Stewardship / Resistance Scan for Nov 15, 2017

News brief

ECDC publishes guidance on reducing CRE infections

The European Centre for Disease Prevention and Control (ECDC) today published guidelines on screening for and prevention of carbapenem-resistant Enterobacteriaceae (CRE) that include hospital stay, chemotherapy treatment, and link to a CRE carrier as risk factors.

CRE—predominantly drug-resistant Escherichia coli and Klebsiella pneumoniae—are responsible for many deaths and high healthcare costs. The ECDC noted in a surveillance report today that E coli resistance is on the rise in Europe (see related CIDRAP News story).

The ECDC published its CRE guidance in Antimicrobial Resistance and Infection Control "to raise awareness and identify the 'at-risk' patient when admitted to a healthcare setting and to outline effective infection prevention and control measures to halt the entry and spread of CRE." A team of experts met twice to formulate the guidance after analyzing the current data and expert opinion.

The guidelines place any patient with one of these factors in the "at-risk" category: (1) overnight stay in a healthcare setting in the previous year, (2) dialysis-dependent or cancer chemotherapy in the past year, (3) known carriage of CRE in the past year, and (4) epidemiologic linkage to a known CRE carrier. The experts define "carrier" as anyone infected with a CRE or harboring one without showing symptoms.

Healthcare professionals should implement the following steps for prevention control for any at-risk patient: (1) pre-emptive isolation, (2) active screening for CRE, and (3) contact precautions. "Patients who are confirmed positive for CRE will need additional supplemental measures," the authors wrote.

The experts conclude, "This guidance document offers suggestions for best practices, but is in no way prescriptive for all healthcare settings and all countries. Successful implementation will result if there is local commitment and accountability. The options for intervention can be adopted or adapted to local needs, depending on the availability of financial and structural resources."
Nov 15 ECDC guidance

Europe's Joint Programming Initiative funds 10 AMR projects

In other European news, the Joint Programming Initiative on Antimicrobial Resistance (JPIAMR) today announced funding of €11.5 million ($13.6 million) for 10 transnational research projects involving multidisciplinary studies on antimicrobial resistance (AMR), including One Health approaches.

Awardees include 47 funded research groups from 11 countries (Canada, Germany, Ireland, Israel, Latvia, the Netherlands, Norway, Poland, Romania, Sweden and Switzerland), and an additional 6 international partners in the Czech Republic, Israel, Romania, and United States.

Funded projects include preventing the spread of methicillin-resistant Staphylococcus aureus from livestock to people, improving prescribing for urinary tract infections in the elderly, AMR manure intervention, online stewardship efforts, and AMR transmission in the food chain.

The final funding decision will depend on national regulations and inspection of the formal proposals by the national funding organizations, the JPIAMR said in a news release.
Nov 15 JPIAMR news release

Brazil study finds standardized MDR-TB therapy effective

Patients with multidrug-resistant tuberculosis (MDR-TB) in Brazil who received standardized regimens had almost a third the rate of failure or relapse compared with those receiving individualized treatment, according to a study yesterday in BMC Infectious Diseases.

Brazilian scientists analyzed data on 1,972 MDR-TB patients from 2007 through 2013, of whom 60% were successfully treated. Success was more likely in patients who didn't have HIV, those were sputum-negative at baseline, had unilateral disease, and had no prior DR-TB.

After the researchers adjusted for these variables, they determined that MDR-TB patients receiving standardized regimens had a 2.7-fold odds of success compared with those receiving individualized treatments when failure/relapse were considered, and a 1.4-fold odds of success when death was included as an unsuccessful outcome. Patients who used levofloxacin instead of ofloxacin had 1.5-fold odds of success.

The authors concluded, "Our findings support the Brazilian recommendation for the use of standardized instead of individualized regimens for MDR-TB, preferably containing levofloxacin."
Nov 14 BMC Infect Dis study

News Scan for Nov 15, 2017

News brief

Flu increasing slightly in Northern Hemisphere

In its latest global flu update, the World Health Organization (WHO) notes that flu increased slightly in the Northern Hemisphere last week and globally influenza A H3N2 is still the dominant strain.

According to the WHO, respiratory illness indicators were at or below seasonal thresholds in Mexico and the United States, and following historical trends in Canada.

Flu activity is still low in general for North America, Central America, and Europe. Levels are also low for much of Asia and the Middle East. Qatar is one of the few places to report high flu activity, and influenza like illness and severe acute respiratory infection indicators appear to have increased in Kazakhstan, Tajikistan, and Uzbekistan in Central Asia.

In India and the temperate zone of the Southern Hemisphere, overall flu indicators are dropping.

Of flu samples collected and tested from Oct 16 to Oct 29, 72.3% were typed as influenza A and 27.7% as influenza B. Of the subtyped influenza A viruses, 13.8% were H1N1 and 86.2% were H3N2.
Nov 13 WHO report

Study finds low overall flu vaccine protection but higher in some groups

Israeli researchers found flu vaccine effectiveness of 29.0% against influenza H3N2 last season, when that strain caused 98% of infections, but protection was as high as 69.2% in some age-groups. The team reported its findings yesterday in Clinical Infectious Diseases.

The investigators analyzed data from 1,088 patients collected during the 2016-17 flu season; among 467 lab-confirmed isolates, 97.9% were the H3N2 strain. They estimated age-specific vaccine effectiveness (VE) using a moving age window of 15 years and weekly analysis.

The team found an overall flu VE of 29.0% against H3N2 flu, but among children age 5 to 17 years, it was 69.2%. Flu VE among those 45 to 64 was 58.8%. Other age-groups had low VE numbers that were not statistically significant.

The researchers conclude, "Estimating VE using a moving age window, and weekly VE analysis may provide more detailed information regarding the relationship between VE and age."
Nov 14 Clin Infect Dis study

WHO: Epidemic phase of Madagascar's plague outbreak winding down

In an update today on plague in Madagascar, the WHO said declines since the middle of October in new cases, hospitalizations, and affected districts suggest that the epidemic phase is ending. It added, however, that sustained efforts are critical for minimizing bubonic illnesses and human-to-human spread of the pneumonic form of the disease.

As of Nov 10, the total number of confirmed, probable, and suspected cases is 2,119, including 171 deaths, for a case-fatality rate of 8%. So far, 76% of the cases have been the potentially fatal pneumonic plague, an unusual feature in Madagascar, where the disease—primarily the bubonic form—is endemic, with a season that runs from September through April.

The WHO said that, as of today, only 12 patients are still hospitalized.

The last lab-confirmed bubonic case was reported on Oct 24, and the last confirmed pneumonic case was reported on Oct 28. In a situation report posted yesterday on the WHO African regional office website, officials said 86 cases were reported from Nov 7 to Nov 10, most of which appear to be probable and suspected.

The WHO said though recent downturns in outbreak markers are encouraging, it expects more cases to be reported until the end of the typical plague season. "It is therefore important that control measures continue through to the end of the plague season," it added.
Nov 15 WHO statement
Nov 14 WHO Regional Office for Africa situation report