Stewardship / Resistance Scan for Jun 14, 2018

News brief

Minnesota officials describe CRE caused by uncommon pathogens

Although carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) involving Escherichia coli, Klebsiella, and Enterobacter cause the most mortality and other clinical impact, CRE associated with less common genera may also cause detrimental infections, researchers with the Minnesota Department of Health (MDH) reported today in Morbidity and Mortality Weekly Report (MMWR).

CRE from less common genera have generally not been targeted for carbapenemase testing, the authors note, in part because some of them have intrinsic resistance to the carbapenem imipenem (IMP) and others express species-specific chromosomal carbapenemases. But the less common CRE organisms can also harbor plasmid-mediated carbapenemases.

The investigators found that 149 (12.0%) of 1,241 CRE isolates tested at the MDH Public Health Laboratory from Jan 1, 2014, through Sep 30, 2017, were CP-CRE. All were from different patients. Of the 149 CRE, 20 (13.4%) were from less common genera. The most common species were IMP-producing Providencia rettgeri (7 isolates) and Klebsiella pneumoniae carbapenemase (KPC)-producing Citrobacter freundii (6).

Among the 20 patients, median age was 56.5 years (range, 14 to 75 years), and 15 patients were hospitalized at the time of culture collection. Two patients were hospitalized internationally—one in Kenya, one in Kuwait—in the year before they tested positive.

The authors concluded, "Less common Enterobacteriaceae genera appear to be a small but potentially important subset of CP-CRE; however, estimates of the true proportion of CP-CRE from these less common genera are limited by the lack of systematic testing. Of note, many of the carbapenemases in the less common CRE genera were not KPC."
Jun 15 MMWR report

Advocates say hospital pharmacists strengthen stewardship programs

The European Association of Hospital Pharmacists (EAHP) is calling for a greater role for pharmacists in antibiotic stewardship programs.

In a position paper on antimicrobial resistance (AMR) issued yesterday, the group calls on national governments and health system managers to "utilise the specialized background and knowledge of the hospital pharmacists in multi-professional antibiotic stewardship teams," arguing that pharmacists can help enforce stewardship and promote prudent use of antimicrobial drugs.

Among the ways that pharmacists can strengthen stewardship programs, the group says, is through reviewing antibiotic duration, advising on the cessation of appropriate antibiotic treatment, and educating other healthcare professionals on restricted use of certain antibiotics.

Other recommendations in the position paper include universal application of infection and prevention control measures, regulatory oversight of antibiotic use in the livestock and agriculture sector, and increased investment to support the development of new antibiotics and new fields of infectious disease control. The EAHP also urges governments to make arrangements to maintain essential antibiotics on the market and prevent shortages.
Jun 13 EAHP position paper

News Scan for Jun 14, 2018

News brief

DRC investigates 10 more suspected Ebola cases

With intensive efforts under way to identify any potential remaining Ebola cases in the Democratic Republic of the Congo (DRC), the health ministry yesterday reported 10 more suspected cases, according to the latest update.

Illness totals fluctuate day to day as tests rule out earlier cases and more suspected illnesses are reported, but no confirmed cases have been tallied since Jun 2. According to the DRC health ministry, 6 of the 10 new suspected cases are in two remote forested locations Bikoro (4) and Iboko (2) and 4 are in Wangata health zone, an area that includes part of Mbandaka, the provincial capital.

The latest cases raise the total to 66, which includes 38 confirmed, 14 probable, and 14 suspected cases. The death count remains at 28.

Vaccination with Merck's VSV-EBOV continues, with 2,633 people immunized so far. The total includes 5 caregivers in Kinshasa, the country's capital, who will be taking care of a health ministry response team that will soon be deployed to the outbreak locations.
Jun 13 DRC health ministry update

Salmonella egg outbreak grows to 45 cases as CDC calls investigation over

The Centers for Disease Control and Prevention (CDC) today reported 10 more Salmonella cases in a multistate outbreak linked to eggs that it says now appears to be over.

The newly confirmed infections bring the outbreak total to 45 cases in 10 states, 1 more state (Alaska) than in the CDC's previous update on May 10. New York state reported the most cases, 14, followed by Virginia, with 8. Rose Acre Farms, of Seymour, Ind., has recalled more the 200 million eggs sold under multiple brand names in response to the outbreak.

Illness-onset dates range from Nov 16, 2017, to May 13, 2018. Patients vary in age from 1 to 90 years old, with a median age of 60. Eleven people were hospitalized, but no deaths have been linked to the outbreak.

"As of June 14, 2018, this outbreak appears to be over," the CDC said.
Jun 14 CDC update

Study: Cancer prevention resonates with parent messages on HPV vaccine

A survey of parents found that, of several reasons health providers give to support human papillomavirus (HPV) vaccination, preventing cancer was most persuasive, researchers reported today in Cancer Epidemiology, Biomarkers and Prevention.

The CDC recommends that girls and boys receive two HPV vaccine doses starting at age 11, but uptake is well below target levels.

In an online national survey conducted in 2016, researchers asked 1,177 parents of children ages 11 to 17 to rate 11 reasons health providers typically give to make the case for HPV vaccination. Among the group, 57% of parents had initiated HPV vaccination for their children.

Preventing some types of cancer was the top reason for immunization, the study found. Preventing common infections, providing lasting benefits, and being a safe vaccine were also persuasive reasons, according to the report. The least convincing reasons were that the vaccine was a scientific breakthrough, health providers had their kids immunized, and that patients were due to receive the HPV vaccine.

Melissa Gilkey, PhD, study coauthor and assistant professor of health behavior at the University of North Carolina, said in a press release from the American Association for Cancer Research (AACR), the journal's publisher, said the findings suggest doctors could streamline their communications with parents about HPV vaccination.

"Cancer prevention was clearly the most convincing reason for HPV vaccination. Reasons that have to do with sexual activity, scientific novelty, or providers' decisions for their own children may ultimately be distractions that are best avoided," she said.
Jun 14 Cancer Epidemiol Biomarkers Prev abstract
Jun 14 AACR press release

Report details deadly 12-case E coli outbreak tied to manure in 2017

Officials with Utah, Arizona, and the CDC today describe a 12-case outbreak last year of Shiga toxin–producing Escherichia coli (STEC) O157:H7 infections tied to contact with cattle manure and person-to-person transmission.

Writing in Morbidity and Mortality Weekly Report (MMWR), the investigators describe STEC O157:H7 in two hospitalized children from a small community on the Utah-Arizona border whose cases were reported to the Utah Department of Health on Jun 26, 2017. Both children developed hemolytic uremic syndrome (HUS), a type of kidney failure, and died within a few days of falling ill.

Several more STEC illnesses were reported in residents of the community shortly afterward. A joint investigation by authorities from the two states eventually turned up 12 patients from eight households, including the 2 children who died. Illness-onset dates ranged from Jun 10 to Jul 9, 2017, and 11 cases involved children 6 years old or younger, with the 12th case involving a 28-year-old.

Four of six infected children who were enrolled in a case-control study reportedly played in an area with animal manure, and two of them touched a cow. The outbreak STEC strain was also isolated from bull and horse manure near a household with two ill children. But since horses are not reservoirs of STEC the way ruminants are, scientists hypothesize that the horses were infected by the bull.

Seven of the cases are considered primary, whereas the other five patients were confirmed to have contracted the disease from an infected person.

The authors concluded, "In this outbreak, playing in an area with animal manure was associated with illness. The five ill children with the earliest illness onset dates lived in close proximity to one another and the culture-positive animal manure."

They added, "Hand hygiene is important to reduce the risk for STEC O157:H7 transmission. Contact with animals or animal manure should be considered in outbreak investigations when ruminants are kept near the home."
Jun 15 MMWR report