News Scan for Dec 31, 2018

Deadly superbug in Brazilian ICU
Avian flu in Vietnam, Taiwan, India

Carbapenem-resistant Acinetobacter strains identified in Brazilian ICU

Brazilian researchers report in PLOS One that strains of carbapenemase-producing Acinetobacter baumannii in intensive care unit (ICU) patients at a tertiary teaching hospital were associated with high mortality and several healthcare-related risk factors.

To identify risk factors associated with the strains, the researchers conducted a case-control study among patients hospitalized in two ICUs at a hospital in Mato Grosso du Sul state from September 2013 through April 2015. For each patient admitted with an OXA-23–producing A baumannii strain isolated from clinical specimens during the study period, a respective control patient was selected from adult inpatients matched for age, clinical manifestation, and hospital ward. All medical, nursing, and microbiologic records of hospitalized patients were reviewed.

Of the 275 episodes of A baumannii infection or colonization observed during the study period, 41 OXA-23–producing strains were isolated from ICU patients with multiple comorbidities. No differences were observed between the 41 case and 41 control patients regarding baseline demographic data, but a multivariate analysis showed that acquisition of OXA-23–producing A baumannii strains was associated with the use of nasogastric tubes, hemodialysis, and therapy with cephalosporins. Analysis of patient outcomes revealed that patients with OXA-23–producing A baumannii had a mortality rate of 34.1%.

All 41 OXA-23–producing A baumannii isolates were multidrug-resistant and susceptible to only amikacin, gentamicin, tigecycline, and colistin. Polymerase chain reaction analysis identified the insertion sequence ISAba1—which is associated with increased gene expression leading to high carbapenem resistance—in all the isolates. Pulsed-field gel electrophoresis analysis revealed that 26 of the isolates belonged to the sequence type (ST) 79 lineage, a high-risk clone in ICUs that's been reported in several multidrug-resistant A baumannii hospital outbreaks in Brazil.

The authors of the study report that implementation of infection control measures, including hand hygiene promotion in the ICU, isolation of patients infected or colonized with carbapenem-resistant strains, and environmental cleaning and disinfection of reusable medical equipment helped reduce the incidence of carbapenem-resistant A baumannii after November 2014.
Dec 28 PLOS One study


Vietnam, Taiwan, India report H5 high-path avian flu outbreaks in poultry

Vietnam, Taiwan, and India have reported new outbreaks of highly pathogenic avian flu in poultry, according to reports posted by the World Organization for Animal Health (OIE).

Vietnam's outbreak began on Dec 21 in Dak Lak province in the south and sickened 100 village birds and killed 50 in a flock of 215 poultry. It involved the H5N1 strain, agricultural officials said. All surviving birds were culled to prevent further disease spread.

In Taiwan, animal health officials confirmed two H5N2 avian flu outbreaks, one involving a goose farm in Taoyuan city in the north and one involving backyard birds in Chiayi County in the south. In the former outbreak, 33 geese died in a flock of 1,201, and the remainder were destroyed. In the latter, all 16 chickens in the flock died. The outbreaks began 2 weeks ago. Taiwan has reported numerous H5N2 outbreaks this year.

In India, meanwhile, H5N1 wiped out 117 of 705 poultry at a farm in Bihar province in the east, not far from the country's borders with Nepal and Bangladesh. The outbreak began on Nov 15, but officials did not confirm avian flu viruses until Dec 19. In addition, officials at Patna Zoo, which is also in Bihar province, reported two more bird deaths caused by avian flu, according to Avian Flu Diary, an infectious disease blog. Last week officials reported that six peacocks at the zoo had died from H5N1.
Dec 27 OIE report on H5N1 in Vietnam
Dec 27 OIE report on H5N2 in Taiwan
Dec 28 OIE report on H5N1 in India
Dec 30 Avian Flu Diary blog post

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