A study of more than 50,000 Canadian seniors diagnosed as having COVID-19 during the first 18 months of the pandemic found that antibiotic use within 7 days of diagnosis was associated with detection of antibiotic resistance organisms, researchers reported today in NEJM Evidence.

The population-wide cohort study, led by researchers with the Ottawa Hospital Research Institute, analyzed data on residents of Ontario aged 66 years and older who had a positive test for SARS-CoV-2 (the virus that causes COVID-19) from January 1, 2020, through June 30, 2021. 

Because antibiotic use in COVID-19 patients was common in the early months of the pandemic in most countries, particularly in older patients, the researchers wanted to evaluate the relationship between peri–COVID-19 antibiotic exposure (within 7 days of index SARS-CoV-2 reporting) and isolation of an antibiotic-resistant organism from a clinical culture within 6 months.

Of the 53,533 eligible patients included in the study, 8,228 (15%) were prescribed a peri–COVID-19 antibiotic, and 1,477 (3%) had a downstream drug-resistant organism identified. Peri–Covid-19 antibiotic use was significantly associated with the presence of any antibiotic-resistant organism (adjusted odds ratio [aOR], 1.24; 95% confidence interval [CI], 1.09 to 1.41) and the presence of gram-negative antibiotic-resistant organisms (aOR, 1.27; 95% CI, 1.11 to 1.46) but not gram-positive antibiotic-resistant organisms (aOR, 1.02; 95% CI, 0.70 to 1.48).

Stewardship in older adults, nursing home residents

Among all individuals who received an antibiotic, the attributable fraction of downstream antibiotic resistance related to peri–Covid-19 antibiotic use was 17% (95% CI, 7% to 26%). Among all individuals with a SARS-CoV-2 diagnosis, the population-attributable fraction of downstream antimicrobial resistance related to peri–Covid-19 antibiotic use was 4% (95% CI, 2% to 7%).

“As antibiotics are often used in the outpatient setting in patients with Covid-19, without clear indications, this study suggests that a substantial burden of antimicrobial resistance in individuals with Covid-19 may have been avoidable,” the study authors wrote

They add that the disproportionate impact on older, more vulnerable patients suggests that antimicrobial stewardship programs targeting antibiotic prescribing in older adults and those residing in nursing homes may be beneficial.

European Union (EU) officials yesterday announced the launch of a 10-year, €253 million ($276 million) effort to tackle antimicrobial resistance (AMR).

Created to support the EU One Health Action Plan against AMR, the Partnership on One Health Antimicrobial Resistance (OHAMR) will involve 53 organizations from 30 countries and use a One Health approach to “connect sectors and accelerate solutions” to reduce antimicrobial use and resistance in people and animals, according to a press release from the European Commission. 

The One Health concept views the health of humans, animals, and the environment as interconnected.

Planned activities of OHAMR include strengthening research capacity in participating countries, supporting access to and better use of AMR data, promoting the translation of research into practice and policy, joint transnational calls for collaborative research and innovation projects, and coordinating and aligning national and European efforts to increase impact.

“Europe is ready to lead in the global fight against antimicrobial resistance,” said Ekaterina Zaherieva, European Commissioner for Startups, Research and Innovation. “This partnership embodies our commitment to step up, innovate, and protect the foundations of modern medicine.”

Eleven new Ebola virus cases have been added to the outbreak in the Democratic Republic of the Congo (DRC) in the past week, pushing the case total to 57, including 35 deaths, for a death rate of 61.4%, the World Health Organization (WHO) reported yesterday.

First declared on September 4, the outbreak is still confined to the Bulape Health Zone in Kasai Province. Of the 57 cases, 47 were confirmed, and 10 were probable; of the 35 deaths, 25 were confirmed, and 10 were probable. Five of the confirmed cases were diagnosed in healthcare workers.

Ebola, which spreads through infected blood and other body fluids, typically causes fever and weakness, followed by diarrhea and vomiting.

Children account for 23% of all infections

Infected patients range in age from 0 to 65 years, with those 0 to 9 years making up 23% of all cases. While females account for most cases (61%), their death rate is lower than that of males (56% vs 73%).

No international traffic-related measures are currently warranted.

“The outbreak shows a decreasing trend of cases in the recent week, nevertheless the attention remains high, and response activities are ongoing in all affected health areas including early case detection, isolation, case management, contact tracing, vaccination as well as risk communication and community engagement,” the WHO wrote. 

As of September 21, investigators have identified 1,180 contacts for follow-up. Of all contacts, 94 completed 21 days of monitoring, while the rest are still being tracked. Of 26 patients admitted to the Ebola Treatment Centre since the outbreak began, 2 recovered and were released on September 16, 5 died, and 19 are still being treated.

In total, 1,740 people have been vaccinated against Ebola in the Bulape, Bulambae, and Mweka Health Zones in the 9 days since the campaign began.

“No international traffic-related measures are currently warranted,” the statement said. Health authorities are reinforcing surveillance at border crossings through activities such as health screening, risk communication, and the integration of border communities in affected areas into early warning systems and the national surveillance network, it added.

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