Stewardship / Resistance Scan for Jan 08, 2018

News brief

VRE infections associated with significant costs, study finds

A case-control study by German investigators has found that nosocomial infections caused by vancomycin-resistant enterococci (VRE) are costlier than those caused by vancomycin-susceptible enterococci (VSE), according to a new study in Antimicrobial Resistance & Infection Control.

VRE infections are known to result in more invasive procedures, additional antibiotic therapy, and extended time in the hospital, and studies conducted in the United States have found a considerable impact on hospital costs. But to date, no such studies have been conducted in Europe. This study, performed at a tertiary care hospital in Hanover, Germany, set out to determine the costs that are directly attributed to vancomycin resistance by comparing hospital costs of VRE and VSE infections. The investigators also determined factors that may be associated with increased costs of VRE patients.

In the study, 42 cases with VRE infections and 42 controls with VSE infections admitted from January 2005 to December 2008 were matched for type of infection, age, gender, admission and discharge within the same year, Charlson Comorbidity Index (± 1), and time at risk for infection. Median overall costs per case were significantly higher for VRE patients compared with controls (€57,675 vs. €38,344, or $69,001 vs. $45,874), with no significant difference in costs between the two groups before onset of infection (€17,893 vs. €16,600, or $21,407 vs. $19,860) but much higher per-patient costs for VRE patients after onset of infection (€37,971 vs. €23,025, or $45,431 vs. $27,546). The median attributable costs per case for vancomycin resistance were €13,157 ($15,742).

Detailed analysis of the costs after onset of infection showed that the major drivers of cost differences were pharmaceuticals, nursing staff, medical products, and assistant medical technicians. Multivariate analysis revealed that VRE infection was independently associated with a 1.4-fold increase in total costs per patient.

"These results emphasize the importance of strategies for the prevention of VRE spread in the hospital," the authors write.
Jan 5 Antimicrob Resist Infect Control study

ICU risk factors for multidrug-resistant Acinetobacter baumannii identified

In another case-control study in Antimicrobial Resistance and Infection Control, researchers in China identified risk factors associated with multidrug-resistant Acinetobacter baumannii (MDR-AB) infection.

In the study, the researchers identified 489 intensive care unit (ICU) patients at three tertiary general hospitals in Xiamen, China, who had A baumannii isolated from January 2015 to December 2015. MDR-AB was detected in 39.9% of all cases (195 patients). In both MDR-AB and non-MDR-AB patients, the pathogen was commonly isolated in the respiratory tract (72.3% vs. 66.3%). Multivariate regression analysis revealed that mechanical ventilation (odds ratio [OR], 3.93), combined use of antibacterial drugs before infection (OR, 4.11), and indwelling catheters (OR, 4.15) were independent risk factors associated with MDR-AB infection.

The researchers also found that the risk of MDR-AB infections increased with higher age and longer time of mechanical ventilation.

The authors of the study say their findings could help inform future management of MDR-AB patients in ICU clinical practice.
Jan 5 Antimicrob Resist Infect Control study

News Scan for Jan 08, 2018

News brief

Saudi Arabia identifies 2 new MERS cases

The Saudi Arabian Ministry of Health (MOH) recorded two new cases of MERS-CoV in Riyadh in recent days.

On Jan 5, a 48-year-old Saudi man from the country's capital was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) after presenting with symptoms. He is in stable condition. The MOH said the man had direct contact with camels, a known risk factor for MERS-CoV.

Yesterday, another Saudi man from Riyadh was diagnosed as having the disease. The 36-year-old is in critical condition. The source of his infection is listed as "primary," meaning it's unlikely he contracted the virus from another person.

On Jan 6 the MOH also reported the death of a patient who was diagnosed last week, a 55-year-old male expatriate from Khamis Mushait. He was not a healthcare worker and had preexisting disease.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,765, including 715 deaths. Six patients are still being treated, according to the MOH.
Jan 5 MOH report
Jan 6 MOH report
Jan 7 MOH report

Sabin announces $6.6 million grant for next-generation flu vaccines

The Sabin Vaccine Institute today announced a new 3-year $6.6 million grant—supported by the Page Family Donor Advised Fund—to speed the development of next-generation flu vaccines. Also, the funding is designed to support immunization-related issues, Sabin, a nonprofit global health group based in Washington, DC, said in its press release today.

Bruce Gellin, MD, MPH, Sabin's president of global immunization, said this year marks the 100th anniversary of the 1918 Spanish flu pandemic, and the world must not wait any longer to develop new vaccines with the potential to eliminate the threat of pandemic and seasonal flu. "Promising research is already underway, but we know we need to do more to ensure that a so-called 'universal flu vaccine' is available before we need it," he said in the statement.

As part of the plans to boost flu vaccine research, Sabin said it will establish an Influenza Leadership Council to identify novel approaches and communicate the urgent need for next-generation vaccines. The members will support an influenza advocacy work to engage the public, such as workshops and pandemic flu simulations. The grant will also support a project with the Aspen Institute's Health, Medicine, and Society Program to establish a group to tackle vaccine science and policy strategy.

In 2012, an expert panel led by the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), the publisher of CIDRAP News, detailed protection gaps in current flu vaccines and problems with their production and urgently called for game-changing flu vaccines.
Jan 8 Sabin Vaccine Institute press release
2012 CIDRAP report

Chinese child recovers after H5N6 infection

China has reported another human H5N6 avian flu case, which involved a 3-year-old girl from Fujian province who had contact with live poultry before she became ill, Hong Kong's Centre for Health Protection (CHP) said in a Jan 6 statement.

The girl recovered after treatment, and so far her close contacts have not reported any symptoms. Her illness marks China's 18th involving H5N6 since the first human case was detected in 2014. At least 10 of the patients died from their infections. She is the second child to be affected by the virus.

China reported its last H5N6 case in November, involving a 33-year-old man from Guangxi province who also had contact with live poultry before he became ill.
Jan 6 CHP statement

Number of confirmed yellow fever cases in Nigeria grows to 33

A World Health Organization (WHO) lab has confirmed a new yellow fever case in Nigeria, while the number of total cases in the country has climbed to 358, Nigeria's Centre for Disease Control (NCDC) reported in an update posted late last week.

As of Jan 2, 33 of 63 samples that had initially tested positive in Nigerian labs were confirmed as positive for yellow fever at a WHO reference lab in Dakar, Sengal. That is one more confirmed case than the WHO reported on Dec 22. Since the Dec 22 WHO update, the NCDC has reported 17 new confirmed and suspected cases, for a total of 358.

The new confirmed case was in Niger state, which brings the number of states with confirmed cases to seven, one more than the WHO had reported. Sixteen states have reported suspected cases.

About 68% of patients are 20 years and younger, and 62% are male. The outbreak started in Kwara state in September 2017.
Jan 5 NCDC update
Dec 27 CIDRAP news scan on WHO update

European salmonellosis outbreak tied to infant formula grows

An outbreak of Salmonella Agona infections in European infants has grown by 1 case, to 36 infections, with an additional case possible, the European Centre for Disease Prevention and Control (ECDC) said in a Jan 5 update.

The WHO first announced the outbreak on Dec 22, when 25 infants in France were known to be infected. Since then Spanish health officials have confirmed a case in an infant, and Greece might also have a case, the ECDC said. Different brands of infant formula from the same producer in France—Lactalis Nutrition Sante—have been implicated. The formula was distributed to 48 countries, including some in Africa, Asia, the Middle East, and French overseas territories, the WHO noted.

"The Institut Pasteur in Paris reported that S. Agona isolates associated with the outbreak displayed an atypical characteristic allowing the identification of cases probably associated with the outbreak," the ECDC said in its update. It added, "A joint whole genome sequencing (WGS) analysis confirmed that the Spanish case is associated with the ongoing outbreak in France and may provide further confirmation whether also the Greek case and possible cases from other countries are associated."

A broad recall of the products was initiated last month.
Jan 5 ECDC update
Dec 22 CIDRAP News scan on WHO statement