News Scan for Jun 14, 2017

News brief

Saudi officials confirm 3 more MERS cases in Riyadh

Today the Saudi Arabian Ministry of Health (MOH) announced three new MERS-CoV cases in Riyadh.

Yesterday, the World Health Organization (WHO) said there were three separate hospital-based outbreaks of MERS-CoV (Middle East respiratory syndrome coronavirus) in that city. At least one of the new cases is tied to the hospital outbreaks, but none of the patients are healthcare workers.

A 70-year-old Saudi woman is in critical condition after presenting with symptoms of MERS-CoV infection. She acquired the virus as a patient in a hospital.

A 59-year-old male expatriate is also in critical condition. The source of his infection is under investigation, according to the MOH. Finally, a 40-year-old Saudi man is in stable condition after being diagnosed as having MERS. His infection is listed as "primary," meaning it's unlikely he contracted the virus from another person.

The new cases raise Saudi Arabia's total since 2012 to 1,636, including 673 deaths. Fifteen people are still being treated for the disease.
Jun 14 MOH update
Jun 13 CIDRAP News story "WHO details Saudi MERS clusters as outbreak grows"

Flu slowly rising in South America

The WHO in a new global update said that flu levels are slowly increasing in parts of the Southern Hemisphere, with influenza B the most dominant strain circulating.

Most of the world reported low levels if influenza-like illness, with only temperate South America reporting a slight rise in the number of flu cases. Chile and Paraguay report numbers that have crossed the seasonal threshold, with Argentina and Uruguay also reporting more activity. Influenza A (H3N2) is dominating in this region.

Africa, Asia, Europe, and North America all report low levels of flu, with influenza B being the dominant strain in those regions.
Jun 12 WHO flu update

PAHO reports small increase in chikungunya cases

The Pan American Health Organization (PAHO) in its regular update on chikungunya on Jun 9, reported 165 more cases in the Americas, a decline from sizable numbers reported over the past few weeks.

The new cases edge the yearly total to 87,637. Brazil, the country with the most cases this year, did not report any totals for the week. Previous weekly reports reflected increases of 1,039, 16,436, 142, and 38,282 cases, respectively.

Countries reporting small numbers of additional cases last week were El Salvador, Guatemala, Panama, Colombia, Ecuador, and Paraguay. No new deaths were added, keeping the total at 13.

Since the first chikungunya outbreaks in the Americas began in the Caribbean in 2013, the virus has sickened at least 2,474,664 people.
Jun 9 PAHO update

Five charged with manslaughter in Flint water case

Michigan's attorney general charged five people, including the state's health and human services director, with manslaughter in the death of an 85-year-old man who died from Legionnaires' disease after drinking tainted water from Flint.

According to the Associated Press (AP), the charge is part of a wider criminal investigation of how Flint's water system became contaminated in 2014.

"The health crisis in Flint has created a trust crisis for Michigan government, exposing a serious lack of confidence in leaders who accept responsibility and solve problems," said state Attorney General Bill Schuette, in the AP story.

Michigan's chief medical officer was charged with—in addition to manslaughter—obstruction of justice and lying to investigators.

Flint water was found to have toxic levels of lead in 2014 and 2015, after city officials OK'd the use of Flint River water, but failed to treat it to reduce corrosion.

The AP said nearly 100 cases of Legionnaires' disease were reported in the Flint area, including 12 deaths, in 2014 and 2015. The serious lung infection is caused by inhaling contaminated water into the lungs.
Jun 14 AP story
Jun 14 State of Michigan announcement

Stewardship / Resistance Scan for Jun 14, 2017

News brief

Egyptian study finds high rates of resistance in community-onset GI cases

A single-center study in Egypt found that nearly two thirds of the Enterobacteriaceae isolates collected from the feces of patients who had community-onset gastrointestinal complaints were extended-spectrum beta-lactamase (ESBL) producers, and 4.4% were carbapenemase-producing Enterobacteriaceae (CPE).

Writing in Antimicrobial Resistance & Infection Control, the authors said they recovered 113 Enterobacteriaceae isolates from 100 consecutive patients at El-Ahrar General Hospital in Zagazig in early 2013. The most common pathogens detected were Escherichia coli (72 of 113), Klebsiella pneumoniae (23), and Enterobacter cloacae (3). Seventy-three isolates (64.6%) were ESBL Enterobacteriaceae.

Of the 100 patients, 68 harbored ESBL Enterobacteriaceae, while 5 tested positive for CPE. Twenty-two (47.8%) of the ESBL-positive isolates were multidrug resistant. Three of the 5 CPE isolates harbored New Delhi metallo-beta-lactamase (NDM), a known resistance gene.

The researchers conclude, "These high colonization rates are worrying, therefore prudent antimicrobial use should be adopted in Egyptian community settings."
Jun 13 J Antimicrob Resist Infect Control study

Egyptian data show high MDR rate in neonatal sepsis

Another Egyptian study published yesterday in the same journal detailed a 38% rate of multidrug-resistant (MDR) bacteria in pathogens isolated from infants who had sepsis.

Of 953 neonates admitted to the neonatal intensive care unit of Cairo University Children's Hospital in a 12-month period, 314 were diagnosed as having sepsis: 123 with early-onset sepsis and 191 with late onset.

The investigators assessed antimicrobial sensitivity and resistance patterns for all 245 isolated bacteria isolated from the patient, with 166 from blood cultures and 79 endotracheal aspirate cultures. Of those 245 bacteria, 92 (37.6%) were MDR. And gram-negative bacteria accounted for 78 of those MDR pathogens, or 84.8%, and the rest were gram-positive.

Of the 314 patients, 67 (21.3%) harbored MDR bacteria. The rate was lower in the early-onset group (18/123, or 14.6%) than the late-onset group (49/191, or 25.7%).

Gram-negative bacteria were most resistant to ampicillins (100%), cephalosporins (93%-100%), and piperacillin-tazobactam (99%), with less resistance to aminoglycosides (36%-52%).
Jun 13 J Antimicrob Resist Infect Control study