Stewardship / Resistance Scan for Jan 25, 2018

Drug-resistant typhoid
;
Fecal transplant for recurrent C diff

Officials in Pakistan announce world's first drug-resistant typhoid outbreak

In what is being called the world's first outbreak of drug-resistant typhoid, more than 100 children are sick and dozens have died in Hyderabad, Pakistan, the country's The News International reported yesterday.

"Typhoid cases resistant to third-generation antibiotic Ceftriaxone have been reported from different areas of Hyderabad, but so far we're unable to find its source," Health Services Sindh Director General Dr Muhammad Akhlaq Khan said.

"Children in the age group of 2-10 years are being affected by this type of disease, but so far we don't have any exact data on the deaths caused by this lethal disease." Scientists at Aga Khan University (AKU) in Karachi, Pakistan, blamed the outbreak on contaminated water, but the Sindh Health Department has ruled that cause out, the story said.

No official case count has been cited, but the city's health department and local gastroenterologists have said more than 100 drug-resistant cases have been reported since November 2016, compared with only 6 cases from 2009 to 2014. The health department, in collaboration with AKU, has launched a mass vaccination campaign aimed at immunizing 250,000 children in the district.

Typhoid is mainly cause by Salmonella enterica serotype Typhi bacteria. About 1.7 million people live in Hyderabad.
Jan 24 News International story

 

Bowel disease, antibiotics tied to fecal transplant for recurrent C difficile

A single-center study in Rhode Island found several risk factors, including inflammatory bowel disease and the use of metronidazole, for fecal microbiota transplantation (FMT) to address recurrent Clostridium difficile infection (CDI), according to a study yesterday in Infection Control and Hospital Epidemiology.

The retrospective study compared 200 adults who underwent FMT for recurrent CDI to 75 patients who did not. The strongest risk factors for FMT for recurrent CDI were concomitant inflammatory bowel disease (P = .002), use of immunosuppressive therapy (P = .04), and use of metronidazole within 2 months before the first CDI (P = .02). The use of vancomycin for the first CDI was also a potential risk factor.

The authors concluded, "This study provides important insights into the factors predictive for FMT in patients with recurrent CDI and highlights the potential racial and medical characteristics that affect the access of the patients to FMT."
Jan 24 Infect Control Hosp Epidemiol study

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