News Scan for Dec 22, 2016

Hospital penalties for resistant bugs
Bacterial vs viral infections
Cholera in Yemen

Hospitals penalized for high rates of MRSA and C difficile

The federal government is for the first time cutting Medicare payments to hospitals that have high rates of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile, according to Kaiser Health News.

The Medicare penalties, a provision of the Affordable Care Act, are for the hospitals that rank in the worst 25% with respect to rates of hospital-acquired conditions (HACs), which include central-line bloodstream infections, surgical site infections, and urinary tract infections. This is the third year that the penalties have been enforced by the Centers for Medicare and Medicaid Services, but the first time that the government has taken MRSA and C difficile rates into consideration.

Overall, 769 hospitals will lose 1% of their Medicare payments under the government's HAC Reduction Program. In total, Kaiser reports, the hospitals will lose about $430 million—18% more than the amount lost by penalized hospitals last year.

MRSA and C difficile have long been problematic pathogens in healthcare settings because of their ability to spread among patients via contaminated surfaces and healthcare workers, and excessive use of antibiotics exacerbates the problem. But progress is being made. According to the latest report on healthcare-associated infections from the US Centers for Disease Control and Prevention, national acute care hospitals saw an 8% decrease in C difficile infections and a 13% decrease in MRSA bacteremia between 2011 and 2014.

Lisa McGiffert, director of Consumer Union's Safe Patient Project, tells Kaiser that because of Medicare's penalty program and other efforts, "more hospitals are thinking about appropriate use of antibiotics."
Dec 21 Kaiser Health News story


New test shows promise in distinguishing bacterial from viral infections

A test combining three blood biomarkers for distinguishing bacterial from viral infections has the potential to improve diagnosis, according to a double-blind study involving young children seen at the hospital for lower respiratory infections in the Netherlands and Israel.

Researchers from both countries reported their findings today in The Lancet Infectious Diseases.

The new test, called ImmunoXpert, combines three proteins that have been used as markers to pinpoint infection sources: tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), interferon gamma induced protein-10 (IP-10), and C-reactive protein (CRP). Researchers compared its performance with commonly used CRP and procalcitonin tests. Clinicians are eager for new testing tools that can quickly distinguish between bacterial and viral infections to help curb antibiotic use and reduce hospitalizations.

In an effort to externally validate ImmunoXpert, the researchers assessed 577 children aged 2 to 60 months. A panel of three pediatricians assessed the children's clinical information but were masked to the test results. They diagnosed 71 bacterial infections and 435 viral infections, with inconclusive assessments for 71.

Sensitivity for distinguishing between the two infections was 86.7% (95% confidence interval [CI], 75.8% to 93.1%). Specificity was 91.1% (95% CI, 87.9% to 93.6%), with a positive predictive value of 60.5% (49.9% to 70.1%). The percentages were a little higher in 354 cases in which the panel's assessment was unanimous.

The team concluded that the trial showed the added value of the test, compared with CRP and procalcitonin, which they say has the potential to reduce antibiotic misuse in young children. They added that more studies are needed to explore the test's usefulness in clinical care.

In a commentary in the same issue, two experts from Italy wrote that, when compared with procalcitonin, the new test improved the identification of bacterial infections by 6.3% and viral infections by 5.4%. When compared with CRP, ImmunoXpert was as effective at identifying bacterial infections, but it improved the identification of viral infections by 8.6%.

They said the test has some limitations that are obstacles to routine clinical use, including that the test requires lab techniques that aren't available outside of hospitals and that the data came from a relatively small number of children.
Dec 22 Lancet Infect Dis abstract
Dec 22 Lancet Infect Dis


Yemen's suspected cholera cases top 11,600

The World Health Organization (WHO) said today that Yemen's cholera outbreak continues to grow. As of Dec 20, there are 1,496 more suspected cases and 4 new deaths from the disease, which causes acute, watery diarrhea. This brings the cumulative case total to 11,644, with 96 deaths.

To limit the spread of the disease in the country's most affected areas, the WHO dispatched rapid response teams to the Arhab district in Sana'a, the country's capital, to test and chlorinate water sources. Though acute, watery diarrhea is endemic to Yemen, ongoing conflict has strained the national health system.

The WHO said that efforts by that organization and partner agencies have tried to increase surveillance and education in the country, but new governorates are still experiencing outbreaks. According to the WHO, more than 7.6 million people, 3 million of them internally displaced, currently live in areas affected by the outbreak.
Dec 22 WHO update

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