Stewardship / Resistance Scan for Jan 10, 2019

News brief

Wyoming reports colistin-resistant MCR-1 infection

A patient in a Laramie County, Wyo., hospital has been confirmed to have an infection caused by an Enterobacteriaceae containing the MCR-1 resistance gene, which confers resistance to the critical antibiotic colistin, the Wyoming Department of Health (WDH) said yesterday in a news release.

The patient is receiving care at Cheyenne Regional Medical Center (CRMC), but officials say the infection was likely acquired outside the hospital. Hoo Feng Choo, MD, an infectious disease specialist at CRMC, said "Thankfully, the patient continues to receive care, has responded to treatment, and is in good condition."

Tests by a US Centers for Disease Control and Prevention (CDC) lab confirmed the findings.

Alexia Harrist, MD, PhD, state health officer, said, "When bacteria become antibiotic-resistant, then certain categories of antibiotic medicines will not work to kill the bacteria to treat an infection. In this case, the organism found is resistant to a category of antibiotics sometimes described as 'last resort' medications used to fight infections. The gene found with this patient has been identified in only a handful of states over the past few years."

She added, "We believe the contact precautions already in place at the hospital have likely limited the potential spread of the bacteria." WDH epidemiologist are working with CRMC staff to help with infection control.

MCR-1 was first identified in China in 2015 and has since been reported in more than 30 nations.
Jan 9 WDH news release


CDC issues advisory over antibiotic-resistant infections in Tijuana, Mexico

The CDC yesterday warned the public and healthcare professionals about potential infections with an antibiotic-resistant form of Pseudomonas aeruginosa bacteria after US residents contracted the serious infections following medical procedures in Tijuana, Mexico.

The agency issued a level 2 (out of 3) alert and recommended visitors to practice enhanced precautions. "All of the travelers with this particular infection had an invasive medical procedure performed in Tijuana," the CDC said. "Most (but not all) of them had weight-loss surgery. About half of those infected had their surgery done at the Grand View Hospital."

Mexican officials have closed the hospital until further notice, the CDC said. It did not specify the number of cases but said, "Infections caused by this particular drug-resistant Pseudomonas are rare in the United States and difficult to treat."

The advisory includes several steps travelers should take, including seeing a travel medicine specialist at least a month before their trip, as well as recommendations for clinicians. Pseudomonas is found widely in the environment, and P aeruginosa is the most common type that infects people.
Jan 9 CDC alert

News Scan for Jan 10, 2019

News brief

Government shutdown cuts domestic food inspections

Because of the federal government shutdown, now in its third week, the Food and Drug Administration (FDA) has suspended all routine inspections of domestic food-processing facilities, a move that alarms some food safety advocates.

Sarah Sorscher, JD, MPH, deputy director of regulatory affairs for the Center for Science in the Public Interest (CSPI) said in a statement, "Regular inspections, which help stop foodborne illness before people get sick, are vital. Work to finish rules under the Food Safety Modernization Act has also ground to a halt, impairing efforts to improve produce safety, recall communication, and outbreak tracing."

On Twitter, FDA Commissioner Scott Gottlieb, MD, said the agency was taking steps to minimize risks during the shutdown. He noted that the agency is still doing inspections on all foreign food, but domestic inspections have been halted.

According to Gottlieb, 31% of those domestic inspections are for high-risk foods. Typically the FDA conducts about 160 domestic food inspections in a given week, he added.
Jan 8 CSPI statement
Scott Gottlieb Twitter feed


CDC ends probe of E coli outbreak tied to tainted California lettuce

Yesterday, the Centers for Disease Control and Prevention (CDC) announced that the outbreak of Escherichia coli linked to tainted romaine lettuce from California appeared to be over, adding that contaminated lettuce that sickened people should no longer be available.

A total of 62 people were infected with the outbreak strain of Shiga toxin–producing E coli O157:H7 in 16 states and the District of Columbia, 3 more cases than the CDC reported on Dec 13, 2018. There were no reported deaths, but 25 people required hospitalization, including 2 who developed hemolytic uremic syndrome, a type of kidney failure.

Illness-onset dates ranged from Oct 7, 2018, to Dec 4, 2018, and 30 of 36 people interviewed reported eating romaine lettuce in the week prior to illness.

"CDC identified the outbreak strain of E. coli O157:H7 in sediment collected within an agricultural water reservoir on an Adam Bros. Farming Inc. farm in Santa Barbara County, which was identified in the traceback investigation,” the agency said.

On Dec 13, 2018, Adams Bros. Farming, Inc, recalled red leaf and green leaf lettuces and cauliflower harvested at the end of November.
Jan 9 CDC


Review: Low impact of last year's vaccination on flu vaccine protection

A meta-analysis published today in BMC Medicine found that receiving the flu vaccine in the previous season had a small impact on flu vaccine effectiveness (VE) against some strains but overall the benefits of receiving the vaccine each year outweighed any shortcomings.

Some studies in recent years have demonstrated reduced VE in people who received the flu vaccine the previous year, but findings have not proven consistent. In today's study, researchers from Canada and Hong Kong assessed 634 studies before including 20 in their analysis.

When the investigators compared vaccination in both seasons compared with vaccination in the previous season only VE was 25% higher against the H1N1 strain, 18% higher against B strains, but the same for H3N2 for those receiving flu vaccine both years. When compared with those receiving no vaccine in either year, the increase in VE was 62% for H1N1, 64% for B, and 45% for H3N2 for people receiving consecutive-year vaccination.

In addition, the group observed no differences in VE between those vaccinated in both seasons compared with those vaccinated only in the current season for H1N1 but 11% lower protection against influenza B strains and 20% lower protection against H3N2.

The authors conclude that the results support getting the vaccine each year regardless of vaccination history. They write, "Although VE was lower against H3N2 and B for individuals vaccinated in both seasons compared to those vaccinated in the current season only, it should be noted that past vaccination history cannot be altered and this comparison disregards susceptibility to influenza during the prior season among those vaccinated in the current season only.

"In addition, our results for H3N2 were particularly influenced by the 2014-2015 influenza season, and the impact of repeated vaccination for all types/subtypes may vary from season to season."
Jan 10 BMC Med study

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