Stewardship / Resistance Scan for Apr 15, 2020

News brief

Study highlights spread of C auris in skilled nursing facilities

Point prevalence surveys at high-acuity long-term care facilities in Chicago indicate that ventilator-capable skilled nursing facilities (vSNFs) are particularly vulnerable to Candida auris, a research team led by the Chicago Department of Public Health reported yesterday in Clinical Infectious Diseases.

The surveys were conducted from August 2016 through December 2018 to identify patients colonized with C auris and assess infection control (IC) measures in the city's high-acuity long-term care facilities, where ongoing spread of the pathogen has been documented since the first two cases of the multidrug-resistant fungus were identified in Chicago in August 2016.

The 47 surveys conducted in 18 facilities identified 490 patients infected (128) or colonized (362) with C auris, and found that the highest prevalence of C auris colonization was in vSNFs (median prevalence, 66%) and long-term acute care hospitals (median prevalence, 31%). IC assessments identified lack of staff member time dedicated to IC activities, lack of infection surveillance systems, and lack of personal protective equipment as common challenges.

A case study and repeat point prevalence surveys conducted at a single vSNF from January 2018 through October 2018 found that C auris prevalence increased from 43% to 71% over 10 months, that most residents remained persistently colonized with C auris, and that 39% of environmental samples collected tested positive for the pathogen. C auris was detected in samples collected from over-bed tables, bedside chairs, nursing carts, doorknobs, bedrails, and windowsills.

"High-acuity long-term healthcare facilities represent high priority settings for public health interventions to contain spread of emerging healthcare-associated MDROs [multidrug-resistant organisms]," the researchers wrote. "Strategies are needed to improve adherence to infection control practices."

According to the most recent case count from the US Centers for Disease Control and Prevention (CDC), there are 1,018 confirmed and probable C auris infections in 16 states, and an additional 2,051 patients who are colonized. Illinois has the second-highest number of cases, at 292, behind New York (465).
Apr 14 Clin Infect Dis abstract
Feb 2 CDC C auris
case count


CDC researchers find MDR Salmonella strain in US travelers

In a research letter today in Emerging Infectious Diseases, CDC researchers reported the identification of a strain of multidrug-resistant (MDR) Salmonella previously found in Taiwan among US patients with a history of travel to Asia.

Using the National Center for Biotechnology Information Pathogen Detection Isolates Browser—a database of bacterial isolates from patients, food, and the environment—the researchers analyzed the genome sequences of 37 isolates genetically related to Salmonella enterica serotype Anatum, an MDR Salmonella strain that emerged in Taiwan in 2011.

Twenty-five of the isolates were from Taiwan, and 12 were from the United States, including 7 from people, 4 from tilapia imported from Taiwan, and 1 from shrimp imported from the Philippines.

The isolates harbored 11 antibiotic resistance genes, including blaDHA-1, a plasmid-mediated AmpC beta-lactamase gene, and the MCR-1.1 colistin-resistance gene. Antibiotic susceptibility testing indicated resistance to multiple antibiotic classes, including three recommended for treating Salmonella infections.

All 7 US patients reported diarrhea, abdominal pain, nausea, and fever, and 4 became ill after returning from the Philippines. Two others travelled to the Philippines and Taiwan, but travel and illness onset dates were not available. One patient had never travelled internationally, but her isolate was genetically similar to the             isolate from shrimp imported from the Philippines. Before illness onset, she ate shrimp at an Asian restaurant.

"Our findings underscore the need for global, One Health surveillance," the authors write. "Given the extent of international travel and trade, data sharing among human health, animal health, and food production sectors and across geographic borders is essential to detect MDR strains and inform strategies and interventions to prevent spread."
Apr 15 Emerg Infect Dis study

News Scan for Apr 15, 2020

News brief

Study: Norovirus kills 900, costs up to $720 million per year in US

Each year, norovirus causes about 900 deaths, 110,000 hospitalizations, 2.3 million clinic visits, and 470,000 emergency department (ED) visits, at an annual healthcare cost of $430 million to $720 million, providing a substantial opportunity for a vaccine, according to a study in Clinical Infectious Diseases.

Norovirus is a leading cause of acute gastroenteritis (AGE) and can lead to hospitalization or death in young children and older people. A candidate norovirus vaccine was recently evaluated in a phase 2b trial.

Researchers at the US Centers for Disease Control and Prevention analyzed administrative data on AGE outcomes from Jul 1, 2001, to Jun 30, 2015, to estimate the norovirus burden, determine the potential value of norovirus vaccines under development, provide a baseline against which future vaccine impact can be measured, and indicate which populations should be targeted for the biggest public health impact.

The researchers based models on data on ambulatory clinic and ED visits from the IBM MarketScan Commercial and Medicare Supplemental Databases, hospitalizations from the Healthcare Utilization Project National Inpatient Sample, and deaths from the National Center for Health Statistics.

The investigators found that rates of AGE-related outpatient visits were highest among children younger than 5 years (23% of clinic visits and 30% of ED visits), while rates of related hospitalization and death were highest among adults 65 years and older (43% of hospitalizations and 86% of deaths).

Norovirus-linked clinic visits cost, on average, $225 million a year, while ED visits cost $237 million. Adults 18 to 64 years old had the highest mean cost per norovirus-related clinic visit ($111) and ED visit ($586) and the highest total national costs for related clinic visits ($84 million) and ED visits ($141 million).

Norovirus-related hospitalizations cost, on average, $106 million a year, with over half of the costs attributed to children younger than 5 years, due to the highest mean cost per hospitalization, at $2,513.

"Norovirus causes a substantial health burden in the United States each year, and an effective vaccine could have an important health impact," the authors wrote. "Active surveillance of norovirus is warranted to refine burden estimates and provide more detail and precision, particularly with regards to specific norovirus genotypes and economic costs."
Apr 14 Clin Infect Dis abstract


Flu declines in Northern Hemisphere, but respiratory illness still elevated

Flu activity in the Northern Hemisphere has decreased, but flulike illness activity is still elevated in some countries, the World Health Organization (WHO) said in its latest regular update.

However, it warned that the global trends should be interpreted with caution because the COVID-19 pandemic might be influencing health-seeking behaviors and health system capacity for flu testing.

In the United States, for example, flulike illness remained elevated, with the percentage of deaths from pneumonia and flu above the epidemic threshold, though flu-related deaths declined.

In Europe, though flu activity decreased in all reporting countries, flulike illness remained elevated in several countries, including Belgium, Germany, and the Netherlands.

In East Asia, flulike illness markers were at inter-seasonal levels, though in South Asia, flu activity increased in Bhutan, and in South East Asia, flu activity rose in Laos. In the Southern Hemisphere, flu was at inter-seasonal levels, but in Australia, the number of emergency department visits for respiratory symptoms was higher than expected this time of year. Flulike illness indicators increased in some South American countries.

At the global level, influenza A made up 63.3% of positive samples, and of subtyped influenza A viruses, 68.1% were 2009 H1N1.
Apr 13 WHO global flu update

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