Stewardship / Resistance Scan for Dec 20, 2017

News brief

Study finds long-term success for fecal transplant to treat C difficile

A study yesterday in Clinical Infectious Diseases reports high long-term success rates of fecal microbiota transplant (FMT) against recurrent Clostridium difficile infection (CDI).

Emory University researchers contacted all eligible patients who received FMT for recurrent CDI from Jul 1, 2012, to Dec 31, 2016. Of 190 eligible patients, 137 (72%) completed the telephone survey.

The survey found that 113 of 137 patients (82%) had no C difficile recurrence after a median follow-up of 22 months. Almost all patients (122 of 128, or 95%) said they would undergo FMT again, and 70% of those 122 said they would prefer FMT to antibiotics as initial treatment if they were to have a CDI recurrence.
Dec 19 Clin Infect Dis study

 

Pulsed-dose fidaxomicin determined superior to vancomycin for C diff

A multicenter European study has found extended pulsed dosing of fidaxomicin to be superior to standard-dose vancomycin for the sustained cure of CDI, according the a report yesterday in The Lancet Infectious Diseases.

In the trial, known by the acronym EXTEND, researchers enrolled 364 patients from 96 European hospitals, half of whom received extended-pulse fidaxomicin (200-milligram [mg] oral tablets twice daily for 5 days, then once every other day on days 7 through 25) and half of whom were prescribed vancomycin (125-mg oral capsules four times daily for 10 days).

In the fidaxomicin group, 124 of 177 patients (70%) were still cured 30 days after their treatment ended, compared with 106 of 179 patients (59%) who received vancomycin. The rate of adverse events did not differ between the two groups.

In a commentary on the study in the same issue, US medical researcher Dale N. Gerding, MD, said the study holds promise but requires "more sophistication" in its application. He says the exact dosing of fidaxomicin for CDI still needs fine-tuning, and its cost is steep. In addition, he writes, "Adjunctive measures such as monoclonal antibodies and faecal microbiota transplants are also available to reduce the incidence of recurrent C difficile infection."

The study was funded by Astellas Pharma, Inc, of Japan, which is licensed to develop and market fidaxomicin in various parts of the world, including Europe.
Dec 19 Lancet Infect Dis study
Dec 19 Lancet Infect Dis
commentary

News Scan for Dec 20, 2017

News brief

WHO: Camel contact implicated in MERS cases

The World Health Organization (WHO), in an update yesterday on 18 Saudi MERS-CoV cases, said that 5 of the 18 cases involved contact with camels before symptom onset.

The 18 MERS-CoV (Middle East respiratory syndrome coronavirus) cases were reported by Saudi Arabia from Oct 31 to Dec 8. There were five deaths among these cases, as well as two deaths in cases reported prior to this update. Thirteen of the cases occurred in men, and half of the cases (9) were reported in Riyadh, Saudi Arabia's capital city.

Four of the five patients who had camel contact reported drinking camel milk. There were no healthcare workers diagnosed as having MERS during this period, but one of the patients, a 13-year-old boy from Riyadh, had close contact with a known case. Investigations are under way regarding the sources of the other cases.

The WHO said that globally, 2,121 laboratory-confirmed cases of infection with MERS-CoV, including at least 740 related deaths, have been reported since 2012.
Dec 19 WHO report
Dec 20 Avian Flu Diary post

 

Study: Zika surge can delay diagnosis, stretch resources

A new study published in Emerging Infectious Diseases showed that the increased screening of pregnant women in Florida during the 2016 Zika epidemic stretched resources and delayed diagnoses.

To conduct the study, University of Miami researchers retrospectively reviewed charts of all 2,327 pregnant women who were tested for Zika virus in 2016 at two tertiary care hospitals in Miami–Dade County. Of the 2,327 women tested, 1,999 (85.9%) were negative for Zika virus. Eighty-six had laboratory evidence of Zika virus infection, and 2 infants were described as having probable congenital Zika syndrome.

Once local transmission began in the summer of 2016 and screening was recommended for all pregnant women in the county, patients experienced significant delays in receiving test results. During August 2016, test results were returned to women and their clinicians within 30 days in only 2.6% of all cases, with an average of 42 days.

"In the cohort we report, delays in receipt of results of Zika virus screening occurred during the first half of 2016," the authors concluded. "The longest delays occurred in before [sic] local mosquitoborne transmission began; delays decreased as the laboratories and public health agencies became accustomed to an increased number of laboratory tests. In the context of pregnancy, delays in result reporting may affect decisions about continuation and termination of pregnancy."
Dec 18 Emerg Infect Dis study

 

South Korea reports detection of a second type of H5N6 avian flu

South Korea has detected a second type of newly reassorted H5N6 avian flu virus at duck farms in Gochang and Yeongam in the country's southwestern region, Xinhua reported today.

The viruses likely came from migratory birds this fall, and are composed of a highly pathogenic H5N8 strain from Europe and a low-pathogenic N6 virus.

The virus detected in Gochang on Nov 19 matched a strain found on the Korean island of Jeju at the end of November and beginning of this month. The virus found near Yeongam on Dec 10, however, was slightly different genetically, according to Xinhua.

During the first week of December, officials culled 76,000 ducks at five farms within a 3-kilometer radius of the affected site on Jeju. Last year, South Korea culled more than 30 million birds to contain the worst avian flu outbreak in the nation's history.

In other avian flu news, Avian Flu Diary reported today that Saudi Arabia's Ministry of Environment, Water, and Agriculture (MEWA) has detected highly pathogenic H5N8 in birds found at a market in Riyadh.

Yesterday several poultry died or appeared sick at the Azizia market in Riyadh, according to a translated statement from MEWA. There are no further details at this time.
Dec 20 Xinhua story

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