CDC reports illustrate link between medical care abroad, resistant organisms

Two case studies today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Report highlight the importance of screening for drug-resistant organisms in patients who've had recent medical care outside the United States

In one study, researchers from the CDC and the Maryland Department of Health report that a Maryland resident with a recent month-long hospitalization in Kenya was admitted to an acute care hospital in Maryland with several infections, and carbapenemase-producing Klebsiella pneumoniae and Pseudomonas aeruginosa were subsequently identified in blood and sputum. Because the multidrug-resistant fungus Candida auris had been reported in Kenya, and the hospital had previously identified a patient from India with carbapenemase-producing organisms (CPOs) who was colonized with C auris, MDH suggest testing the patient for C auris colonization.

On the patient's 12th day in the hospital, C auris was identified, and 21 other patients in the ward were also tested. All screening swabs were negative.

"This case highlights the importance of a high level of suspicion for C. auris in persons admitted to U.S. health care facilities with a history of health care abroad, even if C. auris is not known to be widespread in that location," the authors write. "Early identification of C. auris is critical to preventing further transmission."

In the other study, researchers from the CDC and Washington State Department of Health report that a patient at a Seattle hospital who had undergone urology procedures in India in November 2018 tested positive for carbapenem-resistant K pneumoniae in his urine in December 2018. The urinary isolate was carrying three different carbapenemase genes, and antimicrobial susceptibility testing showed resistance to 15 antibiotics. The patient was subsequently flagged for contact precautions, and no other patients with matching carbapenem-resistant K pneumoniae strains were identified.

The authors of the report suggest that hospitals should consider carbapenem-resistant Enterobacteriaceae screening for patients who've undergone medical procedures abroad and who will be hospitalized or undergo invasive procedures in the United States.
Aug 2 MMWR C auris report
Aug 2 MMWR Carbapenem-resistant K pneumoniae report


Sixth person in the UK dies from Listeria-tainted hospital sandwiches

A sixth person in the United Kingdom has died from listeriosisafter eating a pre-packaged

sandwich at a hospital. The patient, a known case, was one of nine people sickened in this outbreak.

All deaths have occurred at National Health Service hospitals across England, and all cases have been connected to the consumption of pre-packaged salads or sandwiches from The Good Food Chain, which supplies 43 hospitals with food products in the UK. The food supplier has voluntarily stopped production.

"Patient safety is always our absolute priority and as soon as we were informed we may have received contaminated chicken sandwiches from the Good Food Chain we removed all products from our hospitals," said Western Sussex Hospitals' Chief Nurse and Director of Infection Prevention and Control, Maggie Davies, MD. "Since then, we have had no further listeriosis infections reported to us and we want to reassure our patients, visitors and staff that the risk remains very low."

The Good Food Chain first alerted hospitals to the possibility of contaminated chicken sandwiches on May 25.

Listeria monocytogenes is a foodborne bacterium that can cause severe illness in pregnant women, the elderly, and the immune-impaired. Outbreaks of the bacteria have been linked to deli meat, fresh produce, and unpasteurized dairy products.
Aug 1 Guardian story
Aug 1 Western Sussex Hospital press release
Aug 1 Public Health England


Meat from animals possibly exposed to CWD entered Canadian food chain

The Canadian Food Inspection Agency (CFIA) allowed deer and elk meat from a chronic wasting disease (CWD)-affected herd to enter the food supply, according to The Star.

CWD was discovered on a red deer farm in Quebec's Laurentians region last August. Almost 3,000 animals were culled, and 11 carcasses that tested positive for the disease, as well seven others, were destroyed, but the rest of the carcasses were allowed to enter the food system, The Star reports.

Though there have been no documented human cases of CWD, many experts fear the prion disease could cross species if a person eats contaminated meat, as seen in bovine spongiform encephalopathy (BSE, or mad cow disease).

Canadian scientists are conflicted on the decision to allow any meat from the herd into the food system, some saying it poses an unnecessary risk, while others saying CFIA did nothing wrong.
Jul 31 The Star article


Dengue outbreaks strike Bangladesh and Nicaragua

More than 1,300 people were diagnosed as having dengue in 24 hours in one hospital in Bangladesh this week, as the country faces its biggest dengue outbreak in its history. According to the UK newspaper, The Telegraph, at least 41 people have died from dengue since January.

"Since we started keeping record of dengue cases, which is from 2000, this is the worst dengue outbreak we have seen in Bangladesh," said Ayesha Akhter, assistant director at the Bangladeshi Directorate General of Health Services (DGHS), in the news article.

The country has seen 15,000 cases so far this year, 5,000 more than during the same time period in 2018. But more than 10,000 of this year's cases have occurred in June and July. A construction boom in Dhaka, with accompanying standing pools of water, has caused mosquito populations to flourish.

Nicaragua is also reporting record number of dengue fever cases, according to the Associated Press (AP). The news service said at least 8 people this year have died, and there are 55,000 suspected cases — though Nicaragua's health ministry has confirmed only 2,232 cases.

The health ministry issued an epidemiological alert earlier this week, and said government workers are increasing fumigation activities.

Dengue is a flavivirus transmitted by the Aedes aegypti mosquito. Unlike other viruses, repeated infection with dengue can lead to increasing disease severity.
Jul 31 Telegraph story
Jul 31 AP story

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