News Scan for Jan 22, 2021

News brief

Reports detail pediatric eye injuries related to hand sanitizer

As the pandemic has made hand sanitizer ubiquitous, perhaps it was inevitable that clinicians would report sanitizer-related eye injuries in children. Two brief studies published yesterday in JAMA Ophthalmology look into this topic, with the first finding a sevenfold year-to-year increase in sanitizer/eye exposure in French children from April to August, and the second looking at two cases of toxic keratopathy (cornea injury).

Overall, less chemical eye splatter cases were reported to the French Poison Control Centers from April to August 2020 than in the same months the year prior (2,336 [2.2% of pediatric calls] vs 2,553 [4.2%]), according to the first study. Cases in which the affected child was exposed to hand sanitizer, however, rose from 1.3% to 9.9%. The frequency of these cases occurring in public locations also increased, both year-to-year (0 to 63) and from May to August 2020 (16.4% to 52.4%).

During the pandemic months, 16 children were admitted to eye hospitals for hand sanitizer exposure, compared with 1 child in 2019. Two of the 16 needed amniotic membrane transplants.

The other study catalogued the symptoms and treatments of two cases of toxic keratopathy after accidental eye exposure to hand sanitizer. One case was in a 4-year-old who tried to use a sanitizer dispenser from a shop's floor stand; symptoms included lack of blood flow in the eye and a large epithelial defect.

The other case was in a 5-year-old who was experiencing a congested eye and surface cell death in the cornea. After treatment, which in both cases included moxifloxacin and carboxymethyl cellulose drops, the first injury resolved in 2 weeks and the second in 5 days.

"With the current widespread use of hand sanitizer in public places, it is not unexpected that young children would be drawn to these dispensers, many of which appear to be inadvertently designed to facilitate contact between the hand sanitizer and young eyes," writes Kathryn Colby, MD, PhD, in a commentary on both studies. She recommends increased awareness and education, cautionary signage, and possible redesigns, such as the use of shorter hand sanitizer dispensers for children.
Jan 21 JAMA Ophthalmol French study
Jan 21 JAMA Ophthalmol case studies
Jan 21 JAMA Ophthalmol commentary

Phase 1 data show Bharat Biotech's COVID vaccine safe, immunogenic

Phase 1 results from Bharat Biotech's BBV152 COVID-19 vaccine shows it is safe and immune-producing, according to a study published in The Lancet Infectious Diseases yesterday. The adjuvanted vaccine is made with an inactivated whole virus and was stored between 35.6°F and 46.4°F, which could be an advantage over other vaccines that require very low storage temperatures.

Across 11 sites in India, 300 healthy 18- to 55-year-olds received two doses 2 weeks apart in July of 3 micrograms (µg) of the vaccine adjuvanted with receptor 7/8 agonist molecule adsorbed to alum (Algel-IMDG), 6 µg with Algel-IMDG, or 6 µg with Algel. An additional 75 received a control with Algel. Adjuvants boost the body's immune response.

Solicited local and systemic adverse reactions were reported in 17.0%, 21.0%, 14.0%, and 13.3%, respectively. All were mild or moderate, and the most common adverse events reported in the intervention groups were injection site pain (5.0%), headache (3.7%), and fever (3.0%).

Seroconversions rates 2 weeks after the second dose were highest in the Algel-IMDG groups, with 87.9% seroconverting in the low-dose and 91.9% in the high-dose group. CD4+ and CD8+ T-cell responses were also found in a subgroup of 16 Algel-IMDG recipients. As for the Algal group, 82.8% seroconverted, and less than 0.5% CD4+ and CD8+ T-cell responses were found.

"Despite these favourable phase 1 results, concerns linger regarding the potential for an inactivated whole-virus vaccine to elicit antibody-dependent enhancement of infection or vaccine-associated enhanced respiratory disease upon SARS-CoV-2 infection," writes Christina A. Rostad, MD, and Evan J. Anderson, MD, in a Lancet commentary. "We will wait with cautious optimism on this vaccine candidate poised to bolster worldwide equitable access to COVID-19 prevention."

Phase 2 results will focus on two doses of either 3 or 6 µg of the vaccine with Algel-IMDG. The researchers noted that while they were on an accelerated timeline for phase 1 because of the pandemic's severity, in phase 2, they will administer at least some doses on a 4-week schedule.
Jan 21 Lancet Infect Dis study
Jan 21 Lancet Infect Dis commentary

Five countries report more polio cases

Five countries reported more polio cases this week, all due to circulating vaccine-derived poliovirus type 2 (cVDPV2), according the latest weekly update from the Global Polio Eradication Initiative (GPEI).

In the Middle East, Afghanistan reported 15 cVDPV2 cases in seven provinces, with Hilmand reporting 5, which lifts the total for 2020 to 255.

In Africa, Burkina Faso reported 1 case in Dedougou, raising its total for the previous year to 56 from two different outbreaks. Chad reported 4 new cases in three regions: Mayo Kebbi Ouest, Mandoul, and Hadjer Lamis. The country now has 98 cases from three different outbreaks for 2020.

Elsewhere in Africa, Guinea reported 3 cases, 2 in Nzerekore and 1 in Conakry, bringing its total to 39. And Sudan reported 4 more illnesses from three different provinces: South Kordofan, North Kordofan, and North Darfur. The country now has 56 cases for its 2020 total.
Jan 21 GPEI update

H5N8 avian flu hits many French duck farms, expands in Europe's wild birds

France's duck farms in the foie gras production region in the southwest continue to be hit hard by highly pathogenic H5N8 avian flu outbreaks, with 123 more events reported, according to the latest notification from the World Organization for Animal Health (OIE).

The latest outbreaks began from Dec 28 to Jan 18, all involving farms, most of them producing ducks. The majority of the outbreaks struck farms in Landes department, but they were also reported in others in the same part of France, including Pyrenees-Atlantiques, Gers, and Hautes-Pyrenees.

Among all of the events, the virus killed 16,423 of 553,372 susceptible birds, and the survivors were culled to curb the spread of the virus.

In other avian flu developments, several European countries reported more H5N8 detections in wild birds, including the Czech Republic, Spain, Italy, Norway, and Germany, according to OIE reports. Also, Denmark reported H5N5 in wild birds, and Belgium and Romania reported H5 in wild birds.
Jan 22 OIE report on H5N8 in France
OIE outbreak page

Stewardship / Resistance Scan for Jan 22, 2021

News brief

Barriers to antibiotic stewardship at hospital discharge identified

Five barriers to better antibiotic decision-making at hospital discharge emerged after John Hopkins University School of Medicine researchers interviewed healthcare workers and discharged patients.

For the study, which was published yesterday in Infection Control and Hospital Epidemiology, the researchers conducted semistructured interviews with 37 healthcare workers and 16 discharged patients at a tertiary care hospital in Baltimore, Maryland. Their aim was to better understand antibiotic decision-making during the hospital-to-home transition and, how discharged patients manage their medication after leaving the hospital, and to identify barriers and strategies for improving discharge stewardship.

Most antibiotic courses initiated in hospitals are completed by patients after discharge, and previous research indicates that more than half of discharge prescriptions are of excessive duration, overly broad, or unnecessary.

The five main barriers identified through analysis of the interviews were (1) clinician perception of patient expectations for antibiotics, (2) diagnostic uncertainty, (3) a hierarchical culture led by the attending physician versus a multidisciplinary culture, (4) not accounting for in-hospital antibiotics when calculating the total antibiotic duration for discharged patients, and (5) organizational pressure for early discharge prior to the return of clinical and microbiologic data.

To address these barriers, the authors suggest that antimicrobial stewardship programs target hierarchical structures, differences in service cultures, and diagnostic uncertainty, and that the antibiotic decision-making system should account for the total duration of antibiotics to avoid prolonged courses of therapy.

"Implementation of targeted interventions can result in more effective outcomes for antibiotic use at the hospital-to-home transition," they wrote.
Jan 21 Infect Control Hosp Epidemiol abstract

US Candida auris cases continue to climb

The number of confirmed and probable cases of Candida auris infection in the United States has risen to 1,625, according to an update this week from the Centers for Disease Control and Prevention (CDC).

Of the cases reported to the CDC as of Nov 30, 2020, 1,595 (98.2%) have been lab-confirmed and 30 (1.8%) are probable. An additional 3,172 patients have been found to be colonized with the multidrug-resistant yeast, as determined by targeted screening in 19 jurisdictions.

The number of states affected stands at 23, with New York (681), Illinois (411), New Jersey (202), California (117), and Florida (106) reporting the vast majority of cases. While many of the cases have been reported in long-term care facilities, the CDC notes that increased spread of C auris has been observed in acute care hospitals during the COVID-19 pandemic.

Since C auris was identified in 2009 in Japan, outbreaks have been reported in 31 countries, and 14 countries have reported single cases. C auris can cause serious invasive infections in immunocompromised patients, and it has shown resistance to three major antifungal drug classes. The CDC estimates that the mortality rate is anywhere from 30% to 60%.
Jan 19 CDC update

ASP Scan (Weekly) for Jan 22, 2021

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Barriers to antibiotic stewardship at hospital discharge identified

Five barriers to better antibiotic decision-making at hospital discharge emerged after John Hopkins University School of Medicine researchers interviewed healthcare workers and discharged patients.

"Implementation of targeted interventions can result in more effective outcomes for antibiotic use at the hospital-to-home transition," they wrote.
Jan 21 Infect Control Hosp Epidemiol abstract

US Candida auris cases continue to climb

University of Oxford to launch new AMR research institute

Originally published by CIDRAP News Jan 19

The University of Oxford announced today that it has received £100 million ($136 million USD) from the chemical manufacturing company Ineos to launch a new institute to study antimicrobial resistance (AMR).

The Ineos Oxford Institute for AMR Research will focus primarily on developing new antimicrobial drugs, particularly novel drugs just for animals. Scientists at the institute will also contribute to research on the type and extent of drug-resistant microbes across the world, and promote responsible use of antimicrobials in human and animal medicine.

"Just as the discovery of penicillin and subsequent antibiotics transformed modern medicine, the rapid and relentless growth of antimicrobial resistance poses one of the most serious threats to human life worldwide," Oxford professor of medical microbiology Tim Walsh, PhD, said in a university press release.

"Modern agriculture and healthcare both heavily reliant on antibiotics, which is why it is vital to address this issue as a humanitarian emergency and to bring together national and international expertise across scientific disciplines to develop new drugs and policies to tackle this global problem."

The institute will be based in the University of Oxford's departments of chemistry and zoology.
Jan 19 University of Oxford press release

Intense stewardship, infection control tied to less antibiotic ICU use

Originally published by CIDRAP News Jan 19

Implementation of intensive antimicrobial stewardship strategies and monitoring of infection prevention and control practices were associated with a reduction in antibiotic use in the surgical intensive care unit (ICU) of an Indian hospital, researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

The study, conducted by researchers with the Postgraduate Institute of Medical Education and Research in Chandigarh, India, compared antibiotic use in the hospital's ICU surgical recovery unit from April 2017 to June 2017 (the baseline period) with antibiotic use from July 2017 to December 2017 (the intervention period).

During the baseline period, routine prospective audit and feedback of antibiotic prescribing was conducted, per the hospital's antimicrobial stewardship program. For the intervention period, additional stewardship interventions, including antibiotic timeouts, dose optimization, and small training sessions on rational antibiotic use were implemented, along with a bundle of measures for preventing healthcare-acquired infections.

A total of 337 patients were included in the study, with 94 observed in the baseline phase and 243 in the intervention phase. Comparison of the two periods showed a decrease in the days of therapy per 1,000 patient-days (1,112.3 days in the baseline period vs 1,048.6 days in the intervention period) and the length of therapy per 1,000 patient-days (956 vs 936.3 days). The cumulative defined daily doses per 1,000 patient-days for all antimicrobials also fell (1,326.3 vs 1,313.5). Double cover for gram-negative infections was noted in 9.5% of total patients in the baseline phase, compared with 2.9% of patients in the intervention phase.

The analysis also found that the incidence of ventilator-associated pneumonia per 1,000 ventilator-days declined from 46.4 to 35.4, while central line–associated bloodstream infections per 1,000 central line–days remained the same (14.7 vs 14.8).

The authors of the study say the findings, though limited, could be applicable to ICU surgical recovery units in other developing countries with limited resources.
Jan 18 J Glob Antimicrob Resist study