News Scan for Mar 26, 2018

News brief

Saudi Arabia records four new MERS cases

The Saudi Arabian Ministry of Health (MOH) released four new reports of MERS-CoV cases over the weekend, including two cases that had direct contact with camels.

On Mar 21, a 67-year-old Saudi man from Najran was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). He is in stable condition and had contact with camels.

The MOH recorded the case of another patient with camel contact on Mar 24. The patient is a 44-year-old expatriate from Hofuf who is in critical condition.

On Mar 24, the MOH also said a 41-year-old Saudi woman from Jeddah was in stable condition with MERS. She is described as a household contact of a previously noted case, the third such case recorded in Jeddah this month.

Finally, on Mar 23 the MOH said a 64-year-old expatriate man from Riyadh had MERS. He is in critical condition, and the source of his infection is listed as "primary," meaning it's unlikely he contracted the virus from another person.

Saudi Arabia's MERS-CoV total cases since 2012 are 1,825, including 738 deaths. Fifteen people are still being treated for their infections.
Mar 21 MOH update
Mar 23 MOH update
Mar 24 MOH update

Follow-up tests rule out high-path H9N2 avian flu in Ghana poultry

Further analysis of H9N2 avian flu samples from Ghana, which raised concerns in February when the virus was originally reported to be highly pathogenic, is in fact low-pathogenic, the World Organization for Animal Health (OIE) said in a Mar 23 clarification posted on ProMED Mail, the online reporting system of the International Society for Infectious Diseases.

The earlier reported raised concerns, because the development, if true, would have been unprecedented. Low-pathogenic H9N2 is known to circulate in Africa, but a highly pathogenic form had never been detected. Highly pathogenic H9N2 would have implications for both animal and human health.

The OIE said molecular and pathogenicity tests at its reference lab confirmed low-pathogenic H9N2 virus, and because the isolate isn't notifiable, the earlier report was removed from its database on Mar 19.

In a comment on the post, ProMED Mail moderator Arnon Shimshony, DVM, associate professor of veterinary medicine at Hebrew University of Jerusalem, commended Ghana officials for their transparency. Though it's a relief that a reassortment of the widespread H9N2 virus into a highly pathogenic virus hasn't taken place, the event highlights the need for continued vigilance and the important of involving OIE reference labs in epidemiologic investigations, he said.
Mar 23 ProMED Mail post
Feb 15 CIDRAP News story "High-path H9N2 infects Ghana poultry, raising concern"

In other avian flu developments, Northern Ireland recently reported its first highly pathogenic H5N6 detection, according to a Mar 23 report from the OIE. The virus was found in a dead buzzard that was collected in County Antrim as part of wild raptor surveillance.
Mar 23 OIE report on H5N6 in Northern Ireland

Stewardship / Resistance Scan for Mar 26, 2018

News brief

Survey finds audit and feedback key to antibiotic stewardship success

A survey of 244 members of three infectious diseases societies reveals that the most common approached to antimicrobial stewardship programs (ASPs) are antibiotic reviews with prospective audit and feedback (PAF), prior authorization for select antibiotics, and guideline development, according to a study today in Clinical Infectious Diseases.

The survey also revealed a staff-person-to-hospital-bed ratio to guide ASP resource allocation.

In 2016, the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA) and Pediatric Infectious Diseases Society (PIDS) convened an expert group of 13 physicians to identify resources for helping infectious disease specialists initiate and sustain ASPs. The group created a 73-question electronic survey, and 244 members of the three groups responded. Respondents had MD, MBBS, DO, or PharmD degrees, with 189 being physicians and 52 responding as pharmacists.

Respondents' ASPs were typically led by physicians (56%) or co-led by physicians and pharmacists (36%), but 19 (8%) lacked accountable physician leaders. Of the programs, 84% included antibiotic reviews with PAF, and 81% involved prior authorization. Of the 179 ASPs (73%) that included local antibiotic guidelines for common conditions, the most popular were for pneumonia (92%), surgical prophylaxis (86%), urinary tract infection (68%), and skin and other soft-tissue infection (66%).

All but one program included antibiograms, and 125 (51%) performed cascade reporting of antibiotic susceptibilities.

Through feedback on full-time equivalent (FTE) physician and pharmacist staffers devoted to ASPs, the expert group was able to calculate that each 0.50 FTE was tied to a 58% increase in the odds of a program being effective. They also charted potential mediators of ASP effectiveness, with PAF topping the list. The experts determined that, if a program had all the leading components plus technology add-ons, it had a 93% probability of demonstrable effectiveness with a combined 1.1 FTE of support, but the probability rose to 98% for 3.5 ASP FTE.

The authors concluded, "Prospective audit and feedback should be the cornerstone of stewardship programs, and both physician leadership and pharmacists with expertise in stewardship are crucial for success."
Mar 26 Clin Infect Dis study

Study tracks increase in antibiotic-resistant Acinetobacter in US kids

The prevalence of antibiotic-resistant Acinetobacter baumannii in US kids rose markedly from 1999 to 2012, but steadily decreased after its peak in 2008,US researchers reported in the Journal of the Pediatric Infectious Diseases Society.

Investigators from Rush University Medical Center in Chicago and the Center for Disease Dynamics, Economics & Policy (CDDEP) in Washington, D.C., analyzed antimicrobial susceptibility data from The Surveillance Network to phenotypically identify antibiotic resistance in A baumannii isolates in children from January 1999 to July 2012.

They found that the crude proportion of cephalosporin-resistant (CephR) A baumannii increased from 13.2% in 1999 to 23.4% in 2012, with a peak of 32.5% in 2008. The proportion of carbapenem-resistant (CR) A baumannii, meanwhile, increased from 0.6% in 1999 to 6.1% in 2012, with a peak of 12.7% in 2008. From 1999 to 2012, the proportion of CephR and CR A baumannii increased each year by 3% and 8%, respectively. After 2008, though, the researchers observed a significant decrease in the trend, but resistance remained higher than in 1999.

The group concluded, "There is a need for ongoing surveillance of A baumannii infections and continued assessment of effective prevention strategies in vulnerable populations."
Mar 22 J Pediatr Infect Dis Soc study

New tool predicts risk of C diff infections early

A new modeling tool could help institutions predict which patients are most likely at risk for Clostridium difficile infections,one of the most common and dangerous healthcare-associated infections.

Researchers at the University of Michigan, Massachusetts General Hospital, Massachusetts institute of Technology published their preliminary study on the tool in Infection Control and Hospital Epidemiology today. Unlike previous modeling tools, this approach takes a hospital-specific approach to train the prediction model to individual healthcare institutions. The model generates daily risk scores for each patient at a hospital based on electronic health records, admission records, and medical history.

"When data are simply pooled into a one-size-fits-all model, institutional differences in patient populations, hospital layouts, testing and treatment protocols, or even in the way staff interact with the HER [electronic health record] can lead to differences in the underlying data distributions and ultimately to poor performance of such a model," said Jenna Wiens, PhD, at the University of Michigan, in a Massachusetts General Hospital news release. "To mitigate these issues, we take a hospital-specific approach, training a model tailored to each institution."

To test the model, the researchers retroactively applied it to electronic records collected from almost 257,000 admissions to theUniversity of Michigan Hospitals and Massachusetts General. On average, for half of patients who had C difficile infections, the model predicted the infections 5 days earlier than traditional diagnostics.The investigators have made their model freely available.

C difficile, which is resistant to a growing number of antibiotics, sickens nearly 500,000 Americans and is associated with 15,000 to 30,000 deaths annually. Early treatment and intervention can help reduce healthcare-associated costs, the researchers said.
Mar 26 Infect Control Hosp Epidemiol study
Mar 26 Massachusetts General news release

Different groups estimate risk of antimicrobial resistance in Germany

A new study took survey of the antibiotic resistance (ABR) landscape in Germany, by questioning general practitioners (GPs), hospitalists, veterinarians, pig farmers, and members of the general public on their perceptions of the topic. The study was published in the Journal of Antimicrobial Chemotherapy.

A total of 1789 participants (340 GPs, 170 hospital physicians, 215 pig farmers, 60 veterinarians and 1004 members of the public) participated in a telephone surveys. The vast majority of hospital physicians (85%) believed their prescribing practices impacted ABR development, as did 70% of GPs and 53% of veterinarians.

Pig farmers were much more likely to correctly answer basic questions about ABR science than the general public (75% compared to 24%). All medical subscribers questioned said they relied on ABR guidelines and meetings with experts for the latest knowledge on ABR.

"About two-thirds of both GPs and veterinarians stated that they discussed ABR with their patients or farmers, respectively, when prescribing an AB. Interestingly, considerably lower numbers of patients than farmers stated that they received information on ABR when they received an AB prescription," the study authors wrote.
Mar 26 J Antimicrob Chemother study