Stewardship / Resistance Scan for Jul 19, 2018

Swiss VRE outbreak
CRE screening
Drug-resistant yeast

VRE outbreak identified in Swiss hospitals

Swiss researchers have identified a large outbreak of vancomycin-resistant enterococci (VRE) clone ST796 across multiple hospitals in Switzerland, according to a report today in Eurosurveillance.

The outbreak began on Dec 30, 2017, when two cases of vancomycin-resistant Enterococcus faecium bloodstream infection were reported in the hemato-oncology ward of Bern University Hospital. By April 30, 2018, screening of 3,096 samples from contact patients found that 89 patients in four hospitals were colonized or infected by VRE. Whole-genome sequencing (WGS) found that 77 of the 89 isolates (86.5%) were virtually indistinguishable, and core genome multilocus sequence typing (cgMLST) identified them as ST796, which was first recognized at an Australian hospital in 2011 and spread rapidly throughout Australia and New Zealand in the following years.

WGS analysis revealed a clear genomic relationship between isolates from the outbreak and those from Australia.

All 77 of the isolates carried the vanB resistance gene, and antimicrobial susceptibility profiles of 68 of the isolates showed resistance to ampicillin and levofloxacin and high-level resistance to gentamycin. Forty-six isolates were resistant to vancomycin, 21 were intermediate, and 1 was susceptible.

The authors conclude that the rapid spread of this VRE clone, and its history of rapid spread across hospitals, could seriously endanger healthcare facilities and warrants strengthening and synchronization of national infection control practices. The World Health Organization has listed VRE, which can be transmitted via the environment or healthcare workers, as a high priority for antibiotic development.
Jul 19 Eurosurveill rapid communication


Study shows benefits of targeted CRE screening on admission

A study today in Infection Control and Hospital Epidemiology suggests active screening to identify patients colonized with carbapenem-resistant Enterobacteriaceae (CRE) is feasible, especially if targeted toward high-risk admissions and units.

In the study, researchers from Rush University Medical Center in Chicago retrospectively analyzed the implementation and outcomes of CRE admission screening from 2013 to 2016 during two study periods. In period 1, the hospital implemented active CRE rectal culture screening for all adults admitted to an intensive care unit (ICU) and for those transferred from outside facilities to general wards. In period 2, the screening policy in the ICU was modified so that only patients transferred from outside facilities were screened.

Overall, 11,757 patients qualified for screening, and rectal cultures were performed for 8,569 (73%). Overall adherence to screening in the ICU was higher in period 1 than in period (83.4% vs. 67.3%). The CRE culture positivity rate (positive CRE screening cultures divided by the total number of screening cultures collected) was highest in the medical and surgical ICUs during period 2 (3.3% combined rate); this rate was higher than the aggregated rate in the medical and surgical ICUs in period 1 (0.7% combined rate) and higher than the rate in general wards for period 2 (0.6%).

Although moving from a universal to a targeted screening resulted in more efficient screening, the analysis of the two periods also showed that nearly half of the 21 CRE screen-positive patients identified during period 1 (47.6%) were not directly transferred from other institutions, and therefore would have been missed by targeted screening.

Analysis of a subset of CRE screen-positive patients identified during period 2 found that, of 13 patients previously identified by outside facilities as CRE-positive, only 4 had documentation of CRE in their medical records, a finding the authors suggest bolsters the case for admission screening.
Jul 19 Infect Control Hosp Epidemiol abstract


Study indicates common yeast, pathogenic yeast are same species

A type of yeast that's commonly used in the food production industry is the same species as a pathogenic, drug-resistant yeast that's one of the five most prevalent causes of yeast infections, according to a study today in PLoS Pathogens.

In the study, researchers at University College Dublin examined the genomes of 20 clinical isolates of Candida krusei, which causes 2% of all yeast infections and has innate resistance to the widely used antifungal drug fluconazol, with 12 environmental isolates of Pichia kudriavzevii, a yeast regarded as safe by the US Food and Drug Administration because it's been used for centuries to make fermented food products. P kudriavzevii also has biotechnology applications, having been used for producing ethanol and other chemicals.

The results showed that the genomes of the isolates were 99.6% identical in their DNA sequence, indicating they belong to the same species. In addition, the researchers found that the P kudriavzevii isolates had levels of drug resistance similar to those of the C krusei isolates.

The authors of the study say the findings suggest P kudriavzevii could cause disease in humans, and that there should be limits on the levels of drug resistance in P kudriavzevii strains used in industry, particularly in food production.
Jul 19 PLos Pathog study

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