Stewardship / Resistance Scan for Mar 14, 2017

News brief

Australian parent survey finds misconceptions about antibiotics

A large survey of Australian parents has found significant misconceptions about antibiotic use for acute respiratory infections.

The study, published yesterday in the Annals of Family Medicine, describes the results of a telephone survey in which 401 parents of at least one child aged 1 to 12 years were asked questions about the benefits and harms of antibiotic use for three acute respiratory infections or related conditions: acute otitis media, sore throat, and acute bronchitis. The respondents were also asked to recall the last time their child visited a doctor from treatment of one of these conditions, including any discussion about antibiotics.

The results showed that most of the parents believed that antibiotics can (at least sometimes) help all three conditions, with 92% believing antibiotics can help acute otitis media (middle ear infection), 70% believing they can help sore throat, and 55% believing they can help cough. Many parents, however, also agreed that not using antibiotics for these conditions is an option, especially in the case of cough (99%) and sore throat (97%), but less so for acute otitis media. In addition, 78% said they knew antibiotics could potentially harm, with roughly half mentioning antibiotic resistance.

But parents also grossly overestimated the extent to which antibiotics could reduce illness duration, compared with benefits seen from current empirical evidence, and many believed that antibiotics could help avoid complications from acute respiratory infections—such as hearing loss and perforated eardrum in cases of acute otitis media.

In recalling their most recent visit to a pediatrician for treatment of one of these conditions, 44% of parents reported some discussion about why antibiotics might be used, but 72% reported little or no discussion about why antibiotics might not be used, and 78% did not recall any discussion of potential antibiotic harm. Nearly all parents (93%) said they would like to be involved in future decisions about antibiotic use.

"These findings suggest opportunities for improving acute respiratory infection visits by adopting shared decision making," the authors write.
March/April Ann Fam Med study

HIV study indicates potential for sexual spread of drug-resistant bacteria

Findings from a study yesterday in BMC Infectious Diseases suggest the potential for sexual transmission of multidrug-resistant gram-negative (MDRGN) bacteria in men with HIV.

For the study, researchers at University Hospital Frankfurt retrospectively investigated the MDRGN organism prevalence in rectal swabs of 109 HIV-positive men and 109 HIV-negative men who had been admitted to the hospital from November 2014 through March 2016. They were looking to evaluate whether sexual intercourse could be a potential means of transmission for MDRGN organisms. Their hypothesis was that microbiota, including MDRGN, is exchanged during mucous membrane contact.

The researchers theorized that MDRGN prevalence might be higher in HIV-positive men than in HIV-negative men in part because pre- or co-existing sexually transmitted diseases can be a marker for identifying individuals who have engaged in unprotected sexual intercourse. In addition, they cite recent investigations that have documented the spread of pathogenic Escherichia coli and Shigella species in men who have sex with men.

Among the 208 men evaluated, the researchers found a total of 35 MDRGN isolates, with 26 detected in the HIV-positive men and 9 detected in the HIV-negative men (for an overall prevalence of 23.9% vs. 8.3%). The most frequently detected MDRGN species was E coli with resistance due to extended-spectrum beta-lactamase (ESBL) production and additional resistance to fluoroquinolones, which accounted for 25 of the 35 isolates.

"These findings suggest that HIV positive men might be more susceptible to acquire MDRGN," the authors write. But they also acknowledge that a stronger history of antibiotic pre-treatment and the presence of pre-existing comorbidities in HIV positive men are other factors that need to be evaluated in future investigations of sexual transmission of MDRGN.
Mar 13 BMC Infect Dis study

New antibiotic combo announced for gram-negative bacterial infections

Drugmaker Pfizer, Inc. today announced that a novel combination antibiotic for the treatment of serious gram-negative bacterial infections is now available in the United Kingdom and Germany.

The fixed-dose combination of ceftazidime and avibactam, sold under the brand name Zavicefta, is indicated for the treatment of complicated intra-abdominal infection, complicated urinary tract infection, and hospital-acquired pneumonia. It's also indicated for the treatment of two of the MDRGN organisms—Pseudomonas aeruginosa and Enterobacteriaceae—recently identified by the World Health Organization as "priority pathogens."

"Multidrug-resistant (MDR) infections are an increasing global threat," Matteo Bassetti, MD, PhD, chief of the infectious diseases clinic at University of Udine in Italy, said in a company news release. "The availability of Zavicefta is a major step forward for physicians faced with the challenge of treating patients with known or suspected MDR infections."

Zavifecta was approved for marketing in June 2016 by the European Medicines Agency.
Mar 14 Pfizer news release

News Scan for Mar 14, 2017

News brief

Another MERS case related to hospital outbreak in Wadi Al-Dawasir

Yesterday Saudi Arabia announced one new MERS-CoV case in a healthcare worker from Wadi Al-Dawasir. This is the tenth case in what appears to be a hospital-based outbreak in that city.

The patient is a 36-year-old expatriate man who presented with no symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus). His infection is listed as secondary and acquired in a healthcare setting.

Late last week, the Saudi Ministry of Health (MOH) reported six new cases of MERS in Wadi Al-Dawasir, including another healthcare worker who was asymptomatic. MERS-CoV is known to spread rapidly in healthcare settings, and was already implicated in a small outbreak in Buraydah earlier this year.

The MOH also reported the death of a previously listed patient, a 71-year-old man from Al Bahah. That case is not related to the current Wadi Al-Dawasir outbreak.

So far Saudi Arabia has reported 1,578 MERS-CoV cases, 654 of them fatal, since the virus was first detected in humans in 2012. Fifteen people are still being treated for their infections.
Mar 13 MOH report

Avian flu strains strike more birds in Egypt, Europe, Africa

Egypt and Sweden reported more highly pathogenic H5N8 avian flu detections, and Nigeria reported more H5N1 outbreaks on poultry farms, according to the latest reports from the World Organization for Animal Health (OIE).

Egypt confirmed its first H5N8 outbreaks in late 2016 and continues to report sporadic events in poultry. The latest ones struck three backyard poultry holdings from Feb 2 to Feb 21, affecting three governorates: Suez and Damietta in the northeast and Minya in upper Egypt. The outbreaks led to the culling of 75 birds.

Sweden reported seven more H5N8 detections in seven species of wild birds found dead between Dec 1 and Feb 28 from Skane County in the far south and in Stockholm, the country's capital.

In sub-Saharan African developments, two countries reported more outbreaks involving different strains. Nigeria reported three more H5N1 outbreaks involving commercial layer farms in three central states, Plateau, Katsina, and Bauchi. The outbreaks began in early March, and among the three locations the virus killed 5,182 of 18,504 birds.

Meanwhile, South Africa reported two more low-pathogenic H5N2 outbreaks on commercial ostrich farms in Western Cape province. The virus sickened 79 of 906 susceptible birds.
Mar 14 OIE report on H5N8 in Egypt
Mar 13 OIE report on H5N8 in Sweden
Mar 13 OIE report on H5N1 in Nigeria
Mar 14 OIE report on H5N2 in South Africa

Meta-analysis: 2009 pandemic flu vaccine 73% effective

A meta-analysis published yesterday in Vaccine from the University of Nottingham said that the vaccine used during the 2009 swine flu pandemic was 73% effective in preventing illness. The finding confirms previous studies, and also shows that vaccine effectiveness depended on the recipient's age.

In early 2009, a novel H1N1 influenza swept the globe, and 6 months after it appeared, in September of 2009, an inactivated H1N1vaccine was made available. To determine how effective the vaccine was at preventing illness and H1N1-related hospitalizations, the research team conducted a meta-analysis of 23 studies on the vaccine published between 2011 and 2016.

Overall, the vaccine was 73% effective in preventing laboratory confirmed H1N1 and 61% effective in preventing hospitalization from the flu. But the vaccine was much more effective in younger people than those over the age of 50. The adjuvanted vaccine was 88% effective in children versus 40% in adults age 50 and older. Reduction in hospitalization rates followed a similar pattern (86% in children versus 48% in adults).

"We found that the vaccines produced against the swine flu pandemic in 2009 were very effective in both preventing influenza infection and reducing the chances of hospital admission due to flu. This is all very encouraging in case we encounter a future pandemic, perhaps one that is more severe," said Jonathan Van Tam, MD, PhD, the lead study author in a press release from the university.
Mar 13 Vaccine study
Mar 13 University of Nottingham press release