May 10, 2022
Bundled interventions can bolster long-term outcomes of antimicrobial stewardship programs. A cohort study at a university teaching hospital with high rates of antibiotic resistance in Singapore assessed the sustainability of an antimicrobial stewardship program (AMS) using three sequential interventions between 2007 and 2018: prospective review and feedback (PRF), computerized decision support systems (CDSS), and lifting of CDSS. The use trends following PFR increased for piperacillin-tazobactam and carbapenems and declined for other broad-spectrum antibiotics, however, following CDSS establishment, use trends decreased for piperacillin-tazobactam, carbapenems, and other broad-spectrum antibiotics. The findings suggest that sustainable AMS programs in high resistance settings may require concurrent interventions to ensure that the restriction in the use of certain antibiotics does not lead to the increase in the use of others. [JAMA]
Almost half of the mortality cases among acutely ill children in sub-Saharan Africa and south Asia occur after hospital discharge. A prospective cohort study including 3,101 children aged 2–23 months with acute illness who were admitted to one of nine hospitals in six countries across sub-Saharan Africa and south Asia between November 2016, and January 2019 revealed high mortality rates following hospital discharge. Of the 350 deaths in this cohort, 234 (66·9%) occurred within 30 days of hospital admission and 168 (48·0%) within 180 days of hospital discharge. A child-centered, risk-based approach to inpatient and post-discharge management is critically needed in current guidelines to reduce childhood mortality. [The Lancet Global Health]
Multidrug resistance is high in most bacterial species from humans, animals, food, and environmental sources in Ethiopia. A systematic review and meta-analysis of studies conducted in Ethiopia, published from 2015 to 2020 in peer-reviewed journals, aimed to determine the pooled prevalence of multidrug resistance in bacteria from human, animal, food, and environmental sources. The 81 studies (53 human, eight animal, and 16 environmental/food sources) included six species from Gram-positive bacteria and 13 from Gram-negative bacteria, with Staphylococcus, most members of the Enterobacteriaceae and Pseudomonas species being the standard multi-drug resistant bacterial populations found in all sources. [One Health]
Inappropriate antibiotic use grew in US hospitals during the COVID-19 pandemic. A multicenter, retrospective cohort analysis covering 271 US hospitals shows that during the COVID-19 pandemic, critical and acute care hospitals with medium and high rates of antimicrobial resistance (AMR) had significant surges in antibiotic prescriptions and longer durations of antibiotic treatment among all patients admitted, including patients who were bacterial culture-negative. Furthermore, while AMR rates were slightly lower for community-associated infections in the pandemic period compared with the pre-pandemic period (2.61 vs. 2.76 per 100 admissions), AMR rates were higher for hospital-onset infections (0.86 vs. 0.77 per 100 admissions), with the highest rates reported in SARS-CoV-2 positive patients (2.19 per 100 admissions). More than one-third of SARS-CoV-2-positive patients who were prescribed antibiotics were bacterial culture-negative. [ESCMID]
Pandemic preparedness indicators must be approached critically. The global push for pandemic preparedness indicators comes from the need for collective solutions to global pandemics, based on measurements that are accurate and accountable. While some nations, primarily high-income ones, can combine national and global objectives, many governments allocate scarce resources in favor of one over the other. For political choices made related to indicators, it is difficult to collect data and build indicators that meet standards for transparency, veracity, and accountability; those establishing indicators are forced to prioritize which standards to meet. While indicators aid countries in tracking progress and identifying problems, their uncritical use for resource allocation or other vital decisions can lead to misdiagnoses of needs and priorities. [Global Policy]
Nirsevimab could aid in respiratory syncytial virus (RSV) prevention in infants. A recent phase 3 trial in South Africa including 1,490 infants born at a gestational age of at least 35 weeks were randomly assigned to either an intramuscular injection of nirsevimab or placebo administered before the start of the RSV season. The primary efficacy endpoint of medically attended lower respiratory tract infections (LRTI) associated with RSV occurring up to 150 days after the injection was approximately 75% lower in the nirsevimab group versus placebo. However, there was no difference in hospitalization rates for LRTI associated with RSV between the treatment placebo and placebo groups (six infants [0.6%] in the nirsevimab group vs eight infants [1.6%] in the placebo group). [The Lancet Microbe]
Individual heterogeneity heavily impacts local tuberculosis (TB) epidemiology within subpopulations. A prospective, population-based molecular epidemiology study of TB transmission was conducted in both urban and rural settings of Botswana. Using empirical data to fit rural and urban mathematical models, researchers jointly quantified both the effective reproductive number and the propensity for superspreading in each population. They found both urban and rural populations were characterized by a high degree of individual heterogeneity, which disproportionately affected the rural population where 99% of secondary transmission was connected to 19% of infectious cases compared to 60% in the urban population. The findings emphasize the impact of individual heterogeneity on local TB epidemiology within subpopulations. [Nature ]
Increases in insecticide-treated net (ITN) coverage can save many children’s lives in Mozambique. The use of ITNs is considered one of the most effective ways to reduce malaria mortality in children. A multi-cause mathematical model was applied to data on annual provincial ownership coverage of ITNs. Researchers estimated 14,040 under-5 child deaths were averted between 2012 and 2018 through use of ITNs. If 2018 coverage levels are maintained until 2025, an additional 33,277 child deaths could be avoided. If coverage reaches at least 85% in all ten provinces by 2022, then a projected 36,063 child lives can be saved. [PLOS Global Public Health]
A gender-responsive framework could strengthen malaria elimination strategies in Asia-Pacific. Despite tremendous progress towards malaria elimination resulting in a 63% decline in cases and 87% decline in deaths, 300 million people remain at high risk of malaria in Asia-Pacific, with rural poor and vulnerable communities disproportionately affected. Additionally, gender-related sociocultural norms and biological factors impact exposure to malaria and access to services. Many women lack information, agency, and economic possibilities to attain malaria services, and pregnant individuals face a higher risk of malaria due to reduced immunity. Data and research should be disaggregated according to gender and age to inform targeted interventions. Policies to augment the participation of women in decision-making and malaria research are urgently needed. [The Lancet Regional Health]
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