infectious disease (ID) clinician involvement with real-time audit and feedback. They then reevaluated the data, comparing the period before the protocol with the period following implementation of the original protocol and the period following implementation of the revised protocol. The study population included 338 patients who received ECMO from July 2011 through November 2019.

The mean rate of antimicrobial use (expressed as antimicrobial days per ECMO days) did not change significantly from the pre-protocol period (1.98 days; 95% confidence interval [CI], 1.82 to 2.15) through the original protocol period (2.06 days; 95% CI, 1.90 to 2.23), but then declined significantly in the third period (1.09 days; 95% CI, 0.94 to 1.25), with the decline applying primarily to broad-spectrum antimicrobials. The observed reduction in broad-spectrum antimicrobials did not result in significant increases in nosocomial infection rates, length of intensive care unit stay, ventilation time, or mortality.

The authors say the revised protocol was more restrictive and consistent with its approach to antimicrobial use in ECMO patients, and that audit and feedback from ID specialists provided an enforcement mechanism that the original protocol lacked.

“A multidisciplinary team-based approach to antimicrobial stewardship can significantly reduce antimicrobial prophylaxis and overuse in ECMO patients without increased risk of nosocomial infection,” they wrote. “These data can be used to assist other institutions in developing protocols for appropriate antimicrobial use in this population, balancing the threat of antimicrobial resistance and side effects with prevention of nosocomial infections.”
Feb 12 Clin Infect Dis abstract

Ebola sickens third patient in recent DRC cluster

Officials reported a third Ebola case today in the new Democratic Republic of the Congo (DRC) cluster, which is occurring in eastern DRC, where a large outbreak was declared over in 2020.

The health minister of North Kivu today announced a new case in Butembo, where the first illness in the cluster was reported earlier this week, according to Reuters. No other details were available about the patient. A second fatal case was reported on Feb 11, which involves an individual with epidemiologic links to the first case.

Mike Ryan, MD, who leads the World Health Organization (WHO) health emergencies program, said at a WHO briefing today that the group was aware of the third case and that genetic analysis is under way in the DRC to determine if the first new case is related to the earlier outbreak in the DRC or if the new illness may mark a separate introduction from an animal or other source.

The first patient, a woman who died, was married to an Ebola survivor. In past outbreaks, flare-ups were linked to contact with body fluids from survivors, who can harbor Ebola in immune-protected body sites, such as the testes and eyes.

Ryan said vaccine supplies are being sent to the area and that work is under way to upgrade an Ebola treatment center in Katwa. So far, 182 contacts have been identified, only 3 of which haven’t been contacted.
Feb 12 Reuters story

Tajikistan reports first vaccine-derived polio case

Six countries reported new polio cases this week, all involving vaccine-derived types, including the first in Tajikistan, according to a weekly update from the Global Polio Eradication Initiative (GPEI).

In joining the growing number of countries with vaccine-derived polio, Tajikistan reported its first case, which involves a patient from Khatlon province who has vaccine-derived poliovirus type 2 (cVDPV2). The GPEI said the case is linked to an outbreak in Pakistan.

Elsewhere in the Middle East, Afghanistan reported 34 more cVDPV2 cases, all counted in its 2020 total, which has now reached 303. The latest cases were from eight different provinces. And Yemen reported a circulating vaccine-derived poliovirus type 1 (cVDPV1) case, which involved a patient from Saadah province, putting its total for 2019 and 2020 at 30 so far.

Three African countries reported more cases. Chad reported 1 more cVDPV2 case, involving a patient from Logone Oriental state, raising its 2020 total to 99 cases from three different outbreaks. The DRC also reported another case, in a patient from Maindombe province, lifting last year’s total to 76 cases. South Sudan reported 2 more cases, both in Unity province, lifting its 2020 total to 40, all linked to Chad’s ongoing outbreak.
Feb 11 GPEI update