Stewardship / Resistance Scan for Jun 19, 2017

News brief

Study finds low compliance with surgical antibiotic prophylaxis guidance

Only 10% of surgical procedures in Brazil involved full compliance with surgical antibiotic prophylaxis (SAP) guidelines, according to a new study in the American Journal of Infection Control.

The researchers analyzed data on 1,011 neurosurgical procedures in nine hospitals in 2010, including 451 craniotomies (44.6%), 325 spinal fusions (32.1%), 196 laminectomies (19.4%), and 39 other procedures (3.9%).

They found full compliance with SAP guidelines in only 10.0% of the procedures. Indication for an antibiotic was correct in 90.0% of procedures, and the dosage was accurate in 90.6%. Drug type, however, was compliant in only 64.2% of the cases. The investigators also found compliance 77.1% of the time for time for initiating SAP but only 26.1% compliance in duration of SAP.

Timing of SAP was too early in 7.3% of cases and too late in 15.6%. SAP duration was too short 11.7% of the time and too long 62.2% of the time.

The authors concluded, "Targeted training programs need to be developed to ensure dissemination of guidelines among surgeons. Monitoring, feedback, and closer interaction between the infection control personnel and the surgical team are key factors for better compliance rates of SAP."
Jun 16 Am J Infect Control study

Screening for MRSA not tied to prolonged vancomycin use

Screening patients for nasal colonization for methicillin-resistant Staphylococcus aureus (MRSA) does not appear to prolong vancomycin use, according to a retrospective cohort study in the American Journal of Infection Control.

Boston University researchers assessed 2,910 patients who were administered intravenous vancomycin in the VA Boston Healthcare System from January 2013 through November 2015. They found that testing positive for MRSA was tied to an almost triple rate of vancomycin use for more than 3 days. After the team controlled for clinical culture results, they found that MRSA colonization upon admission was not associated with vancomycin use for longer than 3 days. And a negative MRSA nasal swab on admission was tied to a high negative predictive value for all MRSA infections.

The investigators concluded, "Admission surveillance for MRSA nasal colonization is not a major driver of prolonged vancomycin use. A negative admission MRSA nasal screen may be a useful tool for antimicrobial stewardship programs to limit vancomycin use, particularly in noncritically ill patients."
Jun 16 Am J Infect Control findings

US data show most patients wrongly given antibiotics for conjunctivitis

Data from a large US study published in Ophthalmology revealed that 58% of people who have acute conjunctivitis ("pink eye") are wrongly prescribed antibiotics.

The study included data on 340,372 enrollees in a nationwide managed care network who had acute conjunctivitis. The authors noted that 198,462 of them (58.3%) filled one or more topical antibiotic prescriptions, and 38,774 (11.4%) filled prescriptions for antibiotic-corticosteroid combination products. Neither medication is indicated for the condition, and the combination products can in fact worsen the infection and are contra-indicated.

The scientists also found that more affluent and educated patients were more likely to fill an antibiotic prescription, as were patients of optometrists compared with those seeing an ophthalmologist. Patients first diagnosed by an urgent care physician, internist, pediatrician, or family physician were even more likely to fill a prescription for antibiotics.

Acute conjunctivitis can be caused by viruses, bacteria, or allergies, and even bacterial infections typically resolve when left untreated. Antibiotics are rarely necessary.

"This study opens the lid on overprescribing of antibiotics for a common eye infection," said lead author Nakul S. Shekhawat, MD, MPH, in a press release from the American Academy of Ophthalmology (AAO), which publishes the journal. "It shows that current treatment decisions for pink eye are not based on evidence."

The study authors conclude in their paper, "These potentially harmful practices may prolong infection duration, may promote antibiotic resistance, and increase costs."
Jun 14 Ophthalmol study
Jun 19 AAO news release

In related news, the Pan American Health Organization (PAHO) late last week published an alert on increased conjunctivitis cases in five nations: the Bahamas, Brazil, Dominican Republic, Guadeloupe, and Martinique.

Four of the five countries reported fewer than 1,000 new cases, but the Dominican Republic has had 66,126 cases so far this year, PAHO said. That represents a 62% increase compared with the same time in 2016. "Outbreaks of conjunctivitis in other countries of the Region are under investigation," the agency reported.
Jun 16 PAHO update

News Scan for Jun 19, 2017

News brief

Three new MERS cases diagnosed in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) confirmed the diagnosis of three new cases of MERS-CoV in recent days, including one case in an asymptomatic healthcare worker at a hospital in Riyadh. At least three hospitals in Riyadh have reported MERS outbreaks this month.

The healthcare worker was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) on Jun 19. She is a 41-year-old expatriate who is in stable condition.

Yesterday the MOH said a 71-year-old man from Hofuf was in critical condition after being diagnosed with the virus, as was a 22-year-old man from Riyadh. Both men are Saudis, and their sources of infection are listed as primary, meaning it is unlikely they contracted the disease from another person.

The new cases raise Saudi Arabia's MERS totals to 1,653 cases, including 676 deaths. Eighteen people are still being treated for their infections.

In addition, today the World Health Organization (WHO) offered more details on 14 MERS cases identified by the MOH between Jun 11 and 15. One of the patients died, and seven are healthcare workers. The WHO first described the three clusters of MERS outbreaks in Riyadh hospitals on Jun 13.

Nine new cases were associated with cluster 1, a Riyadh hospital described in the Jun 13 update. To date, 32 cases have been linked to this hospital. No new cases have been reported in cluster 2, while cluster 3 has four new cases. To date cluster 3 involves eight healthcare workers.
Jun 17 MOH report
Jun 18 MOH report
Jun 19 WHO update

Trump's HIV/AIDs council loses 6 members

The Presidential Advisory Council on HIV/AIDS (PACHA) now has six vacancies after members resigned and one of them published an op-ed late last week in Newsweek, explaining their concerns that President Donald Trump "simply does not care" about HIV funding and research.

The letter was penned by Scott A. Schoettes, counsel and HIV project director at Lambda Legal. He and five others resigned from PACHA on Jun 13.

PACHA, which was founded in 1995, is responsible for making recommendations concerning HIV/AIDs to the president. While members met with presidential candidates Hilary Clinton and Bernie Sanders, they did not meet candidate Trump. Trump has also not yet appointed anyone to lead the White House Office of National AIDS Policy, which means there is no one regularly presenting information to the president on new or concerning HIV developments.

In the op-ed, Schoettes said Trump's efforts to diminish the Affordable Care Act are particularly damaging to people living with HIV/AIDs, and that his and his colleagues' expertise would be "more effective from the outside."
Jun 15 Newsweek op-ed

More avian flu outbreaks reported in China, Belgium, Taiwan

In the latest avian flu developments, China's agriculture ministry reported a large die-off related to H7N9 avian influenza in Heilongjiang province in the far northeastern corner of the country, according to an official statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

Though the report didn't specify that it was the highly pathogenic strain, its mention of deaths of 19,500 breeding hens suggests that the more lethal version is involved. Highly pathogenic H7N9 was first detected in Chinese poultry in February and has already spread to some of the country's more northern provinces, such as Inner Mongolia.
Jun 19 AFD post

In other developments, Belgian officials today reported more highly pathogenic H5N8 outbreaks, according to separate reports from the World Organization for Animal Health (OIE). The first event began Jun 10 at a trader of birds intended for hobbyists in West Flanders province, killing 500 of 4,047 birds.

The other outbreak involved birds not classified as poultry, a group that includes wild birds. It began Jun 16 in Hainaut province, leading to the deaths of 21 of 26 birds. Both provinces are in western Belgium and the source of the virus in both outbreaks was found to be the introduction of new live animals.
Jun 19 OIE report on H5N8 in Belgian poultry
Jun 19 OIE report on H5N8 in Belgian nonpoultry birds

Elsewhere, Taiwan reported four more H5N2 outbreaks, one from the highly pathogenic virus and three from the low-pathogenic version, according to notifications to the OIE.

The highly pathogenic outbreak began Jun 8 at a commercial farm housing native chickens in Yunlin county, killing 2,767 of 14,000 susceptible birds. The start date for the low-pathogenic outbreaks ranged from Jan 13 to Apr 10, affecting commercial farms in three different locations: Chiayi county, Tainan City, and Yunlin county. Between the three low-pathogenic events, the virus killed 3,039 of 50,334 poultry.
Jun 16 OIE report on highly pathogenic H5N2 in Taiwan
Jun 16 OIE report on low-pathogenic H5N2 in Taiwan

PAHO reports small rise in chikungunya cases

It its regular update on chikungunya in the Americas, the Pan American Health Organization (PAHO) on Jun 16 reported 599 more cases, most of them in Bolivia.

The latest total reflects a jump from 165 new cases reported the previous week, but is below other recent weekly totals, which have ranged as high as 38,282 cases, depending on how frequently countries with large disease burdens such as Brazil update their numbers.

Other countries reporting small numbers of new cases include Colombia, Peru, Costa Rica, Guadeloupe, Martinique, St Barthelemy, and the French part of St. Martin. No new fatalities were reported, keeping that total steady at 13.

Since the first outbreaks in the Caribbean began in 2013, the virus has sickened 2,475,263 people.
Jun 16 PAHO update