Flu Scan for Sep 01, 2017

News brief

Second H1N2v flu case of 2017 reported in Ohio

The US Centers for Disease Control and Prevention (CDC) today confirmed a new case of variant H1N2 flu (H1N2v) in a child in Ohio, the second US case this year caused by that strain, and the 20th variant flu case of the year.

As with previous variant flu cases, the child had exposure to swine at a fair in the week before falling ill. He or she did not require hospital care and has fully recovered, the CDC said in its weekly FluView report. No human-to-human spread was detected. Ohio officials reported the case to the CDC last week.

The previous H1N2v case, also involving a child in Ohio with similar exposure, was reported by the CDC on Aug 4. H1N2v contains genes from swine flu strains plus the M gene from the 2009 H1N1 flu virus.

The CDC has also confirmed 18 H3N2v cases this year, 15 in Ohio and 1 each in North Dakota, Ohio, and Texas.

The agency said in today's update, "Early identification and investigation of human infections with novel influenza A viruses are critical to ensure timely risk assessment and so that appropriate public health measures can be taken."
Sep 1 CDC update

 

China reports fatal H7N9 avian flu case

China has reported another H7N9 avian flu infection, which involves a 58-year-old man from Jiangsu province in the eastern part of the country, according to a statement today from Hong Kong's Center for Health Protection (CHP).

Investigators found that the man, who died from his illness, was likely exposed to the virus at a live-poultry market.

The fifth and by far the largest H7N9 wave in China began last October and has largely tapered off in the summer months, but the country continues to report sporadic human cases as well as outbreaks in poultry.

The new case lifts the total in the fifth H7N9 wave to 756 cases, based on a weekly avian flu update posted by the CHP on Aug 29. At least 247 deaths have been reported.
Sep 1 CHP report

 

Study: Single introduction of canine flu in Chicago caused 2015 outbreak

Researchers describe the 2015 introduction of H3N2 canine influenza virus (CIV) from South Korea to the United States today in Emerging Infectious Diseases.

Though canine influenza has been circulating in China since 2006, the disease was limited to outbreaks in Asian countries. In February of 2015, dogs in Chicago shelters and training schools began showing symptoms of H3N2, including cough and moderate respiratory distress.

Within 2 months, the virus spread to neighboring states. By April, scientists at the University of Wisconsin-Madison performed genetic analyses of the virus, finding it identical to a circulating strain of H3N2 from South Korea.

Further testing showed the strain capable of viral shedding for up to 3 weeks, prompting researchers to conclude that likely introduction of the disease was through an animal, and not fomites (which can transmit live H3N2 virus for only up to 48 hours). Thus, they hypothesized the disease was brought to America through dogs rescued from South Korean meat markets, where up to 19% of dogs are infected with H3N2.

"Hundreds of dogs rescued from meat markets in South Korea have been rehomed in the United States since the beginning of 2015, although no direct link between any of these dogs and the appearance of H3N2 CIV in the United States has been established," the authors write.
Sep 1 Emerg Infect Dis
study

ASP Scan (Weekly) for Sep 01, 2017

News brief

Study: CTX-M-27 gene emerging in clinical E coli isolates in Germany

German researchers have found a significant increase in strains of Escherichia coli carrying a gene linked to extended-spectrum beta-lactamase (ESBL) production, according to a study yesterday in Emerging Infectious Diseases.

The researchers analyzed a representative subset of 953 sequenced isolates from ESBL-producing E coliisolates collected from livestock, humans, companion animals, food, and the environment during 2009 to 2016. They were specifically looking for the CTX-M-27 allele in E coli sequence type (ST) 131, which has emerged globally as a prevalent vehicle for ESBL. While ESBL production in certain clades of E coliST131 associated with urinary tract infections and bacteremia is generally conferred by the CTX-M-15 allele, recent reports from Japan and France have documented an increase of C1-M27 clade isolates.

Multilocus sequence typing identified 159 (17%) of the 953 isolates as ST131. The most prevalent ESBL genes in the ST131 isolates were CTX-M-15 (73[46%]), CTX-M-27 (24[15%]), CTX-M-1 (18[11%]), and CTX-M-14 (15[9%]). CTX-M-27 was present exclusively in clinical isolates, and its incidence increased from 0% in 2009 to 45% in 2016, with 19 of the 24 isolates obtained in 2015 and 2016.

"The data suggest an ongoing shift in CTX-M alleles associated with ST131 infections worldwide that now warrants further attention," the authors write.
Aug 31 Emerg Infect Dis research letter 

 

Study: Respiratory viral testing has small effect on antibiotics for pneumonia

Originally published by CIDRAP News Aug 31

Molecular respiratory viral testing had minimal impact on reducing antibiotic utilization among viral pneumonia patients, according to a study yesterday in the American Journal of Infection Control.

In the multisite cohort study of 190 patients diagnosed with community-associated pneumonia (CAP), researchers compared the clinical characteristics and antibiotic therapy of patients who tested positive on a polymerase chain reaction respiratory viral panel (PCR-RVP) with those who tested negative. PCR-RVP can detect multiple viral pathogens and gives physicians the ability to make a specific diagnosis of viral pneumonia, which in theory should lead to reduced antibiotic use.

Of the 190 patients diagnosed with CAP, 108 (57%) were RVP positive for viral pathogens and 82 (43%) were RVP negative. Clinical outcomes between the two groups were similar. But while RVP-positive patients were less likely to be continued on antibiotic therapy for longer than 48 hours compared to RVP-negative patients (72% vs. 90%), the median duration of antibiotic treatment in the two groups was not significantly different (3 days vs. 4 days).

"Our study suggests that physicians hesitate to discontinue antibiotic therapy even when patients are found to have viral pneumonia using a highly sensitive and specific PCR methodology," the authors of the study write, adding that potential coinfection with bacterial pathogens is a common clinical challenge.

They suggest combining PCR-RVP testing with testing for procalcitonin (PCT), a biomarker that can help differentiate between bacterial and viral pneumonia, could help reassure physicians that patients with viral pneumonia do not have a bacterial superinfection, and help them identify which patients may be candidates for discontinuing antibiotic therapy.
Aug 30 Am J Infect Control abstract

 

Turkish data reveal high level of Staphylococcus antiseptic resistance genes

Originally published by CIDRAP News Aug 31

Researchers in Turkey report a high frequency of antiseptic resistance genes in clinical staphylococci samples in a study yesterday in Antimicrobial Resistance and Infection Control.

In the study, 69 Staphylococcus spp. (including methicillin-resistant S aureus, methicillin-susceptible S aureus, methicillin-resistant coagulase-negative staphylococci, and methicillin-susceptible coagulase-negative staphylococci) and 69 Enterococcus spp. were collected from various clinical samples at a university hospital from January 2010 to March 2011. Researchers then conducted antiseptic and antibiotic susceptibility tests and analyzed antiseptic resistance genes using the polymerase chain reaction method. It has previously been reported that antiseptic resistance genes caused tolerance to a variety of biocidal agents used to prevent infections in hospitals.

Overall, antiseptic resistance genes were found in 49 of the 69 staphylococci isolates, and none of the enterococci isolates. Among the 49 staphylococci isolates positive for an antiseptic resistance gene, qacA/B genes were the most dominant (28/49), followed by qacJ (18/49), qacG (16/49), and smr (11/49) genes. The frequency of qacA/B and smr genes was higher in coagulase-negative staphylococci (CNS) when compared with S aureus isolates, while the frequency of qacG and qacJ genes was higher in S aureus than those of CNS.

The researchers also found a statistically significant association between the presence of antiseptic resistance genes and the minimum inhibitory concentration of benzalkonium chloride (BAC), a biocidal agent commonly used in hospitals. But no significant relationship was found between the presence of antiseptic resistance genes and antibiotic resistance.

"Further studies are needed to revise the biocide policy and to support infection control programs to avoid the development of new resistance mechanisms," the authors write. 
Aug 31 Antimicrob Resist Infect Control study

 

Rare, resistant bacteria linked to chronic ear infections in Angola

Originally published by CIDRAP News Aug 28

Researchers have discovered that more than 10% of patients with chronic ear infections at an ear, nose, and throat clinic in Angola were co-colonized with a fluoroquinolone-resistant bacterium commonly found in bird feces.

In a new study in Emerging Infectious Diseases, the researchers report that analyses of samples from 188 patients at a clinic in Luanda, Angola, who had ear discharge related to chronic suppurative otitis media (CSOM), found that 20 patients (10.6%) were colonized by the gram-negative bacillus Alcaligenes faecalis, which was resistant to both ciprofloxacin and levofloxacin. Pseudomonas aeruginosa was the predominant species in 50% of those patients, and Proteus mirabilis the second most common.

Although the presence of A faecalis was originally a mystery, the researchers learned that, to prevent ear discharge from CSOM, a common condition in many developing countries, patients occasionally filled their external auditory canals with dove or pigeon feces. The authors note that it remains to be confirmed whether A faecalis plays a crucial role for disease progression or is merely a contaminant. CSOM is generally caused by P aeruginosa and P mirabilis.

Because the A faecalis isolates were resistant to fluoroquinolones, they authors suggest an alternative strategy of colistin as topical treatment or supplement with orally administered amoxicillin/clavulanic acid for treatment of more severe cases.
Aug 25 Emerg Infect Dis research letter

 

Study finds short-duration antibiotics superior for intra-abdominal infection

Originally published by CIDRAP News Aug 28

Findings from a new analysis that uses novel methods of evaluating data from antibiotic trials suggest that a short duration of antibiotic therapy is superior to a longer duration of therapy for patients with complicated intra-abdominal infections.

In a study today in Clinical Infectious Diseases, a team of researchers retrospectively applied desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk analyses (RADAR) to data from the Trial of Short-Course Antimicrobial Therapy for Intra-abdominal Infection (STOP-IT), a multisite, randomized controlled trial that evaluated short-duration antibiotic therapy for treating abdominal infections after initial source control. While the initial trial concluded that short, fixed-duration therapy (approximately 4 days) is non-inferior to traditional, longer-duration therapy (approximately 8 days), the researchers theorized that using the DOOR/RADAR approach—which categorizes patients into a list of potential clinical outcomes and ranks them by the desirability of the associated outcome and duration of therapy—could provide stronger conclusions.

Using the DOOR analysis, all 518 STOP-IT patients were categorized as having one of five mutually exclusive outcomes: (1) recovery, with no complications; (2) recovery, with extra-abdominal infection (including Clostridium difficile); (3) recovery with surgical site/wound infection; (4) recovery with recurrent intra-abdominal infection requiring procedure; or (5) death.  Then RADAR was applied to DOOR results to further stratify patients with similar outcomes.

Analysis based on this five-tiered scoring system showed that the probability that randomly selected patients would have a better DOOR score if receiving short-course antibiotics was 49.33%. The probability that randomly selected patients undergoing traditional-duration therapy would have a better DOOR score was 50.6%. Application of RADAR showed that the probability that randomly selected patients would have a better DOOR score if receiving short-course therapy was 63.4%. In addition, analysis of a smaller sample size of patients (150) using DOOR/RADAR showed that the probability of an improved DOOR score was 66.3% for patients in the short-course group.

The authors conclude, "In summary, DOOR/RADAR analysis can be used in antibiotic trials to globally evaluate for superiority of new antibiotic strategies that previously might have been reportable only as noninferior." 
Aug 28 Clin Infect Dis study

News Scan for Sep 01, 2017

News brief

Another asymptomatic MERS case reported in a Saudi household contact

The Saudi Arabian Ministry of Health (MOH) today reported another MERS-CoV case involving contact with another patient in Dumah Al Jandal.

It's not known if the new case is related to a hospital outbreak in that city first reported a month ago. The MOH on Aug 30 confirmed two similar MERS-CoV (Middle East respiratory syndrome coronavirus) cases in the same city.

Today's patient is a 21-year-old Saudi woman (the cases 2 days ago involved Saudi women 22 and 18 years old). As with the previous two cases, the 21-year-old woman is listed as a secondary household contact, has had no symptoms, and is in stable condition.

Yesterday the MOH reported the death of a previously announced MERS patient, a 69-year-old male expatriate in Jeddah. He was not a healthcare worker and had preexisting disease.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,707, including 693 deaths. Seven patients are still being treated, according to the MOH.
Sep 1 Saudi MOH report
Aug 30 Saudi MOH
report

 

Syria, DRC report new vaccine-derived polio cases

According to the Global Polio Eradication Initiative (GPEI), Syria reported six new vaccine-derived polio cases (cVDPV2) this week, and the Democratic Republic of the Congo (DRC) reported one case of vaccine-derived polio. The new cases bring 2017's total number of vaccine-derived polio infections so far to 47, a dramatic increase from 2016's total of 3.

Syria has had 39 vaccine-derived cases in 2017. The six new cases confirmed this week are in Deir ez-Zour governorate, the epicenter of this year's outbreak activity. Paralysis onset was reported between Mar 3 and Jul 10. Healthcare workers are conducting a second round of oral polio vaccination in affected areas of Syria.

The DRC case was recorded in Haut Lomami province, with onset of paralysis on Jun 20. A total of 750,000 children under the age of 5 were targeted in vaccine campaigns throughout the summer.

The GPEI said it's likely both Syria and the DRC will report more vaccine-derived cases in the coming weeks.
Sep 1 GPEI update

 

Study: CTX-M-27 gene emerging in clinical E coli isolates in Germany

German researchers have found a significant increase in strains of Escherichia coli carrying a gene linked to extended-spectrum beta-lactamase (ESBL) production, according to a study yesterday in Emerging Infectious Diseases.

The researchers analyzed a representative subset of 953 sequenced isolates from ESBL-producing E coli isolates collected from livestock, humans, companion animals, food, and the environment during 2009 to 2016. They were specifically looking for the CTX-M-27 allele in E coli sequence type (ST) 131, which has emerged globally as a prevalent vehicle for ESBL. While ESBL production in certain clades of E coli ST131 associated with urinary tract infections and bacteremia is generally conferred by the CTX-M-15 allele, recent reports from Japan and France have documented an increase of C1-M27 clade isolates.

Multilocus sequence typing identified 159 (17%) of the 953 isolates as ST131. The most prevalent ESBL genes in the ST131 isolates were CTX-M-15 (73[46%]), CTX-M-27 (24[15%]), CTX-M-1 (18[11%]), and CTX-M-14 (15[9%]). CTX-M-27 was present exclusively in clinical isolates, and its incidence increased from 0% in 2009 to 45% in 2016, with 19 of the 24 isolates obtained in 2015 and 2016.

"The data suggest an ongoing shift in CTX-M alleles associated with ST131 infections worldwide that now warrants further attention," the authors write.
Aug 31 Emerg Infect Dis research letter

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