News Scan for Jul 17, 2019

News brief

Two more MERS cases recorded in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) confirmed two new cases of MERS today, in Riyadh and Buraydah. The cases were noted in an update to an epidemiologic week 29 report.

A 36-year-old man from the capital, Riyadh, was diagnosed as having Middle East respiratory syndrome coronavirus (MERS-CoV), but the ministry does now know if the man had camel exposure. His infection is listed as "primary," which means it is unlikely he contracted the virus from another person.

A 70-year-old man from Buraydah was also diagnosed as having the virus, and is listed as a "primary" case. His camel contact status is also unknown.

These are the third and fourth cases recorded in July, three of which have been recorded in the last 2 days.
Jul 17 MOH report

 

Ground bison linked to E coli outbreak in 7 states

Yesterday Northfork Bison Distributions Inc., a Canadian food company, recalled several ground bison products after the meat was linked to a multistate outbreak of Shiga toxin–producing Escherichia coliO103 and O121 infections in the United States.

The Centers for Disease Control and Prevention (CDC) said 21 people in seven states had been sickened in the outbreak. Eight people have been hospitalized, and there have been no deaths.

"Recalled ground bison was sold to distributors as ground bison and bison patties, referred to as Bison Burgers and/or Buffalo Burgers," the CDC said. "Consumers should not eat and restaurants and retailers should not sell or serve, recalled ground bison products."

New York State has reported the most cases, with 9, followed by Florida (4), Pennsylvania (3), New Jersey (2), and 1 case each in Connecticut, Michigan, and Missouri.

Illness start dates range from Mar 18 to Jun 18, and 67% of case-patients interviewed recalled eating bison burgers in the weeks prior to illness.

Yesterday Northfolk volunteered to recall all questionable products produced from Feb 22 through Apr 30. According to the Canadian Food Inspection Agency (CFIA), there have been no reported illnesses in Canada.
Jul 16 CDC update
Jul 16 CFIA warning

 

Trump preparing to overhaul flu vaccine development

According to a Politico story yesterday, sources close to President Donald Trump say he is preparing an executive order that will direct the Department of Health and Human Services to overhaul seasonal flu vaccine production and encourage more Americans to get vaccinated.

"Trump would direct the health department to develop an alternative to seasonal flu vaccines, which are largely produced overseas and grown in hen's eggs," the article said. "Trump also would create an interagency task force led by health and global security officials to monitor progress and explore new economic incentives to develop better vaccines."

The executive order would aim to shift production to newer vaccine technologies, including cell-based or recombinant technologies.

The move may come as a surprise since Trump has been associated with the anti-vaccine movement in the past, tweeting in 2014 that vaccines were linked to autism. But recent severe flu seasons, underperforming seasonal vaccines, and a 2018 meeting with Bill Gates on the importance of a universal flu vaccine may have changed Trump's mind, the story said.
Jul 16 Politico news story

Stewardship / Resistance Scan for Jul 17, 2019

News brief

FDA approves Merck's combination antibacterial

The US Food and Drug Administration (FDA) today announced the approval of Recarbrio, a new three-drug antibacterial product developed by Merck, for treating patients with complicated urinary tract infections (cUTIs) and complicated intra-abdominal infections (cIAIs) caused by gram-negative pathogens.

The injectable drug, a combination of the previously FDA-approved antibiotic imipenem-cilastatin and the novel beta-lactamase inhibitor relebactam, was approved for use in adults who have limited or no treatment options available, the FDA said in a press release.

"The FDA remains focused on facilitating the development of safe and effective new antibacterial drugs to give patients more options to fight serious infections," said Ed Cox, MD, MPH, director for the Office of Antimicrobial Products in FDA's Center for Drug Evaluation and Research. "It is important that the use of Recarbrio be reserved for situations when there are limited or no alternative antibacterial drugs for treating a patient's infection." 

Approval was based on efficacy data from a trial of imipenem-cilastatin for treatment of cUTIs and cIAIs, and on in vitro and animal-infection model studies that examined the contribution of relebactam, which protects imipenem from degradation by beta-lactamases. The safety was assessed in two trials: a cUTI trial in which 99 of 298 patients were treated with Recarbrio, and a cIAI trial in which 117 of 347 patients were treated with the drug.

The most common side effects reported were nausea, diarrhea, headache, fever, and increased liver enzymes.

A press release from Merck notes that Recarbrio should only be used to treat infections that are proven or suspected to be caused by susceptible bacteria.
Jul 17 FDA press release
Jul 17 Merck press release

 

Scientists identify potential new Candida auris clade

A team of Dutch, Iranian, and US scientists have identified a potential fifth clade of the multidrug-resistant fungus Candida auris, according to a letter published yesterday in Emerging Infectious Diseases.

The discovery was based on the results of whole-genome sequencing conducted on an isolate from a 14-year-old Iranian girl diagnosed with a C auris infection in her ear. The case, diagnosed in 2018, was the first known C auris infection in Iran, and the patient was reported to have never traveled outside of the country. The isolate was susceptible to the three major classes of antifungal drugs.

Comparison with 74 C auris isolates from other countries confirmed that the isolate was genetically distinct from the four other identified clades (commonly referred to as the South Asian, East Asian, African, and South American clades). Isolates from the East Asian clade were closest genetically.

To date, all of the isolates analyzed from more than 35 countries where C auris cases have been reported have clustered in the four clades.

"Ultimately, our discovery is a reminder that much about C. auris remains to be learned and underscores the need for vigilance in areas where C. auris has not yet emerged," the scientists write.
Jul 16 Emerg Infect Dis research letter

 

Pharmacist review linked to lower antibiotic use in French hospitals

An analysis of nationwide hospital data in France has found that antibiotic consumption was lower in hospitals where the antibiotic advisor was a pharmacist, and a pharmaceutical team reviewed all prescriptions, French researchers reported yesterday in the Journal of Global Antimicrobial Resistance.

For the retrospective observational study, researchers analyzed 2016 data from 77 hospitals involved in the French antibiotic consumption surveillance network. In addition to antibiotic consumption data, they also looked at antimicrobial stewardship (AMS) measures, pharmacist-specific actions, and use of a computerized prescription order entry (CPOE) system. Associations between antibiotic consumption and stewardship measures were assessed using linear regression.

The analysis found that pharmacists were involved in AMS programs in 73% of hospitals and served as the antibiotic advisor in 25%. Univariable analysis identified CPOE use (P = 0.04), pharmaceutical review (P = 0.004), and the antibiotic advisor being a pharmacist (P = 0.003) as measures associated with lower overall antibiotic consumption. In the multivariable analysis, antibiotic advisor being a pharmacist (P = 0.002) and pharmaceutical review covering all beds (P = 0.03) were significantly, independently associated with lower antibiotic consumption.

"These results highlight that actions initiated by pharmacists have a positive impact and should be supported," the authors of the study conclude.
Jul 16 J Glob Antimicrob Resist abstract

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