Stewardship / Resistance Scan for Mar 07, 2018

News brief

Italian study finds large reservoir of MDR bacteria in nursing homes

Researchers in Italy report widespread diffusion of multidrug-resistant (MDR) bacteria in residents from long-term care facilities (LTCFs) in three different northern Italian regions, according to a study yesterday in Antimicrobial Resistance and Infection Control.

The study, conducted in October and November of 2016, involved multicenter point prevalence screening in four LTCFs in the provinces of Milan, Piacenza, and Bolzano. The aim was to compare colonization frequencies with MDR bacteria in the facilities. The screening included Enterobacteriaceae expressing extended-spectrum beta-lactamases (ESBLs), high-level AmpC cephlasporinases, and carbapenemases, Pseudomonas aeruginosa or Acinetobacter baumannii with carbapenemases, methicillin-resistant Staphylococcus aureus (MRSA), or vancomycin-resistant enterococci (VRE).

Among the LTCF residents, 75.0% (78/104), 69.4% (84/121) and 66.1% (76/115) were colonized with at least one of the target organisms in LTCFs located in Milan, Piacenza, and Bolzano, respectively, and many residents had more than one organism. ESBL producers (60.5%, 66.1%, and 53.0%) were highly predominant, mainly belonging to Escherichia coli expressing CTX-M group-1 enzymes. Carbapenemase-producing enterobacteriaceae were found in 7.6%, 0.0%, and 1.6% of residents; carbapemenase-producing P aeruginosa and A baumannii were also detected. Colonization by MRSA (24.0%, 5.7%, and 14.8%) and VRE (20.2%, 0.8%, and 0.8%) was highly variable.

Variability between the facilities was partly attributed to different risk factors for MDR colonization, resident populations and staff/resident ratios, applied hygiene measures, and differences in the local antibiotic resistance epidemiology.

"This widespread diffusion of MDR bacteria in LTCFs of three Italian Provinces confirms that these healthcare facilities are an important reservoir for MDR organisms," the authors conclude. "Future efforts should focus on screening activities, infection control strategies tailored on the complex aspects of LTCFs and implementation of antibiotic stewardship programs."
Mar 6 Antimicrob Resist Infect Control abstract

European C diff guidance stresses stewardship, diagnostics, other steps

The European Society of Clinical Microbiology and Infectious Diseases (ESCMID) has published new guidelines on preventing Clostridium difficile infection (CDI) in acute-care settings that include strong recommendations for a two-stage diagnostic test, surveillance with timely feedback, the use of personal protective equipment (PPE) in outbreak settings, and other steps.

Writing in Clinical Microbiology and Infection, the ESCMID panel of experts detailed their current literature review on interventions to control CDI in adults. In contrast to the previous ESCMID guideline on the topic, they used the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach to rate the quality of evidence.

The guidance includes 36 statements on preventing CDI, including 18 strong recommendations. Strong recommendations include a two-stage test to diagnose CDI, performance of surveillance with timely feedback, no screening of healthcare workers, the use of PPE in outbreak settings, implementation of contact precautions, introduction of daily environmental sporicidal disinfection and terminal disinfection of rooms in outbreak settings, antibiotic stewardship interventions, and education of healthcare workers, patients, and visitors on prevention measures. The experts said the highest quality of evidence grading was for antibiotic stewardship interventions.

"Overall the document aims to provide guidance to those responsible for institutional infection control programs, serving as a reference for best medical practice," lead author Sarah Tschudin-Sutter, MD, MSc, told CIDRAP News.
Mar 2 Clin Microbiol Infect guidance document

News Scan for Mar 07, 2018

News brief

Saudi Arabia records new hospital-related MERS case

The Saudi Arabian Ministry of Health (MOH) announced a new case of hospital-acquired MERS-CoV in Riyadh, involving a health worker who is likely part of a hospital-related outbreak.

The 28-year-old Saudi man is in critical condition after being diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). This is the fourth secondary hospital-acquired case reported in Riyadh this week. All of the patients have been men, but the other three were apparently infected as patients.

Several MERS-CoV outbreaks in hospitals and healthcare clinics have been reported from Saudi Arabia, but the clusters have been smaller over the last 2 years.

Saudi Arabia's MERS-CoV total cases since 2012 are 1,813, including 735 deaths. Ten people are still being treated for their infections.
Mar 5 MOH update

CEPI's first partnership will pursue Lassa fever, MERS vaccines

Today the Coalition for Epidemic Preparedness Innovations (CEPI) announced a partnership with Themis Bioscience to work on advanced development and manufacturing of vaccines for Lassa fever and MERS-CoV.

This is the first agreement made by CEPI, which began last year as a coalition to develop new vaccines. Themis will receive $37,500,000 over a 5-year period to develop the vaccines. The funding is expected to carry Themis through phase 2 trials for the vaccines.

Lassa fever and MERS-CoV were picked because both diseases can be severe and spread by international travelers.

"As we can see with the current outbreak of Lassa fever in Nigeria, these diseases devastate lives and have far reaching economic consequences," Richard Hatchett, MD, chief executive officer of CEPI said. "Vaccines are a vital part of our fight against them but their development is costly, complex and challenging."

Currently, Themis' chikungunya vaccine is in phase 2 trials. The company is also developing a Zika virus vaccine.

CEPI brings together the governments of Norway, Germany, India and Japan, the Bill & Melinda Gates Foundation, Wellcome Trust, and the World Economic Forum to fund new vaccines. Lassa fever, Nipah, and MERS-CoV were the first diseases targeted by the coalition.
Mar 7 CEPI announcement

FDA announces new tickborne parasite test for US blood supply

The United States Food and Drug Administration (FDA) announced today its approval of Imugen Babesia microti Arrayed Fluorescent Immunoassay (AFIA) for detecting antibodies to Babesia microti (B microti) in human plasma samples, and the Imugen Babesia microti Nucleic Acid Test (NAT) detecting B microti DNA in human whole blood samples, according to a FDA statement.

The tests will detect Babesia parasites that are transmitted by blacklegged or deer tick. These infections cause babesiosis, the most frequently reported transfusion-transmitted parasitic infection in the United States.

The United States sees about 1,000 to 2,000 cases of babesiosis each year, with the majority reported from states in the Northeast and upper Midwest.

"While babesiosis is both preventable and treatable, until today, there was no way to screen for infections amongst blood donors," said Peter Marks, MD, PhD, director of the FDA's Center for Biologics Evaluation and Research. "Today's actions represent the first approvals of Babesia detection tests for use in screening donors of whole blood and blood components, and other living donors."

For most people, a babesiosis infection will go unnoticed, but in some, especially those with a compromised immune system, infections can be severe and life-threatening.

Donor testing for Babesia has been in place since August 2012 in selected endemic areas under an investigational new drug application, and the FDA had granted priority review for the tests. So far there is no FDA guidance for testing donor samples, but it plans on releasing draft guidance later this year.
Mar 6 FDA press release

Northern Hemisphere flu activity still high, with mix of flu strains

Many countries in the Northern Hemisphere continue to report brisk flu activity, though disease levels have peaked in some countries, such as the United States and some locations in southwestern Europe and eastern Asia, the World Health Organization (WHO) said in its latest global update.

Activity continued to increase in eastern and northern Europe, such as Denmark, Estonia, Norway, Sweden, and Russia. In western Asia, flu activity is still high in Israel, with disease levels increasing in Cyprus. Also, the number of positive flu tests rose in some Caribbean locations and in Singapore and Southeast Asia.

Flu is still at interseasonal levels in the Southern Hemisphere, which typically doesn't see its season begin until May.

Globally, influenza A and influenza B made up a similar proportion of detections. Of subtyped influenza A strains, 58.2% were characterized as 2009 H1N1 and 41.8% were H3N2. Of influenza B viruses tested, 94.4% belonged to the Yamagata lineage.
Mar 5 WHO global flu update

New study shows Lassa fever likely induces renal dysfunction

A new study in the The Lancet Infectious Diseases shows that Lassa fever likely induces acute renal dysfunction in a significant portion of patients and is an indicator of mortality.

The study looked at the clinical outcomes of 291 patients with Lassa fever treated at the Irrua Specialist Teaching Hospital in Nigeria between 2011 and 2015. Overall case-fatality rate was 24%, but patients with signs of major organ damage were much less likely to survive their infections.

Patients with either elevated serum concentrations of creatinine, aspartate aminotransferase, or potassium were likely to have a poor prognosis. About 28% of patients showed acute kidney injury, and 37% had central nervous system manifestations of the disease that resulted in complications.

An accompanying commentary explained that acute renal injury is also common in Ebola, another hemorrhagic disease. Treating the kidney failure can improve clinical outcomes for Ebola patients and should also be pursued for Lassa patients, the author of the commentary suggests.

Currently, Nigeria is in the midst of an especially large Lassa fever outbreak.
Mar 6 Lancet Infect Dis study
Mar 6 Lancet Infect Dis commentary