Stewardship / Resistance Scan for Jan 23, 2018

News brief

Study finds reduced carbapenem consumption in French hospitals

Researchers in France report that a reduction in carbapenem consumption in French hospitals occurred after the release of national guidelines on carbapenem use in 2010, according to a study yesterday in Antimicrobial Resistance and Infection Control. They suggest that further carbapenem reduction could be linked to reduced use of fluoroquinolones and third-generation cephalosporins (3GCs).

The ward-level multicenter retrospective study, which sought to determine factors associated with reduced carbapenem use in intensive care units (ICUs), medical wards, and surgical wards from 2009 through 2013, was based on data from French surveillance networks of antibiotics and multidrug-resistant bacteria in healthcare facilities. France released guidelines to limit the use of carbapenems in 2010, in response to a rise in carbapenemase-producing Enterobacteriaceae that's been driven in part by a 145% increase in carbapenem use since 2000. The increase in carbapenem use was in response to the spread of extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE).

A total of 493 wards from 259 healthcare facilities were included in the study (85 ICUs, 227 medical wards, and 181 surgical wards). Overall carbapenem consumption over the study period was equal to 73.4 defined daily doses per 1,000 patient days for ICUs, compared with 6.2 in medical wards and 5.4 in surgical wards. While the overall trend showed an increase in carbapenem use from 2009 through 2013 in all wards, the period following release of the guidelines (2011-2013) showed a 2.9% decrease in carbapenem use in ICUs and 1.6% decrease in medical wards. Carbapenem use continued to rise in surgical wards, but the annual growth rate declined from 17.8% to 2.7%.

In multivariable analysis, factors associated with a higher probability of reducing carbapenem consumption included a geographic location in eastern France, a higher initial carbapenem-prescribing profile, and reductions in consumption of fluoroquinolones, glycopeptides, and piperacillin/tazobactam. A higher initial prescribing profile for 3GCs and location in high-risk regions for ESBL-PEs were associated with a lower probability of reducing carbapenem use. The authors note that this finding is explained by ESBL-PE risk, which is promoted by 3GC use and thus leads to more frequent carbapenem prescribing.

The authors conclude, "Our study, carried out on a national scale, in a large number of hospital wards, suggests that a decrease in 3GC proportion in the overall antibiotic use, as well as the continuation of the reduction in fluoroquinolone use, could allow reducing ward-level carbapenem use."
Jan 22 Antimicrob Resist Infect Control study

CARB-X seeks partners to support antibiotic development

CARB-X, the public-private initiative that provides financial and technical support to companies in the early stages of antibiotic discovery and development, is looking to partner with additional accelerator organizations to support its pipeline of research projects.

According to a press release today from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator), the new accelerators are expected to provide a broad range of support to the 22 active research projects in the Powered by CARB-X portfolio. CARB-X says more projects will be added in the coming months.

"Our accelerator partners are essential to CARB-X's mission, providing guidance and expertise to help partner companies accelerate their research and deliver new life-saving antibiotics, vaccines, diagnostics, and other products to patients," CARB-X Executive Director Kevin Outterson, JD, said in the press release.

To date, CARB-X has awarded more than $60 million to help fund early research in new antibiotics, vaccines, and rapid diagnostics to treat drug-resistant infections. The organization is looking to partner with up to six additional accelerator partners in Europe, North America, and the rest of the world.
Jan 23 CARB-X press release

Single-center study finds low levels of C difficile transmission in kids

A single-center Clostridium difficile infection (CDI) study from Northwestern University in Chicago found transmission among symptomatic children uncommon, and they noted that investigation of shared healthcare exposures often did not identify a potential transmission source, according to a study today in Clinical Infectious Diseases.

The investigators performed whole-genome sequencing on C difficile isolates collected from children diagnosed as having CDI from December 2012 to December 2013. Among 131 CDIs in 107 children, the authors identified 104 genetically distinct isolates. Of 84 CDIs occurring 8 weeks or longer after the start of the study, only 10 (11.9%) were caused by a strain similar to another isolate, which would indicate likely in-hospital transmission. The researchers identified shared healthcare facility exposures in only 7 of those 10 cases.

The authors conclude, "C. difficile transmission among symptomatic children was very uncommon, and among putatively transmitted cases, investigation of shared healthcare exposures often did not identify a potential transmission source."
Jan 23 Clin Infect Dis abstract

Deadly outbreak of resistant Acinetobacter frequently involved pneumonia

A separate study yesterday in Antimicrobial Resistance and Infection Control determined that multidrug-resistant Acinetobacter baumannii (MDR-Ab) infections in a Beirut hospital from 2007 through 2014 mostly consisted of ventilator-associated pneumonia and killed up to two thirds of patients.

The researchers conducted a case-control study after MDR-Ab cases more than doubled at the American University of Beirut Medical Center ICU in 2007. That study involved patients diagnosed as having MDR-Ab in 2007 and 2008. The team also conducted a prospective study of MDR-Ab spread in the ICU in 2007 through 2014. The studies included 128 cases collectively and 99 patients who had MDR-Ab colonization but no evidence of active infection.

The vast majority—84%—of cases were deemed hospital acquired, and 53% were ventilator-associated pneumonia. Mortality rates ranged from 52% to 66%. The investigators listed a range because "it was difficult to calculate the attributable mortality due to the fact that many patients were critically ill with multiple comorbid conditions."

The authors concluded, "Infection control measures should be reinforced to control the transmission of these organisms in the ICU."
Jan 22 Antimicrob Resist Infect Control study

News Scan for Jan 23, 2018

News brief

Recent MERS case-patient dies in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) said yesterday a woman from the village of Al Qaryat died from MERS-CoV.

The 60-year-old Saudi woman's MERS-CoV (Middle East respiratory syndrome coronavirus) case was announced last week. Her infection source was listed as "primary," meaning it was unlikely she contracted the virus from another person.

Her death brings the total number of MERS-CoV deaths since 2012 to 725 out of 1,777 cases total. Eight people are currently being treated for their infections.

In other MERS-CoV news, Malaysia declared it is free of virus, given that two incubation periods have passed with no new cases have been announced since Dec 31, when a man who had recently returned from Saudi Arabia was diagnosed as having the disease. According to a media report, a total of 75 contacts were closely followed, but there is no sign of ongoing transmission, the Malaysian ministry of health said.

The man told authorities he drank camel's milk and came into contact with camels as he was making a religion pilgrimage throughout Saudi Arabia.
Jan 22 MOH update
Jan 23 New Straits Times story

Antibody levels shed light on influenza immunity

A study today in mBio shows how human antibodies to hemagglutinin (HA) protein dictate the immune system's response to the influenza virus

Humans generate anti-HA stem antibodies in response to flu infection, and this is the first study to assess if these antibodies are a predictor of protection against influenza.

In the study, 65 healthy adults were isolated and exposed to the 2009 H1N1 strain of influenza, with HA levels measured before, during, and after exposure. A total of 64% of participants had increased HA levels after infection, but HA levels did not correlate to severity of influenza infection.

Researchers said that understanding the HA protein has wider implications for influenza vaccines, as the HA part of the virus doesn't change or mutate as quickly as the neuraminidase (NA) protein, the traditional target for seasonal flu vaccines.

"This analysis demonstrates that antibody responses to influenza virus vary and that protection is likely to be complex and multifactorial. Our belief is that future universal vaccine strategies should ideally focus on more than one target and/or aspect of immunity," the authors concluded.
Jan 23 mBio study
Jan 23 NIH news release

More suspected RVF cases in South Sudan and 1 in Senegal

In an ongoing investigation into a suspected Rift Valley fever (RVF) outbreak in South Sudan, six more suspected cases have been reported, and health officials are waiting on results from tests on a blood sample from a contact of one of the three initial patients in the cluster, the World Health Organization (WHO) Regional Office for Africa said in its last weekly health emergency and disease outbreak update. Testing is also underway on six other suspected cases.

One suspected case reported last week has been ruled out, based on negative lab tests. Of tests on animals, a sample from a sick cow showed an IgG titer consistent with previous RVF infection. Tests on six other animals, which included sheep and goats, were negative.

The WHO said though insecurity in the area is a challenge, surveillance for human and animal cases needs to be scaled up rapidly to detect new cases. It added that while signals point to Rift Valley fever as the outbreak's cause, more substantial confirmation is needed.

In other RVF developments, Senegal's health ministry reported a suspected RVFcase to the WHO involving a Korean man who was hospitalized in Dakar. An IgM test on blood sample from the man, a 52-year-old who was working in Gambia for a fishing company and had no history of handling raw meat, was positive for exposure to Rift Valley virus.

In early December, the man and three travel partners traveled to Senegal, then on to Guinea-Bissau. As they made their way back to Gambia, the man's symptoms began, with his brother and driver also experiencing a dry cough. The man's symptoms worsened, and he was hospitalized in Gambia, where he was diagnosed with severe malaria. When his condition deteriorated, he was hospitalized in Senegal, where blood samples were taken and he died on Dec 31 after experiencing hemorrhagic symptoms. Samples from the man's symptomatic contacts are negative for acute infection.

The WHO said RFV outbreaks are uncommon in Gambia and neighboring countries, with Gambia reporting its last case in 2002. So far, there's no sign of a risk of major outbreaks in any of the three countries the man recently visited.
Jan 22 WHO report
Jan 16 CIDRAP News scan "Rift Valley fever suspected in South Sudan VHF cluster; 2 cases reported"