Stewardship / Resistance Scan for Mar 20, 2019

News brief

Contamination with MDROs after patient interaction common, study finds

Researchers at a large tertiary-care teaching hospital in Chicago reported today in Infection Control and Epidemiology that more than a third of healthcare workers were contaminated with a multidrug-resistant organism (MDRO) after caring for patients infected or colonized with the bacteria, and that errors in doffing personal protective equipment increased the risk of contamination.

The study, conducted at Rush University Medical Center in Chicago, enrolled 125 healthcare workers (mainly physicians and nurses) who were caring for patients on contact precautions for methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci, and multidrug-resistant gram-negative pathogens. The researchers took swab samples from the healthcare workers' hands, clothes, gloves, gowns, and other equipment before and after patient interactions, and observed how the healthcare workers removed gowns and gloves after caring for patients. They also took samples from patients and environmental sites.

Of the 125 healthcare workers, 43 (34.4%) acquired the MDRO that was colonizing or infecting a patient during the patient encounter, with 38 acquiring the target MDRO on gloves and gowns and 4 acquiring it on their hands. Target MDROs were also found on healthcare worker clothing and equipment. Healthcare worker contamination was more common in settings of higher patient and environmental contamination. In addition, more than a third of healthcare workers (37.6%) made multiple doffing errors, including touching the inside of the gown or glove with a gloved hand, or touching the outside of the glove or gown with a bare hand.

Healthcare workers who made multiple doffing errors were more likely to have contaminated clothes after a patient encounter (odds ratio [OR], 13.23; 95% confidence interval [CI], 1.31 to 133.26, P = 0.26). There was also a higher risk of hand contamination when gloves were removed before gowns (OR, 5.56; 95% CI, 1.07 to 28.80, P = .052).

The authors of the study suggest that reinforcing the preferred order of doffing gloves and gowns—gloves and gowns removed together, or separately, with gloves first—could reduce healthcare worker contamination.
Mar 20 Infect Control Hosp Epidemiol abstract


WHO issues consolidated guidelines for MDR-TB treatment, care

The World Health Organization (WHO) today announced new consolidated guidelines aimed at improving treatment for multidrug-resistant tuberculosis (MDR-TB).

The consolidated guidelines incorporate all previous WHO guidance on treating drug-resistant TB dating back to 2011, including the most recent guidance issued in December 2018. The most significant change in the December 2018 guidance was the recommendation of a fully oral regimen for longer MDR-TB treatments, which last 18 to 20 months. The regimen no longer includes the injectable drugs kanamycin and capreomycin, which have been associated with increased risk of treatment failure and relapse and severe side effects, including hearing loss.

The consolidated guidelines also include treatment recommendations for isoniazid-resistant TB, a shorter treatment regimen for certain MDR-TB patients, policy recommendations for culture monitoring and surgery in MDR-TB patients, and optimal models of patient support and care.

The guidelines were released in advance of World TB Day on Mar 24.
Mar 20 WHO consolidated drug-resistant TB guidelines


New antibiotic development partnership formed

The Global Antibiotic Research and Development Partnership (GARDP) announced yesterday that it will partner with German drug maker Evotec AG to establish a joint pipeline of new antibiotics for hard-to-treat bacterial infections.

GARDP said the strategic partnership will focus on accelerating the discovery and development of antibiotics for infections caused by the WHO's priority pathogens by building a platform that spans the length of the drug development value chain. The two organizations also aim to ensure that the novel antibiotics produced through the partnership are sensibly priced and available to all patients who need them.

"Working with Evotec will undoubtedly strengthen GARDP's efforts to develop new antibiotics, while addressing the need for their sustainable access," Seamus O'Brien, PhD, research and development director at GARDP, said in a press release. "Evotec's expertise complements GARDP's approach, which allows both partners to develop a drug from early exploratory to preclinical and clinical studies all the way to patients."
Mar 19 GARDP press release


Sampling finds Legionella, Mycobacterium in home and office tap water

Year-long sampling of cold water taps from offices and residences across the United States for two organisms known to cause two lung diseases—legionellosis and pulmonary nontuberculosis mycobacterium disease—revealed sporadic detections, according to researchers from the US Environmental Protection Agency (EPA).

The taps were monitored from January 2009 through November 2014, and, of the 108 taps, 65 were in offices and 43 were in residences. The locations spanned 31 states, 1 federal territory, and 1 federal district. Water was collected from the same tap at three specific times in 1 year. The team reported its findings today in the Journal of Applied Microbiology.

The investigators tested for Legionella pneumophilia, L pneumophilia serogroup 1, and Mycobacterium avium. The organisms were detected in 41%, 25%, and 45% of the structures, respectively. The team looked for two occurrence patterns, sporadic (a single detection) and persistent (positive tests in at least two of the three samples).

Microbe occurrence was mainly sporadic, with persistence seen more often in office buildings, independent of building age and square footage. For residences, the researchers saw microbial persistence in structures older than 40 years for L pneumophilia, but rarely for M avium. Lack of consistent detections reduces the potential to trigger an outbreak among a family or group of workers, the group concluded.

Maura Donohue, PhD, a study coauthor who works with the EPA in Cincinnati, said in a press release from Wiley, the journal's publisher, that residences are often suspected as the bacteria source when an illness involving one of the two organisms is reported, but the study shows that this may not be the case for sporadic incidence. The group notes that the results show exposure is occasional but that other factors involving aerosols and the host are needed for disease transmission.

"Data from this study can help public health officials pinpoint locations of disease transmission, inform decisions on detection or recovery of the causative agent, and improve public health protection," she said.
Mar 20 J Appl Microbiol abstract
Mar 20 Wiley press release

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