Stewardship / Resistance Scan for May 07, 2019

News brief

Pakistani study finds high mortality rate in patients with Candida auris

A study yesterday in BMC Infectious Diseases by Pakistani researchers describes the wide range of invasive infections and high mortality rate associated with the multidrug-resistant fungus Candida auris.

The retrospective study, conducted at a university hospital in Karachi, included 92 patients who had C auris strains isolated from September 2014 through March 2017. Overall, 193 C auris strains were collected; 65 of the patients were infected and 27 were colonized.

Among the infected patients, bloodstream infections (candidemia) accounted for 38 cases (58%), most of them central line-associated bloodstream infections, followed by urinary tract infections (19 cases, 29%). Other infections included peritonitis, empyema, nosocomial ventriculitis, otitis externa, and surgical site infections. Antifungal susceptibility testing on 63 isolates found resistance to fluconazole in all isolates, voriconazole resistance in 18 isolates (28.6%), and amphotericin resistance in 5 isolates (7.9%). No isolates were resistant to all classes tested.

The crude in-hospital mortality rate among the patients was 42.4%, with 19 deaths directly related to C auris, while 14-day mortality was 31.5%. Mortality was similar among infected and colonized patients (46.2% vs 33.3%) and higher in candidemia patients than non-candidemia patients (60.5% vs 25.9%). On multivariate analysis, candidemia (adjusted odds ratio [AOR], 4.2%; 95% confidence interval [CI], 1.09 to 16.49, P = 0.037) and older age (AOR, 4.5; 95% CI, 1.09 to 18.9, P = 0.038) were associated with greater mortality. Source control was found to be a protective factor (AOR, 0.22; 95% CI, 0.05 to 0.92, P = 0.038).

The mortality figures are in line with previous C auris studies, which have found mortality rates ranging from 30% to 60%.
May 6 BMC Infect Dis study

 

Study supports shorter antibiotic treatment for UTIs in men

The findings from a multi-clinic study support shorter antibiotic therapy for men with uncomplicated urinary tract infections (UTIs) in outpatient settings, researchers from Baylor College of Medicine and elsewhere reported yesterday in Open Forum Infectious Diseases.

In the retrospective cohort study, the researchers examined the administrative and billing records of adult men who were diagnosed as having a UTI and prescribed an antibiotic at three different types of outpatient clinic from January 2011 through September 2015. For eligible visits in which an antibiotic was prescribed, the team extracted data on the antibiotic used, the treatment duration, recurrent UTI episodes, and patient medical and surgical history. The primary exposure was treatment duration, characterized as short (7 days or less) or long (more than 7 days) based on expert recommendation.

Overall, 637 visits were included for 573 unique patients with a mean age of 53.7 years. Fluoroquinolones were the most commonly prescribed antibiotics (69.7%), followed by trimethoprim-sulfamethoxazole (21.2%), nitrofurantoin (5.3%), and beta-lactams (3.8%). Thirty-two patients had UTI recurrence, with 7 having early recurrence and 25 having late recurrence. Antibiotic choice was not associated with UTI recurrence.

In the overall cohort, longer treatment duration was not significantly associated with UTI recurrence (odds ratio [OR], 1.95; 95% CI, 0.91 to 4.21). But an assessment of the association between treatment duration and recurrence in four subgroups found that longer treatment was associated with more than twice the risk of recurrence in the group that excluded men with urologic abnormalities, immunocompromising conditions, prostatitis, pyelonephritis, nephrolithiasis, and benign prostatic hyperplasia (OR, 2.62; 95% CI, 1.04 to 6.61).

Although the authors note that the results need to be interpreted with caution, they say the study adds to evidence that men with UTIs and no additional complications can be treated with a 7-day antibiotic course. "Shorter duration of antibiotic treatment for male UTI may lead to decreased risk of antibiotic resistance, fewer adverse effects, and lower costs," they write.
May 6 Open Forum Infect Dis abstract

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News Scan for May 07, 2019

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Mongolian town quarantined after couples dies from plague

A 38-year-old man and his pregnant wife, 37, died in Mongolia from bubonic plague after eating tainted marmot meat, according to a report in The Siberian Times.

The Mongolian Ministry of Health confirmed the cause of death, and issued a quarantine for Ulgii, the town where the couple lived, leaving several dozen tourists stranded. The quarantine lifted yesterday, the BBC reported. 

Mongolian folk tradition dictates that eating raw marmot can bring good health. The couple reportedly ate raw marmot kidneys.

Buponic plague is caused by the bacterium Yersinia pestis. Fleas infected with the bacteria typically bite animals, including rodents like marmots.

The BBC said 118 people who had contact with the couple were isolated and treated with antibiotics for prophylaxis.
May 4 Siberian Times story
May 7 BBC story

 

Report details tularemia cluster linked to contaminated wine grape juice

An investigation into a cluster of tularemia cases in Germany found that the patients had drunk contaminated pressed grape juice at a wine tasting in Rhineland-Palatinate, according to a report published yesterday in the International Journal of Infectious Diseases.

One of the patients was a 46-year-old man who was hospitalized after prolonged symptoms that included pharyngitis and swollen cervical lymph nodes, which was complicated by septicemia. An ear, nose, and throat physician who consulted on the case sent serum samples to the Robert Koch Institute, where they tested positive for antibodies to Francisella tularensis, the bacterium that caused tularemia.

Ciprofloxacin treatment was initially helpful, but the symptoms got worse and the man was hospitalized again on day 60. Six days later, blood samples tested positive for F tularensis, and a sample from a lymph node aspirate was positive for F tularensis holarctica, the most common subtype in the Northern Hemisphere that typically causes a milder form of tularemia.

The patient was diagnosed as having the oropharyngeal form of the disease, suggesting that he had consumed the infectious agent. Clinicians drained the man's abscess, and he was discharged with oral antibiotics treatment that included ciprofloxacin and rifampicin.

An investigation found that five other patients were infected at the same wine tasting, three of them children. The beverage they sampled was grape must, which is nonalcoholic pressed unfiltered juice. The grape must had evidence of F tularensis DNA, and a mechanical harvester was identified as the source. Though the illnesses are rare, infections from contaminated drinking water and food have been reported before. The authors said the automatic harvest machines could have contaminated the grape must via an infected rodent or rabbit.
May 6 Int J Infect Dis abstract


Study: PCV13 serotypes detected in about 5% of adult pneumonia patients

Despite the high uptake of the 13-valent pneumococcal conjugate vaccine (PCV13) in the United States, 3.8% to 5.3% of community acquired pneumonia (CAP) cases in working-age adults are still caused by strains contained in the vaccine, according to a study published yesterday in Vaccine.

The study collected respiratory samples from 12,055 CAP patients seen at 21 acute care hospitals in 10 US cities between 2013 and September 2016. The mean patient age was 64.1 years, and 52.7% were 65 years or older.

PCV13 serotypes were detected in 4.6% of all patients and 4.2% of those 65 years or older; for patients ages 18 to 64, PCV13 serotypes were detected in 3.8% to 5.3% of patients.

In 2010, PCV13 was introduced into US childhood vaccine schedules, and in 2012, the vaccine was recommended for all adults over the age of 65.

"Despite pediatric herd effects, PCV13 serotypes continue to cause CAP in adults in the United States," the authors concluded. "Given this remaining vaccine-type disease identified in adults, direct vaccination with PCV13 is likely beneficial in all older adults and younger adults with underlying chronic conditions."
May 6 Vaccine study

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