Stewardship / Resistance Scan for Feb 26, 2020

News brief

New global AMR surveillance partnership announced

The International Society for Infectious Diseases' (ISID's) Program for Monitoring Emerging Diseases (ProMED) today announced that it is teaming up with Public Health England to boost global antimicrobial resistance (AMR) surveillance efforts.

The organizations will collaborate on a surveillance platform, called ProMED-AMR, that will use digital detection methods and non-traditional sources to collect information on resistance trends, clusters of AMR, and newly identified cases in all World Health Organization regions. The platform will collect data on resistant pathogens in humans, animals, and the environment, and disseminate vetted and analyzed reports to an international audience of subscribers in real time.

"Antimicrobial resistant organisms have become major emerging pathogens of our era and ProMED-AMR will apply the same approaches to this problem as it has used so successfully in detecting and monitoring other emerging disease threats," ISID president Marc Mendelson, MBBS, PhD, said in a news release.

All information from the platform will be available free of charge.
Feb 26 ISID news release

Study: Antibiotics fail in 22% of pneumonia outpatients

An analysis of US health insurance claims data has found that antibiotic treatment failure occurs in 22% of adult patients receiving outpatient care for community-acquired pneumonia (CAP), a team of US researchers reported today in Open Forum Infectious Diseases.

For the retrospective cohort analysis, the researchers combed through data from the Marketscan commercial and Medicare supplemental databases to identify adults who were diagnosed and treated for CAP in the outpatient setting from 2011 through 2015 and received an antibiotic within 3 days of diagnosis. The primary outcome was antibiotic treatment failure, and secondary outcomes included 30-day all-cause mortality and CAP-related healthcare costs within the 30-day follow-up period.

A total of 251,947 unique patients met the criteria for the study. Their mean age was 52.2 years old, and 47.7% were men. The majority of patients were prescribed azithromycin (39.5%) or levofloxacin (36.9%). Overall, antibiotic treatment failure occurred in 22.1% of patients, but was higher in patients over 65 (25.7%, compared with 21.2% for adults aged 18 to 64). In both groups, treatment failure most frequently occurred with beta-lactam antibiotics. The most common type of treatment failure was a change to a new prescription.

Overall, all-cause mortality within 30 days of index treatment occurred in 7.6% of patients, but it was significantly higher in the antibiotic failure patients compared with the antibiotic success cohort (18.1% vs 4.6%), and the differences in 30-day mortality between antibiotic failure groups increased as a function of age. Mean 30-day CAP-related healthcare costs were also much higher in the patients who experienced treatment failure relative to those that did not ($2,140 vs. $54, respectively).

The authors of the study call the poor patient outcomes observed in patients who experienced antibiotic treatment failure "both clinically relevant and highly concerning."

"Collectively, our findings indicate significant shortcomings in the current treatment approach to managing patients with CAP in the outpatient setting, especially among those who are not responsive to initial therapy," they write. "The results of this study also identify great opportunities to improve the clinical management plans, including appropriate allocation of healthcare resources to avoid adverse outcomes for patients with CAP."
Feb 26 Open Forum Infect Dis abstract

News Scan for Feb 26, 2020

News brief

Study ranks relative effectiveness of influenza vaccines in seniors

A study today in the Journal of Infectious Diseases found that egg-based adjuvanted and high-dose (HD) flu vaccines had slightly higher relative vaccine effectiveness (RVE) than egg-based quadrivalent (four-strain) vaccines in nearly 13 million Medicare beneficiaries 65 and older during the 2018-19 flu season.

Led by US Food and Drug Administration (FDA) scientists, the researchers conducted a retrospective cohort study using inverse probability of treatment weighting and Poisson regression to measure RVE in preventing flu-related hospitalizations and emergency department visits.

They found that egg-based adjuvanted vaccines had an RVE of 7.7% (95% confidence interval [CI], 3.9% to 11.4%), and HD vaccines had an RVE of 4.9% (95% CI, 1.7% to 8.1%). Cell-cultured quadrivalent vaccines were not significantly more effective than egg-based quadrivalent vaccines, which had an RVE of 2.5% (95% CI, -2.4% to 7.3%).

"We did not find major effectiveness differences between licensed vaccines used among the elderly during the 2018-19 season," the researchers wrote. "Consistent with prior research, we found that the egg-based adjuvanted and high-dose vaccines were slightly more effective than the egg-based quadrivalent vaccines."

Previous studies in this age-group found a moderately higher RVE for HD influenza vaccines than standard-dose (SD) vaccines during most seasons. Research during the A(H3N2)-dominated 2017-18 season demonstrated a slightly higher RVE for the cell-cultured vaccine than the SD egg-based versions.

Nearly half a million influenza-related hospitalizations and 12,000 to 56,000 deaths occur each year in the United States, most in people 65 and older. Vaccination is the main tool to prevent flu, but its effectiveness in older people has been low during recent seasons, particularly in those in which H3N2 viruses dominated.
Feb 26 J Infect Dis abstract

FDA warns Jimmy John's after recent E coli, Salmonella outbreaks

The FDA last week warned Jimmy John's restaurants after identifying five outbreaks of Shiga toxin–producing Escherichia coli and Salmonella in recent years linked to the sandwich chain's clover sprouts and cucumbers.

In a Feb 21 letter to Jimmy John's President James North, the agency says it detected the outbreaks along with the Centers for Disease Control and Prevention and state and local organizations. "Taken together, these outbreaks, which spanned over the past seven years and impacted no fewer than seventeen states demonstrate the corporate-wide supplier control mechanisms you have in place for receiving fresh produce are inadequate," wrote William Weissinger, program division director of the FDA's Office of Human and Animal Foods.

In the latest outbreak, involving E coli infection, 20 of 22 people sickened in December 2019 reported eating at Jimmy John's restaurants in Iowa. In 2018, 8 of 10 people infected with Salmonella in Illinois and Wisconsin reported eating sprouts at the chain. In 2014, 11 of 19 cases of E coli in six states were traced to five Jimmy John's restaurants. In 2013, 8 people in Colorado were infected with E coli after eating cucumbers at the chain. In 2012, 23 of 29 people in 11 states infected with E coli had sprouts at Jimmy John's.

In May 2012, the letter states, the FDA met with North, who promised to buy clover sprouts from only a single supplier. However, "documents from traceback investigations conducted by FDA, states and local partners demonstrate that in addition to [that supplier's] sprouts, Jimmy John's restaurants are using multiple other sources of sprouts," the letter noted.

The letter acknowledges that Jimmy John's parent company, Inspire Brands, destroyed all sprouts and sanitized its Iowa-based restaurants in December 2019. However, it asks for a list of steps that the company has or will take to prevent the sale of adulterated food at all of its restaurants. The chain has 15 days to file a written response.

CBS News reports that Jimmy John's stopped selling sprouts at all restaurants on Feb 24.
Feb 21 FDA letter
Feb 26 CBS News story