Simple molecular typing, hospital data tracks antimicrobial resistance in low-resource settings

Basic molecular typing and routine hospital data can be used in resource-limited settings to do lab surveillance of antimicrobial resistance organizations, according to researchers in Sri Lanka who reported their findings yesterday in BMC Infectious Diseases.

They say antibiotic resistance is a major concern in Sri Lankan healthcare, especially as it relates to healthcare-associated infections. High antibiotic resistance in intensive care unit—known to have high antibiotic pressure--is present throughout the country. Though lab infrastructure has improved in Sri Lanka, no routine typing protocols are in place.

Though next-generation sequencing and multi locus sequence typing are standard typing methods, they aren't readily available in resource-limited settings, so the goal of their study was to see if a simpler method such as random amplification of polymorphic DNA (RAPD) and basic clinical data would be feasible for lab surveillance.

In the retrospective study, the team looked at 70 consecutive Gram-negative isolates obtained from an ICU over a 6-month period, using RAPD typing to gauge antibiotic sensitivity patterns. Seven of the isolates were Escherichia coli, and all were multi-drug resistant and were extended spectrum beta lactamase (ESBL) producers that carried blaCTX-Mresistance gene. Fourteen isolates were Klebsiella pneumoniae, and all were multi-drug resistant ESBL producers, all of which harbored the blaSHV gene and all but one of which carried the blaCTX-M gene. All 30 Acinetobacter isolates were multidrug resistant, though only 2 of 15 Pseudomonas aeruginosa isolates were resistant.

RAPD analysis of the four types of organisms found a predominant cluster in each instance, hinting at transfer of organisms within the unit rather than multiple acquisitions from outside environments. The group concluded that simple RAPD typing combined with analysis of hospitalization data could cost-effectively be used to identify trends and spread of resistance organisms.
Jul 11 BMC Infect Dis abstract


Study probes Ebola exposure in healthcare workers

According to a new study in Emerging Infectious Diseases, most healthcare workers (HCWs) exposed to Ebola virus during the West African outbreak did not contact the deadly disease, despite an average of 3.5 occupation exposures each year.

The study was based on data collected in Guinea, where 109 HCWs died during the 2014-2015 Ebola outbreak.  The workers who were the subject of the study used personal protective equipment and were from the French Armed Forces Medical Service and were tracked from January 23 through May 8, 2015.

Of the 57 HCW, researchers tallied a total of 77 occupational exposures, averaging 3.5 exposures per worker in 1 year.

Based on descriptions of the exposures, only 18% were classified as high-risk, and none of the HCWs contracted Ebola.

"We observed various circumstances that could affect exposure to Ebola virus. In contrast to what we expected, exposure incidents during removal of PPE were rare, probably because healthcare workers are extensively trained for this activity. Thus, an increase in infections was not observed," the authors concluded.
Jun 12 Emerg Infect Dis study


Report pinpoints remaining gaps in safe drinking water and sanitation

In the first global assessment of "safety managed" drinking water and sanitation services, the World Health Organization (WHO) and UNICEF today said 2.1 billion people—about 3 in 10—lack access to safe, readily available water and that 4.5 billion—about 6 in 10—don't have access to safely managed sanitation.

The report is part of an effort to monitor progress toward reaching new sustainable development goals, which call for ending open defecation and achieving universal access to basic services by 2030. The groups detailed their findings today in a 66-page report posted on the WHO's Web site. They define "safely managed" as drinking water free of contamination that is available as needed at home and toilets where excreta is treated and disposed of safety. "Basic services" are defined as having protected drinking water available less than 30 minutes away, using improved toilets or latrines that aren't shared with other households, and having soap-and-water handwashing facilities at home.

WHO and UNICEF said though billions of people have gained access to basic services since 2000, they aren't necessarily safe, putting the health of residents—especially young children—at risk for diseases. The report notes that each year diarrhea kills 361,000 children under age 5 and that poor sanitation and tainted water can transmit diseases including cholera, dysentery, hepatitis A, and typhoid.

The problem is especially acute in rural areas, the report says. Tedros Adhanom Ghebreyesus, PhD, WHO's director-general, said in a WHO statement today, "Safe water, sanitation, and hygiene at home should not be a privilege of only those who are rick or live in urban centres."

Among the findings, for example, access to water and soap varies greatly in 70 countries with available data, from 15% in sub-Saharan Africa to 76% in western Asia and northern Africa. The authors also say in 90 countries, progress toward basic sanitation is too slow, making it unlikely that they will achieve the sustainable development goal of universal coverage by 2030.
Jul 12 WHO press release
Jul 12 WHO drinking water, sanitation, and hygiene report


H5N1 strikes backyard birds in Vietnam

Vietnam's agriculture ministry today reported another highly pathogenic H5N1 avian influenza outbreak, coming just over a month since its last such event, according to a report today from the World Organization for Animal Health (OIE).

The virus struck backyard birds in Ha Nam province, located in north central Vietnam. The outbreak began on Jul 4, killing 300 of 1,135 birds and sickening 500 more. Authorities destroyed the remaining birds as one of the response steps, which also included imposing movement controls, establishing surveillance zones, disinfection, and vaccination.

Vietnam has reported a small but steady stream of H5N1 outbreaks this year, which have affected several different provinces.
Jul 12 OIE report on H5N1 in Vietnam

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