Stewardship / Resistance Scan for Apr 20, 2018

More super-resistant gonorrhea
Penicillin 'allergy' and prescribing
Candida auris in Colombia

Good news about UK 'super gonorrhea' case—but 2 new infections noted

UK officials today report good news on the outcome of the man treated for a highly resistant Neisseria gonorrhoeae infection, but they also note two similar cases in Australia.

In an update from Public Health England (PHE), Gwenda Hughes, PhD, head of the agency's Sexually Transmitted Infection Section, said, "We are pleased to report that the case of multi-drug resistant gonorrhoea has been successfully treated. Investigations have also revealed there has been no further spread of this infection within the UK. PHE continues to actively monitor and tackle the spread of antibiotic resistance in gonorrhoea and potential treatment failures."

The man had contracted gonorrhea after having sex with a woman in Southeast Asia. PHE first reported his case on Mar 28. In a full report on the case today, PHE experts said, "Efforts to contact the partner in south east Asia are ongoing."

Hughes said of the Australian infections, "Two similar cases have just been reported in Australia and serve as a timely reminder that we expect to see further cases of multi-drug resistant gonorrhoea in the future. These cases will be challenging for healthcare professionals to manage."

The full report added, "Two cases of gonorrhoea with resistance to ceftriaxone, azithromycin, ciprofloxacin, penicillin, and tetracycline have subsequently been reported in Australia: one had had sex recently in south east Asia; the other case had no recent overseas travel."
Apr 20 PHE update
Apr 20 full PHE report
Mar 28 CIDRAP News story on the UK case


Removing penicillin allergy label from kids saves antibiotics, money

A study today by US researchers reveals that children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction, and the cost savings of removing the penicillin allergy label from these patients was substantial.

As detailed in Pediatrics, the investigators had previously performed three-tier penicillin allergy testing on children with low-risk symptoms, and all of them tolerated a penicillin challenge without an allergic reaction. They hypothesized that the children would have no serious allergic reactions after re-exposure to penicillin.

In the new study, the researchers conducted a case series on 100 children whose tests were negative for penicillin allergy. In the year after they were tested for penicillin allergy, 36 of the kids received a total of 46 prescriptions, 26 of which (58%) were for penicillin derivatives. None of these children had an adverse reaction; 1 developed a rash.

The team determined that "delabeling" the children as no longer penicillin allergic saved $1,368 per patient, with an additional cost avoidance of $1,812, for a potential total cost saving for the pediatric emergency department of $192,223.

The authors conclude, "Delabeling children changed prescription behavior and led to actual health care savings."
Apr 20 Pediatrics abstract


Colombia reports 123 recent Candida auris cases

A report today in Morbidity and Mortality Weekly Report (MMWR) details 123 newly identified Candida auris infections in Colombia, noting that the pathogen has been present there since at least 2015 and that case counts are increasing.

After the US Centers for Disease Control and Prevention issued an alert in 2016 about the worrisome fungal infection, Colombian scientists re-investigated 45 isolates from 2013 through 2016 that had been classified as C haemolunii, which is often misidentified. Upon retesting, all of them proved to be C auris, with the most recent being from 2015, and Colombian officials released a clinical alert for heightened awareness of the pathogen.

After this alert, the Colombian national health institute received an additional 78 C auris isolates from 24 healthcare facilities in nine states, for a total of 123 confirmed cases. Antifungal susceptibility testing on 93 of the isolates showed that 28 (30%) were resistant to fluconazole, 20 (22%) to amphotericin B, 1 (1%) to anidulafungin, and 1 (1%) to both amphotericin B and anidulafungin.

The authors conclude, "The number of reported cases likely does not reflect the true number of infected and colonized persons because of underreporting and underdiagnosis, as well as misdiagnosis as other yeast species."
Apr 20 MMWR report

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