News Scan for Aug 16, 2017

News brief

Latest Saudi MERS case involves man from Jeddah

The Saudi Arabian Ministry of Health (MOH) announced a new case of MERS-CoV today, continuing a small but steady stream of cases in the weeks leading up to the Hajj pilgrimage.

A 69-year-old expatriate man from Jeddah is in critical condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). The source of the man's infection is currently under review, according to the MOH.

The new case raises Saudi Arabia's total number of MERS-CoV illnesses since the virus was detected for the first time in humans in 2012 to 1,697, which includes 690 deaths. Eleven people are still being treated for their infections.
Aug 16 MOH report

 

Study: Zika not always found in semen of infected men

A new study published in the New England Journal of Medicine complicates the understanding of Zika virus RNA in seminal fluid. The findings call into question recommendations about sexual activity when Zika virus is suspected or confirmed.

The study was based on semen samples from 12 men from French Guiana with laboratory-confirmed Zika virus. Four of the men, 33%, had no detectable Zika RNA in their semen. Seven (58%) of the men excreted Zika virus RNA in their semen for up to 1 month. The average duration for Zika RNA detection in semen was 26 days, a shorter amount of time than other studies have reported.

"These data suggest that not all men who are symptomatically infected with ZIKV will have ZIKV RNA detectable in semen," the authors write. Moreover, viral loads in semen samples did not correspond to serum levels.

Currently, the Centers for Disease Control and Prevention recommends that men wear condoms or abstain from sex for 6 months after possible Zika infection. The authors conclude their study by saying more data is needed before making recommendations about sexual health practices.
Aug 16 NEJM study

 

Cyclospora outbreak cases rise in US and Canada

In its latest update on a national rise in Cyclospora cases, the Centers for Disease Control and Prevention (CDC) said 45 more illnesses have been reported in people without a history of international travel who were sick on or after May 1, raising the outbreak total to at least 251 cases.

Cyclospora cases typically rise this time of year, both in travelers infected outside the United States and over the past several summers in people without a travel history who were exposed to imported produce items such as basil, cilantro, and raspberries. However, on Aug 7 the CDC issued a warning to health providers about an increasing number of cases. So far no food source has been connected to the outbreak.

Though cases have been reported from 35 states, Texas is one of the worst affected. In an update yesterday, the Texas Department of State Health Services (TDSHS) said 230 cases from 45 counties have been reported since the middle of June, with many of the cases from Bexar, Harris, Tarrant, and Travis counties.

Canada is also experiencing a Cyclospora outbreak, and in an Aug 11 update the Public Health Agency of Canada (PHAC) reported 26 more locally acquired cases, raising the total to 130 infections from three provinces: British Columbia, Ontario, and Quebec.

Caused by the Cyclospora cayentanensis parasite, cyclosporiasis is an intestinal illness cause by consuming contaminated food or water. Symptoms include watery, profuse diarrhea, as well as fatigue, muscle pain, and low-grade fever.
Aug 11 CDC Cyclospora outbreak update
Aug 15 TDSHS Cyclospora
update
Aug 11 PHAC
update

Stewardship / Resistance Scan for Aug 16, 2017

News brief

Study finds poor treatment outcomes for MDR- and XDR-TB patients in China

A study today in BMC Infectious Diseases reports that patients with multidrug- and extensively drug-resistant tuberculosis (MDR- and XDR-TB) in China's Hunan province had low rates of treatment success.

The aim of the retrospective study, which used data from patients in Hunan province who were treated for TB from 2011 through 2014, was to assess treatment outcomes for patients with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least one second-line injectable drug) and identify factors associated with poor treatment outcomes. Information about patients with drug-resistant TB in China, one of the top 30 MDR-TB and TB burden countries in the world, is limited.

Of the 481 bacteriologically-confirmed patients, 10 (2%) had XDR-TB and 471 (98%) had MDR-TB. Evaluation of treatment outcomes showed that 262 patients (54%) were cured, 14 (3%) completed treatment, 13 (3%) died, 63 (13%) had treatment failure, and 130 (27%) were lost to follow-up. For the entire cohort, the treatment success rate was 57% (n=275), with a success rate of 58% for MDR-TB (n=272) and 30% for XDR-TB (n=3 patients). Resistance to oxifloxacin was an independent predictor of poor treatment outcomes (associated hazard ratio [AHR] = 3.1) and unfavorable treatment outcomes (AHR = 1.7), and those patients who started treatment during 2011-2012 had nearly three times the risk of treatment failure (AHR = 2.8) as those who started treatment in 2014.

The authors note that while the overall treatment success rate of 57% for MDR- and XDR-TB patients in Hunan province is consistent with reported global (52%) and national (56%) MDR-TB treatment success rates, it is still far short of the World Health Organization target of 75% treatment success.

"This low rate of treatment success among MDR-TB patients poses a serious threat for national TB control efforts as patients may develop additional resistance and may also transmit drug resistant forms of TB to others," they write.
Aug 16 BMC Infect Dis study


Surveys examine patients' role in promoting hand hygiene

A study yesterday in the American Journal of Infection Control suggests most parents and adult patients feel it's their role to remind healthcare providers to perform hand hygiene, while providers are less open to the idea.

In the study, researchers at a tertiary care teaching hospital in Morgantown, W. Va., performed a cross-sectional survey of parents of hospitalized children, adult patients, and primary care physicians to examine their attitudes toward a new patient empowerment tool (PET) that can be used by patients to remind doctors and nurses to wash their hands. The PET, introduced in 2015, consists of a picture with a reminder phrase (eg "Did you wash your hands?") attached to a tongue depressor. From 2015 to 2016, hand hygiene rates at the hospital increased from 48% to 75%.

A total of 222 parents and adult patients responded to the survey (114 parents and 108 adult patients). Parents were more likely than adult patients to feel that it's their role to speak up if a physician (95.6% vs. 77.6%) or a nurse (99.1% vs. 86.0%) did not perform hand hygiene. A smaller number of parents (77% for physicians and 81.4% for nurses) and adult patients (64.8% for physicians and 71.2% for nurses) felt comfortable using the PET to remind healthcare workers to perform hand hygiene.

Of the 89 physicians who responded to the survey (29 residents 60 attending physicians), only 54.9% (65.5% of resident physicians and 49.0% of attending physicians) agreed that patients should be involved in reminding providers to perform hand hygiene. Of the physicians who did not support patient involvement, 37% felt it was not the patient's responsibility to remind them to perform hand hygiene, 16.2% said it was embarrassing to the doctor, and 13.5% said it would negatively affect the doctor patient relationship. Physicians said they would be more likely to sanitize their hands if a patient made a verbal request rather than using the PET.

"Health care providers should not see patient participation as a threat, but instead as another tool to improve patient care," the authors write. "We should work to make patients and families more comfortable in participating in their care, but even more importantly, we need to change the culture of medicine."

Hand hygiene is considered the single most effective measure to reduce health-associated infections, which occur in 5% to 10% of patients admitted to acute care hospitals in the United States.
Aug 15 Am J Infect Control study

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