Stewardship / Resistance Scan for Oct 25, 2017

MRSA vaccine candidate
Provider role in CRE spread
Airborne resistant pathogens

Good phase 1 results noted for vaccine against MRSA, other pathogens

Alopexx Vaccine LLC today reported positive phase 1 results for its broad-spectrum antimicrobial vaccine, which targets drug-resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA) and serious infections like pneumonia, meningitis, bloodstream infections, and gonorrhea.

Alopexx, based in Concord, Mass., says it will begin larger phase 2 trials in the first quarter of 2018, according to a company news release.

The phase 1 trial included 16 healthy volunteers who received one of four vaccine doses, ranging from 15 milligrams (mg) to 150 mg. The vaccine, AV0328, targets the broadly expressed microbial antigen, poly-N-acetyl glucosamine (PNAG). AV0328 was safe and well-tolerated in the study, with only minor and transient injection-site reactions in each dosing group.

In addition, researchers noted "clear increases" in antibody titers against PNAG at the two highest doses—75 mg and 150 mg—as well as complement activation and binding to the PNAG antigen. In cell culture, "robust bactericidal killing of N. gonorrhea, including antibiotic-resistant strains, and N. meningitidis (serogroups A, B, C, W, Y), as well as opsonic killing of S. pneumoniae, multi-drug resistant Klebsiella pneumonia, colistin and multi-drug resistant strains of E. coli and S. aureus, including MRSA clinical isolates, was observed," according to the release.

"We are very encouraged by these early clinical data demonstrating the safety, tolerability, and initial indications of clinical activity of AV0328 in humans," said Hal Landy, MD, Alopexx chief medical officer. "We look forward to further evaluating AV0328 against a breadth of infections caused by PNAG-expressing pathogens, including serious soft-tissue infections caused by methicillin-resistant S. aureus (MRSA), pneumonia, meningitis, tuberculosis, and sexually transmitted diseases, including those caused by antibiotic-resistant organisms."
Oct 25 Alopexx news release


Study looks at role of shared providers in transmission of CRE infections

A new study by researchers at the University of Virginia suggests that hospital patients who shared healthcare providers with carbapenem-resistant Enterbacteriaceae (CRE) patients may have an increased risk of acquiring a CRE infection.

In a paper published yesterday in Infection Control and Hospital Epidemiology, the researchers describe a 1:4 case-control study conducted at a tertiary care hospital in central Virginia from May 2011 through March 2015. The objective of the study was to investigate the role healthcare providers play in patient-to-patient CRE transmission in a facility with a robust CRE surveillance program. With a mortality rate of nearly 50%, CRE are among the most urgent drug-resistant healthcare threats.

The study included case-patients with one or more negative CRE tests followed by a positive culture and a length of stay of more than 9 days. The controls were patients with two negative test results who were staying at the hospital at approximately the same time as the case-patients. Nonphysician providers were compared between study patients and sources during their evaluation windows. Dichotomous and continuous exposures were developed from the number of source-shared providers and were used in univariate and multivariate regression.

A total of 121 cases and 484 controls were included in the study. Multivariate analysis showed that the odds of a case being exposed to one or more shared-source providers was 2.27 times the odds of a control being exposed to one or more shared-source providers. Multivariate continuous exposure showed odds of 1.02 for case patients compared with controls.

"In summary, results from this study indicate an important relationship between sharing providers with CRE patients and increasing the risk of CRE acquisition," the authors write. "This finding indicates the importance of hand hygiene in infection prevention as well as the potential for limiting shared providers through additional regulation and improved cohorting of CRE patients, particularly in high-risk units."
Oct 24 Infect Control Hosp Epidemiol abstract

Ethiopian scientists detect resistant pathogens in hospital air

Ethiopian researchers detected extended-spectrum-beta-lactamase (ESBL)–producing and Metallo-beta-lactamase (MBL)–producing Pseudomonas aeruginosa and Acinetobacter baumannii in air samples in their referral hospital, according to a study this week in Antimicrobial Resistance and Infection Control.

The team conducted a cross-sectional study at Wolaita Sodo University Teaching and Referral Hospital from Dec 1, 2015, to Apr 30, 2016. They collected 216 total indoor air samples during the first week of each month on Mondays and Fridays. They obtained 67 isolates (43 A baumannii and 24 P aeruginosa), for an overall isolation rate of 31%.

ESBL production was observed in 24 (55.8%) of the isolates and MBL production in 13 (30.2%). Five isolates (11.6%) contained both.

The authors conclude, "Though the current isolates were not identified from patients in this study, the role of contaminated indoor air for the production of ESBL and MBL isolates could play a major role if contact is established."
Oct 23 Antimicrob Resist Infect Control study

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