A national quality improvement (QI) initiative was associated with increases in appropriate antibiotic prescribing for pediatric infections at 118 US hospitals, researchers reported yesterday in Pediatrics.

The initiative, implemented at hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network, aimed to increase the proportion of children receiving appropriate empiric, definitive, and duration of antibiotic therapy for community-acquired pneumonia, skin and other soft-tissue infection, and urinary tract infection—the three most common infections for which children receive care in the emergency department (ED) or hospital. Interventions included monthly audit with feedback, educational webinars, peer coaching, order sets, and a mobile app containing site-specific, antibiogram-based treatment recommendations.

The study included 43,916 encounters of children from 60 days to 18 years who were evaluated in the ED or hospital. Appropriate prescribing was measured during an 18-month baseline (30,799 encounters) and a 10-month intervention period (13,117 encounters) from 2020 to 2022.

Improved empiric prescribing and duration of therapy

The overall median adherence to empiric, definitive, and duration of antibiotic therapy for all infections combined was 67%, 74%, and 61%, respectively, at baseline and 72%, 79%, and 71%, respectively, during the intervention period. Interrupted time series analysis revealed a 13% (95% confidence interval [CI], 1% to 26%) intercept change at intervention for empirical therapy and a 1.1% (95% CI, 0.4% to 1.9%) monthly increase in adherence per month for antibiotic duration above baseline rates. No change was observed for definitive antibiotic therapy.

Although the goal of 85% or higher adherence to appropriate prescribing was not achieved, the study authors say the observed rates of appropriate prescribing observed in the study were higher than reported in previous studies.

"Our project's results highlight the potential for multisite QI collaboratives to effectively improve antimicrobial prescribing across diverse settings," they wrote.

Today a new meta-analysis of six randomized controlled trials in JAMA Neurology finds no increase in seizures in the month following COVID vaccination. 

The study compared the incidence of new-onset seizures between the 63,521 vaccine and 54,919 placebo recipients involved in randomized controlled trials conducted in the last 4 years.

“The new onset seizures following vaccination, even with the different types of vaccine, we found no statistical difference,” study author Churl-Su Kwon, MD, MPH, said in an interview posted online on the journal site. 

In the vaccine group there were 9 seizure events reported, compared to 1 in the placebo group, resulting in an odds ratio of 2.70  (95% confidence interval [CI], 0.76 to 9.57) during the 28 days following vaccination.

When analyzing the entire study periods included in the analysis (median time 43 days), the authors reported no significant difference between the vaccine and placebo groups in terms of incident new-onset seizure (13/43,724 events [0.03%] in vaccine and 5/40 612 [0.012%] in placebo recipients; odds ratio 2.31; 95% CI, 0.86 to 3.23).

The findings suggest that there is no difference in risk of seizure incidence among vaccinated individuals vs placebo recipients

"The findings suggest that there is no difference in risk of seizure incidence among vaccinated individuals vs placebo recipients," the authors concluded. "However, the risk of seizure occurrence after SARS-CoV-2 infection seems to be relatively high."

For the first time, a wild deer in Pierce County, Wisconsin, has been confirmed to have chronic wasting disease (CWD), the Wisconsin Department of Natural Resources (DNR) reports today.

The 4- to 5-year-old doe, which had showed signs of illness, was found in Spring Lake, which is located within 10 miles of the Dunn and St. Croix county borders. 

As a result of the finding, Pierce County will begin a 3-year baiting and feeding ban on May 15, St. Croix County will ban baiting and feeding for 2 years starting on the same date, and Dunn County will renew its current ban. The DNR said it will also host a public meeting.

Found in deer and other cervids such as moose and elk, the infectious illness is caused by misfolded proteins known as prions. The disease poses an ongoing threat to cervids, given that CWD can spread from animal to animal and through environmental contamination. 

No human cases have been reported, but health officials urge people to avoid eating the meat of infected animals and to take precautions when field-dressing or butchering cervids.

• Amid a sharp rise in US maternal and congenital syphilis cases over the past few years, Colorado's governor recently issued a statewide public health order to address the state's persistent and sharp increase in congenital syphilis. In a recent statement, officials said congenital syphilis cases rose sevenfold from 2018 to 2023. So far this year, 25 cases have been confirmed, including five stillbirths and two newborn deaths. The public health order expands access to testing during pregnancy and stipulates that healthcare providers must offer testing more frequently during pregnancy. Also, it requires testing at correctional facilities.
• Health officials in Madison, Wisconsin, recently reported a measles case involving someone who traveled to and works in neighboring Rock County. In a statement, Public Health Madison and Dane County said it is working with the Wisconsin Department of Health Services (WDHS) and the Rock County Department of Health to identify contacts and potential exposures. The WDHS identified potential exposures at two healthcare facilities in Janesville, as well as a gas station in Milton, an electronics repair shop in Madison, and a fast food restaurant in Cottage Grove. The infection is part of a rise in global cases, including in the United States. In its latest weekly update, the Centers for Disease Control and Prevention (CDC) on April 26 reported three more cases, raising the national total to 128 from 20 jurisdictions, more than double the cases reported for 2023.