Stewardship / Resistance Scan for Feb 13, 2019

News brief

Dental antibiotic stewardship program shows promising results

A team of dentists, pharmacists, and physicians at the University of Illinois reported today in Open Forum Infectious Diseases that implementation of a comprehensive antibiotic stewardship intervention in a dental practice was associated with a significant improvement in antibiotic prescribing.

After conducting a baseline needs assessment and literature evaluation to identify opportunities to improve antibiotic prescribing, faculty from the University of Illinois at Chicago (UIC) College of Dentistry, UIC College of Pharmacy, and the University of Illinois Hospital and Health Sciences System devised and implemented a multimodal intervention that focused on antibiotic use for acute oral infections, a common condition in the UIC dental clinic.

The intervention, which is consistent with the Centers for Disease Control and Prevention's Core Elements of Outpatient Antibiotic Stewardship, included patient and provider education, clinical guideline development, and an assessment of the antibiotic prescribing rate per urgent care visit before and after the educational intervention.

The results of the assessment showed that, among all providers in the practice, the antibiotic prescribing rate per urgent care visit decreased by 72.9% before and after the multimodal intervention (pre-intervention urgent care prescribing rate [September 2017], 8.5% [24/283]; post-intervention [May 2018], 2.3% [8/352], P < 0.001). Clinical providers also reported that they had become more conscious of appropriate prescribing since implementation of the educational guidelines.

The authors of the study say the results suggest that simple educational interventions may decrease antibiotic prescribing in the dental setting, which accounts for 10% of all outpatient prescribing, and may be adapted to other dental practices.
Feb 13 Open Forum Infect Dis abstract


Study weighs value of antibiotics for resistant Staph in pandemic settings

An effective antibiotic that can treat secondary Staphylococcus aureus infections in a pandemic flu outbreak is worth more than $3 billion, according to a new study by researchers from the Center for Disease Dynamics, Economics, and Policy (CDDEP) and their colleagues in Scotland and the Netherlands.

Writing in Health Economics, the authors said though antibiotic reserves are part of pandemic preparedness plans, experts haven't explores the value of stockpiling or conserving the effectiveness of antibiotics, despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics because of emerging antibiotic-resistant organisms.

Using a mathematical framework based on UK preparedness plan assumptions the scientists estimated the value of investing in developing and conserving an antibiotic to lessen the burden of bacterial infections from resistant S aureus during a pandemic flu outbreak.

The team found that the value of withholding an effective new oral antibiotic can be positive and significant unless the pandemic is mild, with few secondary illnesses involving the resistant strain or if most patients can be treated intravenously.

Ramanan Laxminarayan, PhD, MPH, CDDEP director and the study's senior author, said in a CDDEP press release that secondary bacterial infections are a major cause of death and disability with flu, and antibiotic resistance is a major barrier to treating those infections. "This study shows that the value of an effective antibiotic against Staph infections, as an insurance policy against future pandemics, is between $3 [billion] and 4 billion at baseline," he said.
Feb 11 Health Econ abstract
Feb 12 CDDEP press release



News Scan for Feb 13, 2019

News brief

Saudi Arabia, Oman record new MERS cases

Today health officials in Saudi Arabia and Oman reported one new case of MERS-CoV each. This is the sixth case recorded in recent weeks in Oman; in Saudi Arabia, the new case is possibly linked to an ongoing hospital outbreak in Wadi ad-Dawasir.

According to the Muscat Daily yesterday, the Omani Ministry of Health tweeted that a new patient had been diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus).

Recent cases in Oman are the first recorded in that country since March of 2018. Earlier this week, the World Health Organization said the cluster reported in Oman included five women, age 30 to 59, living in the same region. Officials provdied no details on the new patient.

In Saudi Arabia, the Ministry of Health (MOH), in an update to its epidemiologic week 7 report, said a 50-year-old man from Wadi ad-Dawasir is in home isolation for his infection. He did not have camel contact, and the source of his infection is under investigation.

The latest case raises Saudi Arabia's number of MERS-CoV cases since the first of the year to 60, which includes 37 from Wadi ad-Dawasir.
Feb 12 Muscat Daily story
Feb 13 Saudi MOH report
Feb 11 CIDRAP News story "Saudi MERS total grows; WHO details Oman cluster"


FDA implicates reservoir water in E coli lettuce outbreak investigation

Today US Food and Drug Administration Commissioner, Scott Gottlieb, MD, released findings from an FDA investigation into the source of a romaine lettuce Escherichia coli outbreak that sickened 62 people late last year in 16 states and the District of Columbia, implicating irrigation water and possible wild-animal exposure but leaving some questions yet unanswered.

The illnesses were caused by Shiga toxin–producing E coli O157:H7 traced back to a contaminated farm in Santa Barbara County, California. The FDA investigation found that contaminated water on the farm's agricultural reservoirs caused the outbreak. 

"It is believed that this water came into contact with the harvested portion of the romaine lettuce, since the outbreak strain of E. coli O157:H7 was found in sediment from the reservoir and in no other sampled locations," Gottlieb said. "The water from the reservoir doesn't explain how lettuce grown on other ranches or farms identified by traceback may have been contaminated. So, this one farm cannot explain the entire outbreak."

The FDA also said investigations revealed evidence of extensive wild animal activity on the farm, including waterfowl, rodents, and coyotes, as well as animal burrows near the contaminated water reservoir.

Gottlieb said the FDA and the Centers for Disease Control and Prevention (CDC), which partnered with the FDA to investigate the outbreak, will continue to work with farmers and producers to reduce contamination risk.

From 2009 to 2017, the FDA and CDC identified 29 foodborne illness outbreaks of Shiga toxin–producing E coli with a confirmed or suspected link to leafy greens. Earlier in 2018, romaine lettuce grown in Yuma, Arizona, was also linked to a multistate E coli outbreak. 
Feb 13 FDA press release  
Jan 10 CIDRAP News Scan "CDC ends probe of E coli outbreak tied to tainted California lettuce"


H5N8 avian flu strikes penguin breeding site in Namibia

Namibia's agriculture ministry yesterday reported a highly pathogenic H5N8 avian flu outbreak—the country's first detection of the strain—that struck African penguins at a conservation site on Halifax Island, located just off the country's mainland, according to a notification from the World Organization for Animal Health (OIE).

The outbreak began on Feb 2 at the island breeding site of about 7,000 African penguins. The virus killed 217 birds and sickened 223. The penguins had neurologic signs, corneal opacity, and lethargic or comatose behavior. Six birds were culled. Two of the birds collected from the island and taken to the Luderitz Marine Research Quarantine Center showed neurologic signs and were destroyed.

The source of the virus isn't known but may be migratory birds. Animal health officials said the disease is limited to African penguins and no other wild birds on Halifax Island were affected.

H5N8 has been implicated in an outbreak involving penguins before in the region. In February 2018, South Africa reported an outbreak in sea birds that included African penguins, which were treated for their infections because of their endangered status.
Feb 12 OIE report


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