News Scan for Jul 03, 2018

News brief

Illnesses climb to 90 in Kenya's Rift Valley fever outbreak

Kenya has reported 36 more illnesses in its Rift Valley fever outbreak, lifting the total to 90, the World Health Organization (WHO) African regional office said in its latest weekly health emergencies update. No new deaths have been reported, keeping the fatality count at 10.

The epidemiological investigation has found that the index case-patient became ill on May 11, marking the beginning of the outbreak.

So far, 18 of the cases have been confirmed by polymerase chain reaction testing. The hardest hit group is men ages 21 to 30 years old. Three counties have reported illnesses: Wajir, Marsabit, and Siaya.

The WHO said cases have rapidly increased in the last week, and that the event is occurring among seminomadic and remote communities that depend on livestock for their income and food source.

Animal outbreaks of Rift Valley fever have also been occurring alongside the human cases. Kenya's health ministry yesterday reported three more outbreak in animals, according to a notification from the World Organization for Animal Health (OIE). All three began in the middle of June, affecting goats, sheep, and cattle in Isiolo and Siaya counties. For one of the locations, authorities said the cases were reported in an area where mosquito populations increased after heavy rains and flooding. An investigation linked the spread of the virus to illegal animal movements, contact with infected animals during grazing or watering, and vectors.

Humans can contract the virus from eating meat from infected animals or from contact with blood or organs of infected animals.
Jun 29 WHO African regional office weekly bulletin
Jul 2 OIE report

 

Texas reports 56 Cyclospora cases as authorities look for common source

Texas health officials yesterday said they are investigating 56 Cyclospora illnesses reported since the beginning of May and investigations are underway to see if there's a common source for the infections and if they are related to illnesses in other states.

The report from the Texas Department of State Health Services (TDSHS) comes as federal and state officials are probing an outbreak linked to Del Monte fresh vegetable trays that has sickened 185 people in four Upper Midwest states: Minnesota, Iowa, Wisconsin, and Michigan. The trays contained fresh broccoli, cauliflower, celery sticks, carrots, and dill dip, and most of the sick people who were interviewed had bought the pre-packaged trays from Kwik Trip convenience stores.

The disease is caused by the Cyclospora cayetanensis parasite, and symptoms include watery diarrhea, appetite loss, cramping, bloating, and fatigue. Past outbreaks have been linked to imported produce such as basil, cilantro, mesclun lettuce, raspberries, and snow peas. However, in some instances, the source hasn't been found.
Jul 2 TDSHS press release
Jun 29 CIDRAP News scan "
CDC: 41 more cyclosporiasis cases linked to vegetable trays"

 

FDA winds down kratom Salmonella probe, urges consumers to avoid products

Top officials from the US Food and Drug Administration (FDA) yesterday said agency has concluded its investigation into a large Salmonella outbreak linked to contaminated kratom supplements, emphasizing that evidence gathered points to an ongoing risk.

During the outbreak, which began in February involving Salmonella I 4,[5],12:b:-, the investigation and product testing implicated several brands and the involvement of five additional Salmonella subtypes. Several companies voluntarily recalled their products, but one linked to illnesses did not, prompting the FDA's first mandatory food product recall.

Of 81 samples tested, 42 (52%) were found to be contaminated with Salmonella. Though the samples weren't randomly collected and were consumed by or mentioned by patients, the contamination level is unusually high. "This means that users of these products had essentially a one in two chance of being exposed to this pathogen," the FDA said.

Most kratom enters the United States from rural regions of Indonesia and Thailand, where it can become contaminated during harvesting and processing. Though some is processed further once it enters the United States, the procedures apparently don't eliminate the contamination. "This places unsuspecting consumers at risk of salmonellosis."

The supplement doesn't have any proven medical uses and carries safety risks due to its use as an opioid alternative, which is reason for consumers to avoid it, the FDA said. "Now, in addition to those risks, we can conclude that there may be a high proportion of kratom and kratom-containing products contaminated with salmonella. It’s another firm reminder of why people should avoid kratom."
Jul 2 FDA statement
May 25 CIDRAP News scan "
CDC calls kratom-linked Salmonella outbreak probe over after 199 cases"

Stewardship / Resistance Scan for Jul 03, 2018

News brief

ECDC report shows rising resistance in gram-negative bacteria

A new European surveillance report shows rising resistance to key antibiotics, and increasing trends in multidrug resistance, in invasive gram-negative bacteria.

The report from the European Centre for Disease Prevention and Control (ECDC), based on data for 2014 from the European Antimicrobial Resistance Surveillance Network (EARS-Net), shows that the European Union/European Economic Area (EU/EEA) population-weighted mean percentages of invasive Klebsiella pneumoniae isolates resistant to fluoroquinolones, third-generation cephalosporins, and aminoglycosides increased significantly from 2011 through 2014, and combined resistance to all three drugs rose from 16.7% in 2011 to 19.6% in 2014. In addition, the population-weighted mean percentage of K pneumoniae isolates resistant to carbapenems rose from 6.0% in 2011 to 7.3% in 2014. Resistance to carbapenems was more frequently reported in bloodstream infections in southern and southeastern Europe.

During the same period, the percentage of invasive Escherichia coli isolates resistant to third-generation cephalosporins increased from 9.6% to 12.0%, and combined resistance to third-generation cephalosporins, fluoroquinolones, and aminoglycosides rose from 3.8% to 4.8%. Antimicrobial resistance in Acinetobacter species showed large variations across Europe, with generally high resistance percentages reported from Baltic countries, southern, and southeastern Europe. Combined resistance to fluoroquinolones, aminoglycosides, and carbapenems was the most frequently reported resistance phenotype in 2014.

Large inter-country variations in the percentage of methicillin-resistant Staphylococcus aureus (MRSA) isolates were also observed, but the EU/EEA population-weighted mean percentage decreased from 18.6% in 2011 to 17.4% in 2014, continuing the downward trend reported in the 2009-2012 period.

The authors of the report warn that the combination of rising multidrug resistance in gram-negative bacteria, plus additional resistance to carbapenems, means that very few options are left for patients infected with these pathogens. "The ongoing increase in resistance to a number of key antimicrobial groups in invasive bacterial isolates reported to EARS-Net is therefore of great concern and constitutes a serious threat to patient safety in Europe," they conclude.
Jul 3 ECDC surveillance report

 

Genomic analysis shows diversity of MCR-1-carrying E coli 

A study today in the journal mBio provides new insights into the transmission and epidemiology of the MCR-1 colistin-resistance gene.

In the study, scientists from China and the United Kingdom conducted a comprehensive genomic analysis of 80 MCR-1-positive Escherichia coli (MCRPEC) strains isolated from clinical samples and fecal samples of inpatients and healthy volunteers at a hospital in Hangzhou. They wanted to better understand the genetic diversity of the isolates and how the MCR-1 gene circulates in a hospital setting, which could help inform infection control policies.

The results of the analysis showed that the 80 MCRPEC were significantly diverse, distributed throughout four phylogroups and represented by 50 ST clades, a finding that indicates a lack of clonal spread and implies there was no outbreak of MRCPEC in the hospital. But similarities in isolates from two patients who were kept in the same surgical ward at the same time suggests the possibility of nosocomial transmission of MCRPEC exists.

Further analysis revealed that in 73 of the 80 MCRPEC isolates, the MCR-1 gene was carried on plasmids, and that the genetic context of the plasmids showed great diversity, as evidenced by the different functional insertion sequence elements, toxin-antitoxin systems, and heavy metal resistance determinants. Additionally, MCR-1 was found to be frequently associated with genes encoding beta-lactam and fluoroquinolone resistance. Antibiotic resistance profiling showed that all strains were resistant to multiple categories of drugs.

"These findings provide important information on the transmission and epidemiology of mcr-1 and are of significant public health importance as the information is expected to facilitate the control of this significant antibiotic resistance threat," the authors write.
Jul 3 mBio study

 

Meta-analysis finds no ICU mortality increase with audit and feedback

A systematic review and analysis of studies on antimicrobial stewardship in the intensive care unit (ICU) has found that the use of audit and feedback did not increase mortality, Canadian researchers report in Clinical Infectious Diseases.

Following a review of 2,448 unique citations, the researchers found 11 studies that evaluated prospective audit and feedback in an ICU setting and reported any measure of mortality. Prospective audit and feedback was defined as an intervention in which healthcare workers with antimicrobial stewardship expertise, independent of the clinical team, provided written or oral instructions on antimicrobial use for specific patients to the ICU clinical team on a regular basis.

The selected studies included three interrupted time series analyses and eight uncontrolled before-after studies. Six studies involved audit and feedback for all ICU patients, while the other five studies focused only on patients on broad spectrum antibiotics, patients with positive cultures, or patients with hematological malignancies. Frequency of feedback varied from 3 days per week to daily.

In the meta-analysis of the five studies where the intervention was similar, and the outcome was measured in the same population (all ICU patients) and defined in the same way (ICU mortality), the pooled relative risk for mortality was 1.03. A second meta-analysis of three smaller studies that evaluated mortality only in patients directly assessed by the ASP found a pooled relative risk of ICU mortality of 1.06. Three studies were not appropriate for meta-analysis, but their results were consistent with the overall findings.

The authors say that while the findings have several limitations—including the variability between studies with respect to patient populations and the nature of intervention, the lack of adjustment for confounding variables, and the possibility of publication bias—the results provide the strongest evidence to date that implementing audit and feedback in the ICU setting does not increase patient mortality.
Jun 30 Clin Infect Dis abstract

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