Stewardship / Resistance Scan for Jan 03, 2018

News brief

Concerns raised about fluoroquinolone use in New Zealand

Scientists in New Zealand are calling for tighter restrictions on the use of fluoroquinolones, according to reporting by the New Zealand Herald.

New Zealand's Pharmaceutical Management Agency, known as Pharmac, has a list of approved conditions that fluoroquinolones should be used for, but the paper reports that documents obtained from each of the country's 20 District Health Boards reveal that in several hospitals, the drugs have been given to patients with conditions other than those specified by Pharmac. In addition, prescriptions for fluoroquinolone eye drops, which are recommended for cornea infections and sometimes used to treat middle ear infections, have increased by more than 300%.

In May 2017, according to the paper, an infectious disease physician and a pharmacist wrote a letter to Pharmac asking the agency for a change in classification that would require physicians to get approval from an infectious disease specialist or microbiologist before using ciprofloxacin. In their letter, they cited the fact that ciprofloxacin use had increased significantly in New Zealand from 2006 to 2014, and during that time resistance to the drug had likewise increased. Pharmac has not yet announced any plans to restrict use of the drug.

Microbiologists are also concerned about potential side effects, such as nerve damage and tendon ruptures. The Herald reports that the New Zealand Centre for Adverse Reaction Monitoring has received 445 reports of suspected negative reactions to fluoroquinolones since 2007, including 64 cases of tendonitis and 24 tendon ruptures.

According to the Best Practice Advocacy Centre for New Zealand, a non-profit that advocates for best practices in healthcare treatments, ciprofloxacin should be reserved for use in acute pyelonephritis, traveler's diarrhea, gonorrhea, severe foodborne disease caused by Campylobacter or Salmonella, bone and joint infections, and invasive Pseudomonas infections—but only when no other options are available.
Jan 3 New Zealand Herald story

FDA to fast-track new drug application for plazomicin

Biopharmaceutical company Achaogen yesterday announced that the US Food and Drug Administration (FDA) will review the company's New Drug Application (NDA) for plazomicin, an antibiotic for the treatment of complicated urinary tract infections (cUTIs) and bloodstream infections caused by multidrug-resistant (MDR) gram-negative pathogens.

According to a company press release, the FDA has given the drug Priority Review designation, a fast-tract review awarded to drugs that would be a significant improvement over current therapy or provide a treatment where none currently exists. The FDA has set a target action date of Jun 25.

Plazomicin was developed to treat serious bacterial infections caused by MDR pathogens, including extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE) and has been evaluated in two phase 3 clinical trials, EPIC and CARE. In the EPIC trial, plazomicin met the objective of non-inferiority compared with meropenem in patients with cUTI and acute pyelonephritis. In the CARE trial, patients with serious CRE infections receiving plazomicin had a lower rate of mortality and serious disease-related complications compared with those given colistin. The drug was well-tolerated in both trials.

"The number of confirmed cases of CRE annually in the U.S. is at least 70,000, and is projected to double by 2022," Blake Wise, Achaogen's Chief Executive Officer, said in the press release. "We are excited about plazomicin's potential to address certain multi-drug resistant gram-negative infections and feel that plazomicin would be a valuable new treatment option for patients with serious bacterial infections, including those due to CRE and ESBL-producing Enterobacteriaceae."
Jan 2 Achaogen press release
Dec 12, 2016, Achaogen press release on phase 3 results

News Scan for Jan 03, 2018

News brief

Two new MERS cases confirmed in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) recorded two new cases of MERS-CoV in the past several days.

On Dec 30, a 55-year-old expatriate man from Khamis Mushait was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms. He is in critical condition. The man's source of infection is listed as "primary," meaning it's unlikely he contracted the virus from another person.

Yesterday, the MOH said a 57-year-old Saudi man from Riyadh is also in critical condition after showing symptoms of MERS-CoV. His source of infection is also listed as primary.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,762, including 713 deaths. Five patients are still being treated according to the MOH.
Dec 30 MOH report
Jan 2 MOH report

Nigeria reports 7 more confirmed monkeypox cases

Seven more cases of monkeypox have been confirmed in Nigeria, according to the latest update by the Nigerian Centre for Disease Control (NCDC). There are now 68 confirmed cases of the disease in Africa's largest outbreak, with 197 suspected cases and 2 deaths also reported.

The NCDC, in a report dated Dec 22, said that the number of suspected cases was still declining across 22 Nigerian states. Bayelsa, Rivers, and Lagos states have the most cases, including 6 of the 7 newly confirmed cases.

Though clusters of cases have appeared, there is still no obvious link between patients, the NCDC said. However, 11 (7%) of the 149 contacts listed for confirmed cases have contracted the virus, demonstrating that human-to-human transmission is taking place.

Both fatalities have occurred in patients who are immune-compromised, the NCDC said. Most people who contract the disease, which is related to smallpox, recover fully within 3 weeks.
Dec 22 NCDC report

New York City Zika survey reveals gaps in knowledge

A survey to assess Zika prevention and transmission knowledge in residents of New York City neighborhoods that have strong connections to Latin America countries found gaps in information, researchers based at Columbia University reported yesterday in BMC Public Health.

Between Jun 30, 2016, and Oct 21, 2016, they administered an anonymous self-directed 155-question survey developed by the World Health Organization to a convenience sample of people who visited a local health center in northern Manhattan. They were especially interested in Zika knowledge among pregnant women, so the team also administered the survey to obstetric patients at two Columbia University facilities. After 224 respondents took the survey, they received Zika educational materials.

Pregnancy, as expected, was associated with knowledge about about Zika transmission, but not other aspects of the disease. Surprisingly, the team didn't see a connection between travel history and Zika knowledge. Most were aware that mosquitoes can transmit the virus, but they weren't as familiar with other forms of transmission. Only about 60% thought is was possible to contract Zika in their community. Most participants were able to identify some symptoms of Zika virus, but few were able to list all of them. Pregnant women were more likely to know about the risk of Zika-related birth defects, as well as Guillain-Barre syndrome.

Though the survey was translated into Spanish, researchers found some signs of problems with some of the translations.

"The lack of knowledge surrounding Zika as well as insufficient practices in Zika prevention indicate the necessity for sustained public health educational efforts in Zika virus," researchers concluded.
Jan 2 BMC Public Health abstract

Study finds higher airborne microbe levels in more complicated surgeries

An air sampling study of operating rooms at a large medical center in Taiwan found low microbial counts, with the number of colonies higher during transplant and pediatric surgery. Researchers from Taiwan who analyzed air samples from 28 operating rooms from May to August 2015 reported their findings yesterday in BMC Infectious Diseases.

Of the 250 air samples they collected, the mean overall number of colonies was 78 colony forming units per cubic meter (cfu/m³), well below the acceptable 180 cfu/m³ bacterial limit for working operating rooms. A total of 25 samples (10%) contained pathogens. Eleven samples had colony counts exceeding that limit, and all but two of those were obtained before incision when activities such as draping could lead to an increase in bacteria in the air. Similar to earlier studies, staphylococci were the most frequent pathogen isolated.

The team said the higher numbers of colonies seen during transplant and pediatric surgery could relate to higher numbers of staff participating in the operation. They also noted that levels were higher during deep-incision procedures, possibly because they are more complex, requiring participation of more doctors, and that colony levels appears to rise with air temperature.

The main findings suggest that when complex surgeries with larger numbers of staff are done, hospitals could consider increasing the frequency of ventilation system air exchanges to help limit microbial colonies in the air, the authors write.
Jan 2 BMC Infect Dis abstract