News Scan for Aug 04, 2017

Saudi MERS case, death
Molecular diagnostics for TB
Australian drug stewardship report

New MERS case, death reported in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) identified a new case of MERS-CoV in Jeddah today and said a patient identified earlier this week has died from complications of the virus.

A 44-year-old female expatriate in Jeddah is in stable condition after being diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). The source of her infection is listed as a secondary household contact.

The MOH also said a 57-year-old Saudi man from Dumah Al Jandal has died from MERS. The MOH first reported his case 2 days ago.

As of today, Saudi Arabia's MERS-CoV cases since 2012 total 1,686, including 685 deaths. Seven people are still being treated for infections.
Aug 4 MOH


Molecular testing for drug-resistant tuberculosis shows promise

A study yesterday in Clinical Infectious Diseases suggests that molecular-based diagnostic tests for the detection of drug-resistant tuberculosis (TB) may predict treatment response better than traditional drug susceptibility testing (DST) methods.

In a retrospective study involving isolates from 171 multidrug-resistant TB and extensively drug-resistant TB patients in Lima, Peru, a team of researchers from Massachusetts sequenced the gyrA and gyrB genes; mutations in these genes are the main cause of fluoroquinolone (FQ) resistance in Mycobacterium tuberculosis. They were looking to determine the significance of "intermediate" gyr mutations in treatment response and compare this with treatment response for "high-level" gyr mutations. They also wanted to see how gyr mutation detection compares with culture-based DST in predicting treatment outcome.

In a univariate analysis that controlled for other host and treatment factors, and compared with patients with isolates that didn't have gyr mutations, high-level gyr mutations were found to significantly predict poor treatment outcomes with a hazard ratio of 2.6. In comparison, the hazard ratio for intermediate gyr mutations was 1.3, which did not reach statistical significance. The researchers also found that resistance defined by the detection of either high-level or intermediate gyr mutations was also superior to resistance determined by culture-based ciprofloxacin DST in predicting poor treatment outcomes.

The authors write, "Our comparison with culture-based DST is the first to suggest that gyr mutation detection is as good, if not better, in identifying patients unlikely to respond to FQ treatment."
Aug 3 Clin Infect Dis study


Australian Commission publishes report on human antimicrobial use

The Australian Commission on Safety and Quality in Health Care (ACSQH) this week published its second annual report on antimicrobial use in human health, noting challenges like the increased prevalence of some antibiotic-resistant organisms and problems with improper prescribing, as well as areas for next steps, like implementing actions to control carbapenemase-producing Enterobacteriaceae (CRE).

The authors note that, since 2014, fluoroquinolone resistance in Escherichia coli from blood cultures has increase 2.5% and in Shigella sonnei it's up10.9%. They also note that the proportion of vancomycin-resistant Enterococcus faecium (VRE) isolates in the country increased have rapidly since 2005, and is now higher than that in any European nation. In addition, community-onset methicillin-resistant Staphylococcus aureus (MRSA) is now more common than healthcare-associated MRSA.

Regarding antibiotic prescribing, the report notes that, on any given day in an Australian hospital in 2015, 40.5% of patients were administered an antimicrobial. Of these, 23.3% of antimicrobial prescriptions were noncompliant with guidelines, and 21.9% were considered inappropriate. The authors also say that antibiotics used for surgical prophylaxis are often not required and are given for too long.

Action steps include reducing unnecessary prescribing in the community; taking steps to control CRE, which were outlined in an ACSQH report in May; monitoring resistant gonorrhea, minimizing the spread of VRE, and improving appropriate prescribing for surgical prophylaxis.
Aug 2 ACSQH news release
Aug 2 ACSQH full report

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