News Scan for Oct 28, 2021 - CIDRAP

Rapid test linked to improved antibiotic therapy for bloodstream infections

Use of a rapid diagnostic test in patients with bloodstream infections (BSIs) was associated with shorter times to optimal antibiotic therapy and antibiotic de-escalation, researchers reported yesterday in Clinical Infectious Diseases.

In the quasi-experimental, multicenter Improving Outcome and Antimicrobial Stewardship (IOAS) study, researchers compared clinical and antimicrobial stewardship metrics in BSI patients at 5 US hospitals before and after implementation of Accelerate PhenoTest BC Kit (AXDX) testing.

AXDX is a rapid diagnostic platform that provides pathogen identification and antibiotic susceptibility test (ID/AST) results from positive blood cultures up to 40 hours earlier than traditional methods. The primary outcomes were time to optimal therapy (TTOT) within 96 hours of blood culture positivity and 30-day mortality.

A total of 854 patients with BSI (435 pre-AXDX, 419 post-AXDX) were included in the study. Patient demographics, co-existing conditions, and baseline clinical characteristics were similar between the two groups.

Median TTOT was 17.2 hours shorter in the post-AXDX arm (23.7 hours) compared with the pre-AXDX arm (40.9 hours). Median time to first antimicrobial modification (24.2 vs 13.9 hours) and first antimicrobial de-escalation (36 vs 27.2 hours) were also shorter in the post-AXDX arm.

There was no statistical difference in 30-day mortality (8.7% pre-AXDX vs 6.0% post-AXDX) between in the two arms, or in the secondary clinical outcomes of length of stay and adverse events. Length of stay was shorter in the post-AXDX arm (5.4 vs 6.4 days) among patients with gram-negative bacteremia.

"This multicenter, real-world study suggests early ID/AST via AXDX has a significant impact on optimizing antimicrobial utilization and outcomes for patients with BSIs," the study authors wrote. "While challenging to demonstrate definitively, the value of early antimicrobial optimization is likely associated with widespread patient and societal benefits such as limiting the emergence of antimicrobial resistance and reduced harm from unnecessary antimicrobial exposures."
Oct 27 Clin Infect Dis abstract

CDC worried about low flu vax levels in kids, pregnant women

The US Centers for Disease Control and Prevention (CDC) said yesterday that it is worried about lagging flu vaccine uptake in children and pregnant women so far this season, based on its first coverage estimates for the groups.

For kids, flu vaccination is down 6% compared with the same time last year, which the CDC said is especially concerning, because coverage last season was already down because of COVID-19. And for pregnant women, the CDC is seeing a 15% drop from last year, spanning all racial and ethnic groups.

Younger children and kids with underlying health conditions face a higher risk of flu complications, as do pregnant women.

The CDC said with 137.7 million flu vaccine doses distributed so far, supply isn't likely the reason for immunization drops in the two groups. It added that other factors could include low flu activity last season, vaccine fatigue against the backdrop of COVID-19 vaccination, confusion about whether a flu vaccine is needed, and changes in healthcare-seeking behavior.

Officials also said a recent Harris poll suggested that one in four people believe the COVID-19 vaccine protects against flu and vice versa. It reiterated that the diseases are caused by different viruses and that one vaccine isn't a replacement for the other.
Oct 27 CDC statement

H5N1 avian flu strikes UK swan facility

Animal health officials in the United Kingdom reported a highly pathogenic H5N1 avian flu outbreak at a wild bird rescue facility in Worcestershire. Media reports said the facility houses swans.

In a statement, the UK's Department for Environment, Food, and Rural Affairs (DEFRA) said all birds at the site will be humanely culled, and protection zones have been established around the facility as part of measures to curb the spread of the virus. An investigation is under way to identify the source of the virus.

The new outbreak came on the heels of a DEFRA risk assessment this week that warned H5N1 could spread widely in wild birds and poultry in the cooler months ahead.
Oct 28 Irish Farmers Journal story
Oct 26 DEFRA statement
Oct 27 CIDRAP News scan

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