News Scan for Sep 07, 2016

Undercount of drug-resistance deaths
AMR genes in household dust
Yellow fever over in Uganda

US failing to accurately track drug-resistant infection deaths, report says

A yearlong investigation by Reuters alleges that thousands of US deaths from antibiotic-resistant infections are going uncounted because federal and state health agencies are doing a poor job of tracking them.

In the first part of a series on "superbugs," the news service today outlines how, in several cases, the death certificates of patients who died as the result of a bacterial infection contracted in the hospital fail to include any mention of the infection.

This happens for several reasons; for example, doctors might not want to wait for laboratory confirmation of an infection, or the patient may have been suffering from several other conditions. But Reuters also found that hospitals are reluctant to acknowledge hospital-acquired infections because of potential legal liability, loss of insurance reimbursements, and public-relations damage.

And this is just one part of the problem. Even when deaths from antibiotic-resistant infections are recorded, many still go uncounted at the state level. A Reuters survey of all 50 state health departments found that 24 states and the District of Columbia do not regularly track deaths caused by drug-resistant infections. And the states that do track such deaths do so inconsistently, and only for a few types of infections.

In the survey, those states reported a combined total of 3,300 deaths due to drug-resistant infections from 2003 to 2014. A Reuters analysis of death certificates from the same period, in contrast, found that drug-resistant infections played a role in 180,000 deaths.

Meanwhile, because there is no unified national surveillance system to monitor drug-resistant infections and related deaths, those deaths recorded at the state level often don't make it into federal health statistics. As a result, Reuters found that the widely cited national estimates of antibiotic-resistant infection deaths provided by the Centers for Disease Control and Prevention (CDC)—23,000 a year—are "mostly guesswork," an extrapolation based on small samplings of infections and deaths collected from 10 states in 2011. CDC officials acknowledged to Reuters that those estimates are limited.

Comparing the battle against antibiotic-resistant infections to the fight against HIV/AIDS, Reuters argues that an accurate count of where and when antibiotic-resistant infections and deaths are occurring will prompt national action and enable public health agencies to "quickly allocate money and manpower where they are needed."
Sep 7 Reuters story


Study links household antimicrobial chemicals to antibiotic resistance

A new study has found a connection between antimicrobial substances found in household dust and levels of antibiotic resistance genes.

In the study, published today in Environmental Science & Technology, researchers collected 44 dust samples from a mixed-use athletic and educational facility, then analyzed the samples for antimicrobial chemicals, microbial community profiles, and antibiotic resistance gene profiles.

Among the chemicals they found were triclosan, which is a common ingredient in over-the-counter antibacterial soaps and has been linked to antimicrobial resistance in drinking water and wastewater. They also identified several antibiotic resistance genes, with the three most abundant genes covering resistance to a wide range of antibiotics.

Overall, the dust contained low levels of triclosan and low concentrations of antibiotic resistance genes. But further analysis revealed six positive associations between the concentration of an antimicrobial chemical and the relative abundance of an antibiotic resistance gene. In particular, the investigators found a link between higher concentrations of triclosan and higher levels of a macrolide resistance gene.

The authors of the study note that while their findings show only a correlation between the presence of antimicrobials in household dust and an increase in antibiotic resistance genes, they suggest that antimicrobials may have an influence on the promotion and retention of antibiotic resistance genes. They recommend further studies.

Last week, the Food and Drug Administration announced a ban on triclosan and 18 other antimicrobial and antiseptic chemicals commonly found in over-the-counter soaps.
Sep 7 Environ Sci Technol study
Sep 2 CIDRAP News story "FDA: No antimicrobial agents in over-the-counter soap"


Uganda declares yellow fever outbreak over

Health officials in Uganda have declared the outbreak of yellow fever that began there earlier this year over, according to a Bloomberg story yesterday.

Authorities vaccinated more than 600,000 people in May and June after the outbreak began in early April. "Following the successful yellow fever vaccination campaign in the affected districts, no new cases of yellow fever have been confirmed," the country's Ministry of Health said in a statement, according to the story. "Disease surveillance efforts are still ongoing to detect any other possible outbreak."

The World Health Organization said in a Jun 9 update that Uganda had 68 suspected cases, of which 7 were lab confirmed. In May the agency said 7 had died of suspected yellow fever.

The outbreak is not linked to much larger ones in Angola and the Democratic Republic of the Congo totaling about 6,000 cumulative cases.
Sep 6 Bloomberg story
Aug 31 CIDRAP News story "WHO: Yellow fever not a public health emergency"

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