News Scan for Mar 25, 2019

News brief

CDC: With California cluster, 46 new infections, measles cases reach 314

The US Centers for Disease Control and Prevention (CDC) today said measles case counts have reached 314 cases in 15 states—46 more cases than the agency reported in a Mar 18 update. For comparison, the CDC reported 372 cases for all of 2018.

Over the weekend, California confirmed a new cluster of three measles cases in Shasta and Tehama counties. The outbreak is connected to a person who contracted measles during international travel, according to an Action Now local news story.

Arizona, California, Colorado, Connecticut, Georgia, Illinois, Kentucky, Michigan, Missouri, New Hampshire, New Jersey, New York, Oregon, Texas, and Washington have all recorded cases since Jan 1.

So far, the CDC has identified six outbreaks that involve three or more cases, in New York City; Rockland County, New York; Washington state; Texas; Illinois; and California.
Mar 25 CDC
update
California Department of Public Health page
Mar 25 Action Now News
story

 

MERS infects 2 more in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) has reported two more MERS-CoV cases over the past few days, according to epidemiologic week 12 and 13 updates.

One of the MERS-CoV (Middle East respiratory syndrome coronavirus) infections involves a 66-year-old man from Medina who had contact with camels. The other patient is a 61-year-old man from Khames Meshait in southwestern Saudi Arabia who had primary exposure, meaning he likely wasn't exposed to another known patient. A few other cases have recently been reported in Khamis Mushait, including one from earlier this month that involved secondary contact.

The country has now reported 107 cases for 2019, including 57 linked to a large outbreak in Wadi ad-Dawasir in which most cases were linked to healthcare exposure.
Mar 22 MOH report
Mar 25 MOH
report

 

CDC wraps up probe of ground beef Salmonella outbreak

The CDC on Mar 22 posted a final update on a Salmonella Newport outbreak linked to ground beef, which resulted in 403 cases in 30 states. Since the CDC's last report on Dec 12, officials confirmed 70 more cases, along with 2 more affected states.

First reported in October, the outbreak was linked to beef products from JBS Tolleson, Inc., that were produce late last summer and distributed to several retailers, including some large ones such as Winn-Dixie, Walmart, and Sam's Club. The company recalled about 12 million pounds of its non-intact raw beef products.

In its update, the CDC warned that although the outbreak investigation is over, contaminated products could still be in freezers, and it urged consumers not to eat the company's recalled beef, which carries the "EST 267" establishment number.

Of 340 patients with information available, 117 (34%) were hospitalized, and no deaths were reported. The latest illness onset was Feb 8, 2019. Patient ages range from younger than 1 year to 99, with a median age of 42. Forty-nine percent were male.

During the investigation, food surveys found that 86% of the sick patients had eaten ground beef at home the week before they became ill, much higher than the 40% reported in a similar survey of healthy people. Tests by health officials in Arizona and Nevada found the Salmonella Newport outbreak strain in unopened packages of ground beef from retail stores.
Mar 22 CDC final outbreak update

 

One new polio case in Nigeria, positive case contacts in Nigeria

In its latest weekly update late last week, the Global Polio Eradication Initiative (GPEI) recorded one new case of circulating vaccine-derived polio in Nigeria, the country's second in 2019.

The case of circulating vaccine-derived poliovirus type 2 (cVDPV2) was reported in Kwara state. In 2018, Nigeria saw 34 cases of polio.

"The country continues to be affected by two separate cVDPV2 outbreaks, the first centered in Jigawa State with subsequent spread to other states as well as to neighbouring Republic of Niger, and the second in Sokoto State," the GPEI said. "Recent confirmation of spread of one of the cVDPV2 outbreaks, both within Nigeria and internationally, underscores the urgent need to fill remaining vaccination gaps in the ongoing outbreak response, and to optimize the geographic extent and operational quality of mOPV2 [oral polio vaccine] response."

Last year, Niger experienced an outbreak of 10 cases genetically linked to the outbreak in Jigawa state in Nigeria. While Niger did not record any polio cases in the last week, officials found five cVDPV2-positive samples in healthy community contacts of a case-patient diagnosed in December 2018.
Mar 22 GPEI report  

Stewardship / Resistance Scan for Mar 25, 2019

News brief

Study finds peer comparison helps reduce fluoroquinolone use

A new study in the Journal of the American College of Clinical Pharmacy shows that the use of peer comparison reports based on prescriber specialty was tied to less use of fluoroquinolone antibiotics throughout a large community-hospital system.

In the quasi-experimental study, which was conducted at 16 community hospitals in Florida in 2017, researchers evaluated the impact of 1,265 peer comparison reports issued to high-volume prescribers in three different medical specialty cohorts: internal medicine/hospitalists/family medicine, intensivists/pulmonologists, and infectious diseases. The reports provided feedback to each eligible prescriber on their prescribing patterns and compared them to others within their peer group.

The primary study outcome was fluoroquinolone days of therapy (DOT) per 1,000 patient-days (PD) in the intervention period compared with the baseline period. Additional outcomes included total antibiotic days of therapy, total percentage of antibiotic days attributable to fluoroquinolones, and cases of hospital-acquired Clostridioides difficile/1,000 PD.

During the intervention period, fluoroquinolone use declined 29% compared with the baseline period, from 83.9 DOT/1,000 PD to 58.3 DOT/1,000 PD. Declines were observed in all facilities included in the study, but fluoroquinolone use decreased most among the facilities with the highest baseline use. The percentage of antibiotic days attributable to fluoroquinolones fell from 15.4% in the baseline period to 11.3% in the intervention period. In addition, total antibiotic days of therapy fell by 6%, and use of other key antibiotic classes, including third-generation cephalosporins and anti-pseudomonal beta-lactams, remained unchanged. The rate of hospital-acquired C difficile fell by 20%.

The authors of the study say their findings are consistent with most of the previous studies that demonstrate that behavioral interventions can have a positive impact on antibiotic prescribing, and they conclude that providing prescribers with feedback on antibiotic use may be a useful behavior modification tool for inpatient stewardship programs.
Mar 23 J Am Coll Clin Pharm abstract

 

Antipseudomonal combo therapy for pneumonia linked to higher mortality

A study last week by researchers with the University of Texas and the University of Connecticut has found that older adults who received antipseudomonal combination therapy (PCT) for community-onset pneumonia had worse outcomes than those who received antipseudomonal monotherapy (PMT).

The population-based, retrospective cohort study, published in the American Journal of Infection Control, used data from more than 150 hospitals and 1,400 clinics in the Veterans Health Administration (VHA) system. The researchers used VHA electronic medical records to categorize pneumonia patients as having low, medium, or high risk of drug-resistant pathogens and to assign them to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. They then compared all-cause 30-day mortality in the two groups.

Of the 31,027 patients who met the criteria for the study, 23% received PCT and 77% received PMT. The unadjusted mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43 to 1.66) and in all three risk groups: low (aOR, 1.69; 95% CI, 1.50 to 1.89), medium (aOR, 1.30; 95% CI, 1.14 to 1.48), and high (aOR, 1.21; 95% CI, 1.04 to 1.40)

The findings are important, because community-acquired pneumonia guidelines from both the American Thoracic Society and the Infectious Diseases Society of America recommend PCT when Pseudomonas pneumonia is suspected. The authors of the study say that the data from this study, and their previous study of empiric Pseudomonas therapy in patients with community-acquired pneumonia, indicate that the guidelines should be changed.

"We support the use of empiric PMT in high-risk patients, but we do not support the use of empiric PCT in pneumonia patients from any of the risk groups," they write. "PCT may be beneficial over PMT for patients with known Pseudomonas (ie, definitive therapy)—a question beyond the scope of this study—but PCT is not associated with additional benefit in patients simply suspected of having Pseudomonas (ie, empiric therapy)."
Mar 21 Am J Infect Control study

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