Stewardship / Resistance Scan for Jan 24, 2019

Antibiotic-resistant Brucella
New STI test cleared
KFC fulfills antibiotics pledge

CDC warns of raw milk exposure to drug-resistant Brucella after 3rdcase

A New York resident who drank raw milk from a Pennsylvania dairy has contracted the nation's third known case of brucellosis caused by the antibiotic-resistant Brucella RB51 strain, the Centers for Disease Control and Prevention (CDC) said yesterday in a Health Alert Network (HAN) notice. The previous two illnesses occurred in 2017.

"The New York State Department of Health and Pennsylvania Department of Health are investigating Brucella RB51 exposures that may be connected to consuming raw (unpasteurized) milk from Miller's Biodiversity Farm in Quarryville, Pennsylvania," the CDC said. Officials say people in 19 states across the country have consumed raw milk products from the farm and may have been exposed to the bacterium.

The New York resident was diagnosed as having brucellosis in November after drinking raw milk from the farm, and milk samples from the dairy tested positive for Brucella RB51. Anyone who drank raw milk or consumed other raw milk products from the dairy since 2016 may have been exposed, the CDC said.

Brucella strain RB51 is a live-attenuated cattle vaccine strain, which can be shed in milk and can cause infections in humans who drink the milk without pasteurization. The strain is resistant to rifampin and penicillin, so the CDC recommends both doxycycline and trimethoprim-sulfamethoxazole as first-line treatment. Blood culture is recommended for diagnosis.

Symptoms of brucellosis can include fever, sweats, general malaise, loss of appetite, headache, fatigue, muscle and joint pain, and potentially more serious complications like endocarditis and neurologic symptoms. Pregnant women are at risk of miscarriage.

The CDC reported the first two confirmed US RB51 cases in a Texas woman in September 2017 and in a New Jersey woman in November of that year.
Jan 23 CDC HAN advisory
Sep 15, 2017, CIDRAP News story "CDC issues alert over raw milk and Brucella infection"
Sep 21, 2017, CIDRAP News story "CDC issues raw milk Brucella warning for 4 states"


FDA clears first test for Mycoplasma genitalium

The US Food and Drug Administration (FDA) today cleared a new test for diagnosing the common sexually transmitted infection (STI), Mycoplasma genitalium, a step that could aid antibiotic stewardship efforts.

The test—Aptima, manufactured by Hologic Inc, of Marlborough, Mass.—is the first on the market to target M genitalium, which the Centers for Disease Control and Prevention (CDC) called an emerging public health threat in 2015.

According to Hologic, more than 15% of Americans in certain high-risk groups may be infected with the bacterium, and as many as 50% of women and 42% of men may have antibiotic-resistant infections. Also, some patients may be asymptomatic or have symptoms similar to those caused by chlamydia, so accurate diagnostic testing is crucial. If left untreated, M genitalium infections can result in infertility in women and an increased risk for HIV transmission.

"Although Mycoplasma genitalium is typically more common than gonorrhea, there is very little public awareness of this rising sexually transmitted infection, which can cause serious and potentially devastating health problems," said Damon Getman, PhD, the senior principal research scientist and director of research at Hologic, in a company press release.

The FDA said the STI test will help clinicians choose the correct antibiotic to target the bacterium, potentially limiting the misuse of antibiotics that results in antimicrobial resistance.

"In the past, it has been hard to diagnose this organism," said FDA Commissioner Scott Gottlieb, MD in a statement. "By being able to detect it more reliably, doctors may be able to more carefully tailor treatment and use medicines most likely to be effective. In cases where M. gen. is detected, doctors can consider forgoing use of antibiotics that are known to be ineffective against M. gen. and choose a treatment more likely to be appropriate."
Jan 23 Hologic press release
Jan 23 FDA


KFC makes good on pledge to eliminate medically important antibiotics

Fast food chain KFC announced today that it has fulfilled its pledge that 100% of the chicken purchased by the company would be raised without medically important antibiotics by the end of 2018.

KFC said that it has worked closely with more than 2,000 US poultry producers to meet its promise, which was announced in April 2017. KFC is one of several fast food chains to commit to reducing or eliminating chicken raised with medically important antibiotics in recent years, a move that has been driven by consumer demand and growing public health concern about antibiotic resistance.

"Recognizing the rising public health concerns about the increased threat of resistance to human antibiotics, KFC has advanced this initiative while keeping both customers—and the health of flocks from which they source—top of mind," the company said in a press release.

Matthew Wellington, antibiotics program director for US PIRG (Public Interest Research Group), which was among a coalition of groups that had urged KFC to enact better antibiotic policies, said the announcement illustrates the important role that food companies play in efforts to reduce antibiotic use in food-producing animals.

"KFC making good on its promise to cut the use of medically important antibiotics in its chicken supply shows that food companies can use their purchasing power to make a positive impact," he told CIDRAP News. "It's good news for consumers and will help preserve these life-saving medicines for future generations."
Jan 24 KFC press release

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