Unnecessary Antibiotics for Respiratory Infections Linked to Harm, Higher Costs
A study of more than 3 million patients with bacterial and viral respiratory infections found that inappropriate antibiotic prescriptions were associated with an increased risk of adverse events and higher health care costs, researchers reported today. Infectious Diseases Clinic.
The study, conducted by researchers at Washington University School of Medicine in St. Louis and the Pew Charitable Trusts, used data from the commercial MarketScan database to analyze antibiotic exposure among adults ages 18 to 64 who were diagnosed them with a bacterial or viral infection. infection from April 2016 to September 2018.
They analyzed inappropriate versus appropriate prescribing, focusing on the relationship between inappropriate antibiotics and adverse drug events and 30-day attributable expenditures. Inappropriate antibiotics were defined as antibiotics not recommended by the guidelines for bacterial infections and any antibiotic for viral infections.
Among 3,294,598 eligible adults (median age, 43 years; 41% male), there were 1,656,960 bacterial respiratory infections and 1,637,638 viral respiratory infections. The proportion of adults with bacterial infections who received inappropriate antibiotics varied by infection, from 43% (sinusitis) to 56% (pharyngitis), while inappropriate antibiotics for viral infections ranged from 7% (influenza) to 66% (bronchitis).
Analysis of different infections found that inappropriate antibiotics for pharyngitis were associated with an increased risk of Clostridioides difficile infection (hazard ratio [HR], 2.90; 95% confidence interval [CI]1.31 to 6.40) and nausea/vomiting/abdominal pain (HR, 1.10; 95% CI, 1.03 to 1.08), while an increase in vulvovaginal candidiasis was associated with inadequate antibiotics for viral upper respiratory tract infections (HR, 1.24; 95% CI, 1.14 to 1.34) and nonsuppurative otitis media (ear infection; HR, 1.39; 95% CI, 1 .09 to 1.77).
The 30-day median total attributable expense for inappropriate antibiotics for bacterial infections ranged from $18 (sinusitis) to $67 (pharyngitis) and from –$53 (bronchitis) to $49 (influenza) for viral infections.
“These results support the need for increased outpatient antibiotic stewardship efforts to discourage prescribing of antibiotics for viral infections, encourage proper selection of guideline-recommended antibiotics for bacterial infections, and reduce harm and expense.” related to antibiotics,” the study authors concluded.
November 9 Clin Infect Dis abstract
listeria Deli-related outbreak sickens 16 in 6 states, 1 fatally
The Centers for Disease Control and Prevention (CDC) yesterday announced a Listeria monocytogenes outbreak linked to meat and cheese sold in delicatessens that has so far sickened at least 16 people, one of them fatally, in 6 states.
So far, officials haven’t identified a specific food source, which they said is difficult, given that listeria it spreads easily from food to surfaces in the delicatessen environment and can persist in display cases and on equipment.
Interviews with 12 sick people revealed that 11 had eaten deli meat and cheese. Of seven sick people in New York, five had purchased meat or cheese from at least one location of NetCost Market, a supermarket chain that sells international foods. However, the CDC said it does not believe NetCost Market is the source of the outbreak, because some sick people did not shop there. “A contaminated food likely introduced the outbreak strain of listeria in delicatessens in several states,” the CDC said.
In 2021, New York City and State officials found the outbreak strain in environmental and food samples from the same NetCost Market store in Brooklyn and in food from one of the stores on Staten Island. After a deep cleaning and negative tests, listeria it was found again in the Brooklyn store in September 2022.
Disease onsets range from April 2021 to September 29, 2022. Affected states include New York (7), Maryland (3), Illinois (2), Massachusetts (2), California (1), and New Jersey (1). All patients are adults, and of 13 people with ethnic information, 11 are of Eastern European descent. Thirteen people were hospitalized, including a Maryland resident who died. One of the sick people was a pregnant woman who lost her baby.
The CDC has advised people at increased risk of listeria illness (pregnant women, the elderly, and people with weakened immune systems) to avoid eating meat and cheese from deli counters unless heated to at least 165°F.
November 9 CDC outbreak notice
Bird flu outbreaks affect more poultry flocks in 8 states
In recent days, the US Department of Agriculture’s (USDA) Animal and Plant Health Inspection Service (APHIS) has reported outbreaks of highly pathogenic avian influenza in eight states, including three with outbreaks on commercial farms.
The new developments brought the number of birds lost in current H5N1 outbreaks in Eurasia to within a stone’s throw of the record loss of 50.5 million birds that producers suffered during outbreaks of avian influenza in 2015. Latest outbreaks now have caused the loss of 50.3 million birds. in 46 states, according to APHIS.
Pennsylvania has reported three outbreaks at turkey farms, all in Lehigh County, which together have more than 46,000 birds. Iowa reported its second recent outbreak on a layer farm in Wright County, which has more than 1 million birds. Iowa has been the state hardest hit by poultry losses. In Wisconsin, the virus hit a game bird farm in Jefferson County that is home to 180,000 birds.
Seven states reported more outbreaks in backyard birds, including Iowa, Pennsylvania, Washington, Ohio, Virginia, Wyoming, and New York.
USDA APHIS avian influenza updates
In international developments, France’s agriculture ministry raised its avian flu alert, prompting a requirement that farmers must keep poultry indoors, according to Reuters.
The pace of outbreaks has increased in recent months, with France experiencing its worst outbreaks, leading to the culling of 22 million birds so far. The UK recently announced a similar requirement to protect poultry.
November 10 history