News Scan for Sep 20, 2016

News brief

WHO details MERS case in Austria

The World Health Organization (WHO) today described a case of MERS-CoV in a Saudi man diagnosed with the virus while he was visiting Vienna, Austria. This is the second case of MERS-CoV (Middle East respiratory syndrome coronavirus) reported in that country and was noted in recent media reports.

A 67-year-old camel breeder was visiting Austria when he first experienced fever and a cough on Sep 6. He was taken to a hospital on Sep 7, and diagnosed with severe pneumonia. On Sep 8, MERS-CoV was confirmed by a reference laboratory in Vienna. The patient remains isolated and in critical condition.

The WHO said the case represents a serious public health threat for Austria, as hospital-based outbreaks are common with MERS-CoV. The last MERS case in Austria was also in a Saudi visitor, in 2014.
Sep 20 WHO report

Flu season hangs on in Australia and South Africa, few hot spots elsewhere

Flu activity in Australia continued to increase over the past few weeks with H3N2 as the dominant strain, and disease levels in that part of the world seem to have peaked, the World Health Organization (WHO) said yesterday in its regular global flu update.

In neighboring New Zealand, however, flu markers are still running below the seasonal baseline.

Southern Africa's flu season is still underway with all three strains cocirculating, while other parts of Africa are reporting sporadic H3N2 detections, except for elevated influenza B levels in Madagascar.

In South America, flu and other respiratory viruses declined in most countries, except for Chile and Argentina, where levels remained elevated.

Southeast Asian flu activity remained at low levels, as for most the Caribbean region, where many countries are battling other respiratory viruses such as parainfluenza in Suriname and respiratory syncytial virus (RSV) elsewhere.

Globally, 78% of flu viruses tested in recent weeks were influenza A and 22% were influenza B. Of the subtyped influenza viruses, 81% were the H3N2 strain.
Sep 19 WHO global flu update

Triclosan sutures can help prevent surgical site infections in children

A new study in the The Lancet Infectious Diseases shows that using sutures containing the antimicrobial triclosan can reduce the incidence of surgical site infections (SSIs) in children. SSIs are responsible for 31% of healthcare-associated infections.

Finnish researchers found that children who were treated with triclosan-containing sutures had a 3% incidence of SSIs, while those treated with standard sutures had a 5% incidence of SSIs. The study took place between 2010 and 2014, and involved 1,633 children. Twenty of the 778 children treated with tricolsan sutures suffered from SSIs, compared to 42 of the 779 children who got the control sutures. According to the authors, to prevent one SSI, triclosan sutures had to be used in 36 children.

Triclosan has made headlines recently after the Food and Drug Administration said it could no longer be marketed in over-the-counter products, in an effort to combat antimicrobial resistance. The ingredient can still be used, however, in healthcare settings.
Sep 20 Lancet Infect Dis study
Sep 20 Lancet Infect Dis commentary

West Africa Ebola strain deadlier than central African strain

A study published yesterday in the Journal of Infectious Diseases compared two strains of Ebola virus in rhesus macaques, and found that the West Africa Ebola strain (Makona) causes more severe disease than the central African strain (Kikwit).

Researchers suspected that heightened viremia and viral shedding contributed to the severity of the Ebola outbreak in 2014, which originated in West Africa. Compared to earlier outbreaks in Central Africa, the West African Ebola outbreak was much deadlier, taking more than 11,000 lives in 3 years. To evaluate this hypothesis, researchers infected 15 monkeys with 3 different Ebola strains, two from West Africa.

All monkeys infected with West African strains (EBOV-C05/C07) died, while two out of three monkeys infected with Central African strain (EBOV-K) died. Those infected with EBOV-C05 also showed more enhanced replication and disease pathology in their lungs than the monkeys infected with the other two strains. Animals infected with the two West African strains shed more virus than those sickened by the Kikwit strain, though the difference wasn't statistically significant.
Sep 19 J Infect Dis study

Antimicrobial Resistance Scan for Sep 20, 2016

News brief

World Bank predicts dire economic consequences from unchecked AMR

A new report from the World Bank says rising antimicrobial resistance (AMR) has the potential to cause as much economic damage as the 2008 financial crisis.

The report, published yesterday by the World Bank Group, predicts that if rising AMR is not addressed, global GDP could fall by 1.1% to 3.8%, healthcare costs could grow by an additional $1.2 trillion annually, and as many as 28 million people would be pushed into extreme poverty by the year 2050. The brunt of the impact, the report says, would fall on lower- and middle-income countries, where higher disease prevalence would have a more significant effect on economic output.

The report also projects that rising AMR could result in significant losses for the world's farmers, with the decline in global livestock production ranging between 2.6% and 7.5%. In low-income countries, the decline could be as high as 11%.

"This report provides another timely reminder that rising drug resistance is a looming threat to our prosperity and sustained economic development in all parts of the world," Lord Jim O'Neill, chairman of the Review on Antimicrobial Resistance, said in a World Bank press release.

To avoid the financial consequences, the report recommends, among other things, greater investment in both human and veterinary health systems and in AMR surveillance, diagnostic, and containment capabilities. While such investments will be costly, especially for low-income nations, the report concludes that the expected benefits will be greater than the investment costs.
Sep 19 World Bank Group report on drug-resistant infections
Sep 19 World Bank press release

Study: Azithromycin shows little benefit in reducing asthma symptoms

The addition of azithromycin to standard treatment for asthma attacks has little benefit in relieving symptoms and improving lung function, according to a study yesterday in JAMA Internal Medicine.

Azithromycin Against Placebo in Exacerbation of Asthma (AZALEA)—a randomized, double-blinded clinical trial at 31 medical centers in the United Kingdom—evaluated 4,582 people presenting to emergency care with asthma attacks from 2011 to 2014. Nearly half of screened patients (2,044, or 44.6%) were excluded because they had already received antibiotics, and only 390 eventually met study criteria. Researchers randomized a total of 199 patients to receive either 500 milligrams of azithromycin for 3 days (97 people) or placebo (106 people) within 48 hours of an asthma exacerbation.

No difference in average self-reported symptom scores occurred between the treatment and placebo group at any point during the 10 days following an attack. Researchers also found no significant difference in reported quality of life, lung function, or time to 50% reduction in asthma symptoms, the study said.

Nine patients in the azithromycin group and 12 in the placebo group tested positive for bacterial infections, and 36 patients overall tested positive for viral infections. The azithromycin group reported a greater number of adverse gastrointestinal and cardiac events compared to the placebo group (35 versus 24, and 4 versus 2, respectively), though patients receiving the antibiotic had a lower frequency of respiratory, thoracic, and mediastinal events, the authors said.

They concluded that the AZALEA study shows almost no benefit for prescribing azithromycin to patients suffering an asthma attack.

Two commentaries in the same issue of JAMA Internal Medicine offer insight into the trial’s results. The first, written by Guy G. Brusselle, MD, PhD, and Eva Van Braekel, MD, PhD, notes differences between the AZALEA trial and the Telithromycin, Chlamydophila, and Asthma Study (TELIKAST), the latter of which showed significant clinical benefit to administering the antibiotic telithromycin to patients having an asthma attack.

Brusselle and Van Braekel note that because all patients in the AZALEA study received a corticosteroid as part of standard care, the observed anti-inflammatory benefits of a macrolide antibiotic may have been substantially reduced. Additionally, only 5% of the AZALEA treatment group tested positive for a bacterial infection, as compared to 60% of patient in the TELICAST study, rendering antibiotic therapy more effective and appropriate in TELICAST participants, the authors said, adding, "Restricting the use of antibiotics to those patients with acute exacerbations who will benefit the most is therefore paramount."

Perhaps the greatest difference between the two trials stems from AZALEA’s exclusion of a large number of patients who already received antibiotics. Brusselle and Van Braekel note that this substantial exclusion may have caused selection bias, in which patients included in the study had already been deemed less likely to respond to antibiotic therapy.

A second commentary by Ateev Mehrotra, MD, MPH, and Jeffrey A. Linder, MD, MPH, notes the troubling overuse of antibiotics in the AZALEA study and offers a three-pronged approach for implementing greater antimicrobial stewardship while improving asthma care.

Mehrotra and Linder advocate for: (1) reframing the issue as an individual, rather than a public health, problem with significant risks to patient health when antibiotics are used inappropriately; (2) instituting social and behavioral interventions, such as prescription audits, for clinicians; and (3) using telemedicine to deter patients from seeking ambulatory care and antibiotic prescriptions for common illnesses.
Sep 19 JAMA Intern Med study
Sep 19 JAMA Intern Med commentary by Brusselle and Van Braekel
Sep 19 JAMA Intern Med commentary by Mehrotra and Linder

Multidrug-resistant strain of MRSA found in Memphis fitness centers

An uncommon multidrug-resistant (MDR) strain of methicillin-resistant Staphylococcus aureus (MRSA) has been found on indoor surfaces in the United States for the first time, according to a study today in the American Journal of Infection Control.

Researchers from the University of Memphis and the Food and Drug Administration’s Southeast Regional Laboratory tested 32 samples from exercise machines, dumbbells, toilet handles, and stair handrails at four Memphis fitness centers.

All but three of the samples (29, or 90.6%) had evidence of S aureus colonies, 12 (37.5%) of which were identified as MRSA. All MRSA isolates were resistant to 7 to 12 antibiotics, and, troublingly, six were resistant to linezolid, one of the few remaining antibiotics considered effective against MRSA. The authors said that this marks the first time that linezolid-resistant MRSA has been identified in the Memphis area.

All MRSA isolates showed significant diversity of extracellular toxin genes and belonged to clonal complex or sequence type 59, a distinct genotype that is rare in the United States and has previously never been isolated from an indoor environment in the country, the authors said. They noted that further research is needed into potential transmission risks and hygiene precautions at fitness centers in the Memphis metropolitan region.
Sep 20 Am J Infect Control study