Stewardship / Resistance Scan for Jun 06, 2017

News brief

Pharmacist-driven ASPs tied to fewer deaths, better antimicrobial use

A pharmacist-driven antimicrobial stewardship program (ASP) in intensive care units (ICUs) in eastern China was associated with decreased mortality, lowered emergence of multidrug resistance, and optimized use of antimicrobial agents, according to a study yesterday in the American Journal of Infection Control.

Researchers from Hangzhou analyzed data from 577 patients in multiple ICUs, 353 of whom were involved in a pharmacist-driven ASP. The primary outcome was all-cause hospital mortality.

The pharmacist-directed ASP was associated with a 19.3% hospital mortality rate, compared with 29.0% for other ASPs. In addition, the pharmacist-driven strategy was tied to a shorter duration of empirical antimicrobial therapy (2.7 days vs 3.0 days) and a 1-day shorter accumulated duration of antimicrobial treatment.
Jun 5 Am J Infect Control study

Lactobacillus isolate from yogurt shows promise against resistant bacteria

A Lactobacillus isolate from yogurt, called Lactobacillus parafarraginis, inhibited the growth of several multidrug-resistant (MDR)/extended spectrum beta-lactamase (ESBL) bacteria from patients at a hospital in Washington, D.C., according to preliminary data presented at the ASM (American Society of Microbiology) Microbe meeting that wrapped up yesterday.

Researchers from Howard University screened 68 lactic acid bacteria isolated from commercial yogurt and cheese for antimicrobial activity against Staphylococcus aureus, Listeria monocytogenes,and Escherichia coli O157:H7. Although 93% showed antimicrobial activity against the pathogens, they identified an L paragarraginis isolate as showing high potential against resistant bacteria.

When tested in the lab, the bacterium inhibited 14 MDR and ESBL bacteria from clinical sources: E coli (5 isolates), Pseudomonas aeruginosa (2), Acinetobacter baumannii/haemolyticus (3), Enterobacter aerogenes (1), Proteus mirabilis (2),and Klebsiella pneumoniae (1).

"Considering the current upsurge of antibiotic resistance in hospitals, especially among the gram-negative bacteria, and the exigent need to find viable alternatives, findings from the study may hold promise for possible therapeutic application," said lead author Rachelle Allen-McFarlane, Howard University doctoral candidate in biology, in an ASM press release.
Jun 2 ASM Microbe abstract
Jun 2 ASM news release

MSSA study finds more evidence for emerging genotype, spread from NYC

A retrospective analysis of 34,025 methicillin-susceptible Staphylococcus aureus (MSSA) isolates collected at 136 Veterans Administration (VA) medical centers between 2003 and 2014 suggests that an emerging genotype resistant to commonly used antibiotics is increasingly implicated in invasive infections and is diffusing outward from New York City.

A team based at the University of Iowa published its findings yesterday in Antimicrobial Resistance and Infection Control. They used resistance to clindamycin and erythromycin, but susceptibility to tetracycline, as a cost-effective proxy for genotype analysis to track patterns with the ST398 genotype, which emerged in New York City.

They found that 4,582 (13.5%) isolates met the definition of ST398. When they gauged the proportions of ST398 by hospital and compared facility distance from New York City, they found that levels increased nearly three-fold over the 12-year period, but it wasn't evenly distributed: It diffused outward from the city.

Though the definition they used doesn't definitively signal that the MSSA infections were caused by ST398, the spatiotemporal patterns seen in the resistance pattern suggest it, the group wrote. The rise of ST398 in New York City VA hospitals and diffusion to facilities in other parts of the country is consistent with earlier reports of the city as the source as well as with the patterns seen at hospitals that aren't part of the VA system.

The spread of ST398, thought to be easily transmissible among humans, would be worrisome, because ST398 may be more fit and virulent in both its MSSA and methicillin-resistant forms, and clindamycin resistance has important clinical implications.
Jun 5 Antimicrob Resist Infect Control abstract

News Scan for Jun 06, 2017

News brief

WHO: New suspected case of Ebola in DRC

The World Health Organization (WHO) in its latest update reported a new suspected case of Ebola in the Democratic Republic of the Congo (DRC), prompting the surveillance of 15 additional contacts. The suspected case is from the Ngayi health area, in northern DRC.

Yesterday, a suspected case with a symptom onset date of Apr 29 was retrospectively confirmed as Ebola. So far, the last confirmed case reported was on May 11. There are currently 5 confirmed, 3 probable, and 1 suspected case. Of these, 4 patients survived and 4 died, making the case-fatality rate 50%.

The WHO said most case contacts completed their 3-week monitoring period on Jun 2. And despite being approved by regulatory committees in the DRC, ring vaccination with the unlicensed Ebola vaccine is still not advised at this point.
Jun 5 WHO situation report

Saudi Arabia confirms 3 new MERS cases, 2 in Riyadh

Saudi Arabia has three new MERS-CoV cases, two of them part of a growing cluster of healthcare-linked infections in Riyadh, the country's Ministry of Health (MOH) reported today. The MOH has now confirmed 18 cases in 6 days, 15 of them in Riyadh.

The new Riyadh MERS-CoV (Middle East respiratory syndrome coronavirus) cases involve an 84-year-old Saudi man and a 48-year-old male Saudi healthcare worker, both of whom have asymptomatic infections and are in stable condition. The older man contracted the disease as a hospital patient, and the younger man's infection is also healthcare-related, but the MOH doesn't specify whether he contracted the virus on the job.

The third case involves a 45-year-old expatriate in Hofuf who is also in stable condition. The man, who is not a health worker, had direct contact with camels before his infection, a known risk factor.

The new MERS cases lift the country's total since 2012 to 1,626, and 671 of them have proved fatal. Eight patients are still undergoing treatment.
Jun 6 MOH update

Puerto Rico declares Zika outbreak over

Yesterday Puerto Rico declared the 2016 Zika outbreak over. According to Reuters, only about 10 cases of Zika have been reported per month since April, representing a stark contrast to August of 2016, when the US territory reported 8,000 cases per month.

Despite the declaration, the Centers for Disease Control and Prevention (CDC) has not changed its travel guidance for Puerto Rico and still urges pregnant women to avoid any unnecessary travel to the country.

CDC acting Director Anne Schuchat, MD, said that while she is "pleased that the peak of the Zika outbreak in Puerto Rico has come to a close….We cannot let our guard down."

Puerto Rico had some of the highest reports of microcephaly, a potentially staggering birth defect associated with maternal Zika infection, during the 2016 outbreak.
Jun 5 Reuters story

Taiwan reports more H5 avian flu outbreaks, France detects low-path H7

In the latest avian influenza developments, Taiwan reported a spate of highly pathogenic H5N8 and H5N2 outbreaks that occurred during the first half of May, and France reported a low-pathogenic H7 detection at a poultry farm in the central part of the country, according to reports to the World Organization for Animal Health (OIE).

In separate reports, Taiwan reported four more H5N8 outbreaks and three more involving H5N2. The H5N8 detections involved chickens at slaughterhouses that were tested after their signs of disease were seen on postmortem inspection. Two facilities are in Taipei City, one is in New Taipei City, and the other is on Kaohsiung City. Officials destroyed the birds, disinfected the slaughterhouses, and traced the birds to the source farms.

Meanwhile, the three H5N2 outbreaks occurred at commercial farms, two producing ducks and the other chickens. Two of the events occurred in Pingtung County, while the other was detected in Changhua County. Taken together, the virus killed 1,083 of 37,406 birds, and the remaining ones were culled.

In France, the agriculture ministry said surveillance sampling at a farm with mallards and pheasants in Indre department in the central part of the country turned up low-pathogenic H7 avian influenza. Authorities destroyed all 4,980 birds to curb the spread of the virus.
Jun 3 OIE report on H5N8 in Taiwan
Jun 3 OIE report on H5N2 in Taiwan
Jun 2 OIE report on H7 in France

Clinical trials begin for two chikungunya vaccines

New clinical trials launched yesterday for two chikungunya vaccines, one developed by Austria-based Themis Bioscience and the other by India's Bharat Biotech.

The Themis vaccine phase 1/2 trial, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), has started enrolling healthy adults and will take place at several NIAID-funded vaccine and treatment evaluation units, according to a statement yesterday.

The vaccine, called MV-CHIKV, contains a measles vaccine virus modified to produce chikungunya virus proteins. A 2014 phase 1 trial showed that it prompted an immune response and was safe. For the new trial, researchers will enroll 180 healthy adults aged 18 to 45 at three sites. Participants will receive two doses at different intervals of either a low- or high-dose vaccine or placebo.

Themis is also conducting a phase 2 trial of the same vaccine in Europe.

Meanwhile, Bharat Biotech announced yesterday that a phase 1 trial has begun in India of its inactivated vaccine based on a chikungunya strain isolated in the country, the Mumbai Mirror reported yesterday. The placebo-controlled study will include 60 healthy volunteers who will receive escalating doses of the vaccine in a prime-boost regimen.
Jun 5 NIAID press release
Jun 5 Mumbai Mirror story