Stewardship / Resistance Scan for Jul 25, 2019

News brief

Study finds substantial costs, extended hospital stays from C diff

A population-based analysis indicates that hospital-acquired Clostridioides difficile infection (HA-CDI) is associated with millions of dollars in attributable costs and with extended hospital stays, Canadian researchers reported today in Infection Control and Hospital Epidemiology.

In a multicenter, propensity-score–matched cohort study, researchers from the University of Calgary and Alberta Health Services compared adult inpatients at 14 Alberta hospitals who had developed HA-CDI with adult inpatients who had not developed HA-CDI, using data available from April 2012 through March 2016. The outcomes were attributable costs and length of stay at the hospital where HA-CDI was identified.

The mean adjusted costs of HA-CDI cases was $83,155 (USD $64,178), compared with $12,465 (USD $9,620) for non-cases, with HA-CDI cases incurring more costs across all categories and having longer stays. Of the 2,916 HA-CDI cases at facilities with microcosting data available, 2,871 were matched to 13,024 non-cases. Adjusted outcomes after matching showed that the total adjusted cost among HA-CDI cases was 27% greater than non-cases (ratio, 1.27; 95% confidence interval [CI], 1.21 to 1.33). The mean attributable cost of a typical HA-CDI case was $18,386 (USD $14,190). The adjusted length of stay among HA-CDI cases was 13% longer than non-cases (ratio, 1.13; 95% CI 1.07 to 1.19), corresponding to an extra 5.6 days in the hospital.

Extrapolating those results to the entire cohort of HA-CDI cases that occurred in Alberta during the study period, the burden to the healthcare system was an additional 5,856 hospital days and an excess of $19,227,379 (USD $14,839,376) per year on average.

The authors of the study conclude, "Our estimates will assist decision makers, healthcare providers, and patients in understanding the healthcare system burden of disease, justifying expenditures in intervention efforts and policies related to infection prevention and control, evaluating program effectiveness, determining allocation of research funding, and assessing the potential cost savings or bed days saved due to prevented infections."
Jul 25 Infect Control Hosp Epidemiol abstract


MCR-1, MCR-3–carrying E coli reported in New Zealand

Researchers from New Zealand yesterday reported the identification of the colistin-resistance genes MCR-1 and MCR-3 in a clinical Escherichia coli isolate. The findings were published in the Journal of Antimicrobial Chemotherapy.

The isolate, one of 23 clinical randomly collected in New Zealand from 2015 through 2018 and tested for colistin susceptibility, was from a woman in her late 60s with a spinal cord injury who was being treated for a urinary tract infection (UTI). Antimicrobial susceptibility testing showed that the isolate was resistant to multiple classes of antibiotics, and multilocus sequence typing identified it as belonging to ST101, an E coli sequence type found infrequently in New Zealand. Whole-genome sequencing located the MCR-1 and MCR-3 genes on separate plasmids, along with other antibiotic resistance genes, including blaCTX-M-55. 

Further inquiry revealed the patient had traveled to Thailand 4 months prior to her UTI, and the researchers suspect that the MCR-1 and MCR-3–carrying E coli was likely acquired there, since MCR-3 and blaCTx-M-55 have links to Thailand.

To date, only two other clinical isolates carrying both MCR-1 and MCR-3—a Salmonella isolate and an E coli isolate—have been reported.
Jul 24 J Antimicrob Chemother abstract


Resistant Pseudomonas death in Utah linked to surgery in Mexico

A Utah resident who died after traveling to Tijuana, Mexico, for weight-loss surgery tested positive for a multidrug-resistant form of Pseudomonas aeruginosa, according to a news release from the Utah Department of Health (UDOH).

The patient was one of eight Utah residents who tested positive for Verona integron-encoded metallo-beta-lactamase–producing carbapenem-resistant P aeruginosa (VIM-CRPA) after getting weight-loss surgery in Tijuana. Interviews with patients or their family members revealed that seven of the eight patients had the same surgeon.

The Utah VIM-CRPA cases are linked to similar cases that have been reported to state health departments and the Centers for Disease Control and Prevention (CDC) since September 2018. On May 24, the CDC reported that 12 VIM-CRPA cases with links to surgical procedures in Mexico had been identified in seven states. Eleven of the 12 patients reported having bariatric surgery at five hospitals in Mexico. Six of the patients were subsequently hospitalized in the United States for their infection, and one died.

UDOH said individuals who had a surgical procedure in Tijuana during or after August 2018 and are experiencing signs of infection—including fever, redness, drainage from the surgical site, or swelling at the surgical site—should seek immediate medical care. The department is also recommending that residents not travel to Mexico for invasive surgical procedures.

"I cannot stress enough the safest course of action is not to travel to Mexico for these procedures," Allyn Nakashima, MD, manager of the UDOH Healthcare-Associated Infections/Antimicrobial Resistance Program, said. "Using an internationally accredited facility is not a guarantee that your medical care will be free of complications."
Jul 22 UDOH news release
May 23 CIDRAP News stewardship/resistance scan

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News Scan for Jul 25, 2019

News brief

Phase 1 trial of first MERS vaccine shows strong immune response

Results from the world's first phase 1 trial of a vaccine against MERS-CoV (Middle East respiratory syndrome coronavirus) demonstrated a strong immune response after two doses and a good safety profile. The trial involved 75 US Army volunteers and was published yesterday in The Lancet Infectious Diseases.

The study, conducted at Walter Reed Medical Center, assessed three doses of GLS-5300 MERS coronavirus vaccine, given to healthy adults ages 18 to 50 over a 3-month period. Twenty-five participants received 0.67 milligrams (mg) of the DNA vaccine, 25 got 2-mg injections, and the final group received 6 mg of the vaccine.

No major safety events were recorded, and seroconversion occurred in 59 (86%) of 69 participants and 61 (94%) of 65 participants after two and three vaccinations, respectively, the authors said. "There were no differences in immune responses between dose groups after 6 weeks. At week 60, vaccine-induced humoral and cellular responses were detected in 51 (77%) of 66 participants and 42 (64%) of 66, respectively," the authors wrote.

The authors concluded the data support the further development of GLS-5300 vaccine. In a commentary on the study, In-Kyu Yoon, PhD, and Jerome H. Kim, PhD, of the International Vaccine Institute in South Korea said, "Completion of the phase 1 trial of GLS-5300 represents an incremental but important step in the development of vaccines against emerging viral global threats."
Jul 24 Lancet Infect Dis study
Jul 24 Lancet Infect Dis commentary


Virginia notes uptick in Cyclospora illnesses

The Virginia Department of Health today announced a sharp increase in cyclosporiasis cases since mid-June in parts of Northern Virginia. To date there have been 15 cases, compared with 8 cases during the same time last year.

"Additionally, more than 40 people from two large businesses in the area have reported gastrointestinal illness, and are under investigation for suspected cyclosporiasis. A food or water source of this outbreak has not yet been identified, and the investigation is ongoing," the department said in a news release.

Cyclospora is a foodborne parasite that cases intestinal illness, and has been linked to fresh produce, including raspberries, basil, arugula, snow peas, mesclun lettuce, and cilantro. From 2000 to 2017, officials confirmed 39 Cyclospora outbreaks in the United States—all linked to fresh food.

Cyclospora causes watery diarrhea that can come and go until a patient seeks treatment.
Jul 23 Virginia Department of Health news release


CEPI, Themis announce chikungunya vaccine partnership

Valneva, a biotechnology company based in Norway and France, yesterday announced a new partnering agreement with the Coalition for Epidemic Preparedness Innovation (CEPI) worth up to $23.4 million to support manufacturing and late-stage development of a live-attenuated single-dose chikungunya vaccine (VLA1553).

In a statement, the company said the support from CEPI comes from the European Union (EU) Horizon 2020 program. As a step to ensure equitable access, the funding also includes a partnership to speed regulatory approval in regions where outbreaks occur as well as World Health Organization prequalification that would pave the way for broader use in lower- and middle-income countries.

As part of the deal, Valneva will maintain a stockpile of the vaccine and take steps to transfer manufacturing to partners in lower- and middle-income countries to boost vaccine access to populations at risk.

The investment is part of CEPI's third call for proposals through the EU Horizon 2020 program, which since January has resulted in $66 million in investments in two chikungunya vaccines and two Rift Valley fever vaccines. In June, Themis Bioscience and CEPI announce a partnership to support phase 3 development of the company's single-dose chikungunya vaccine (MV-CHIK).

CEPI was founded following West Africa's Ebola outbreak as a new way to fund and speed the development of new vaccine candidates against emerging infectious diseases, especially Middle East respiratory syndrome coronavirus (MERS-CoV), Nipah virus, and Lassa virus. It is supported by seven nations and a host of global health groups.
Jul 24 Valneva press release
Jul 25 CEPI press release
Jun 4 CIDRAP News scan "CEPI, Themis announce chikungunya vaccine partnership"


Maine doctors advised to test for Powassan after confirmed human case

The Maine Center for Disease Control & Prevention (Maine CDC) is warning physicians to consider testing certain patients for Powassan encephalitis (POW), a tick-borne disease, after a resident of southern Maine was hospitalized with the illness in late June.

The Maine CDC said doctors should consider testing for POW in any patient presenting with unexplained encephalitis, meningitis, or high fever (100.4°F or 38°C) during the summer and early fall.

POW is transmitted through infected Ixodes ticks. The illness can be serious and often requires hospitalization. Symptoms begin 1 week to 1 month after a tick bite and include fever, headache, vomiting, weakness, confusion, seizures, and memory loss.
Jul 24 Maine CDC advisory

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