Stewardship / Resistance Scan for May 23, 2019

News brief

Study links lower triage scores to delayed sepsis antibiotics

Sepsis patients who received a slightly higher emergency department (ED) triage score received antibiotics faster, a crucial step for survival, researchers from Intermountain Medical Center reported yesterday at the American Thoracic Society annual meeting under way in Dallas.

For the study, the team looked at adult sepsis patients who were treated at four Intermountain EDs in Utah from July 2013 to January 2017, according to an Intermountain press release. The EDs use a common five-point acuity score, with one being most in need of immediate care and five the least. They focused on patients with mid-range scores of 2 (emergent) and 3 (urgent) who had abnormally low blood pressures. Of 799 patients, 591 has a score of 2 and 208 had a score of 3. Then they gauged how quickly the patients received antibiotics.

Those who had triage scores of 3 had door-to-antibiotic times that were 32 minutes longer than those assigned a score of 2.

Ithan D. Peltan, MD, MSc, the study's senior author and attending physician in the Intermountain Medical Center Shock Trauma Intensive Care Unit and Intermountain Healthcare Telecritical Care, said in the statement that federal and international standards encourage starting broad-spectrum antibiotics within 3 hours of a sepsis patient's ED arrival. "Those 32 minutes can make a major difference in a patient's chances for survival."
May 22 Intermountain Medical Center press release


Report on superbugs from Mexico highlights medical tourism dangers

Officials from the Centers for Disease Control and Prevention (CDC) and seven state health departments today provided new details on 12 US patients who contracted Verona integron–encoded metallo-beta-lactamase–producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) tied to medical procedures in Mexico—and how the infections could pose a risk to US hospitals.

Reporting in Morbidity and Mortality Weekly Report (MMWR), the investigators say the CDC received 31 reports of VIM-CRPA through its Antibiotic Resistance Laboratory Network from Sep 18 through Nov 19, 2018. Six of those cases were tied to invasive medical procedures in Mexico. After the CDC alerted healthcare professionals about the risk, six more cases came to light.

The 12 patients were from seven states: Utah, Washington, Arizona, Arkansas, Oregon, Texas, and West Virginia. Specimen collection ranged from November 2015 through December 2018. Eleven of the patients were medical tourists—they had traveled to Mexico specifically for bariatric surgery—and the 12th underwent endoscopic cholangiopancreatography in September 2018 after falling ill while traveling. Six patients were hospitalized in the United States for their VIM-CRPA infections, and one who developed a bloodstream infection died. Previous reports have noted that the infections have been tied to Grand View Hospital in Tijuana.

"This investigation highlights the potential for acquiring infections with highly antibiotic-resistant organisms not commonly found in the United States when receiving health care abroad that, once imported into this country, can spread within U.S. health care facilities," the authors write.

They add, "Any patient with an overnight stay in a health care facility outside the United States in the preceding 6 months should undergo rectal screening for carbapenemases on admission to a U.S. health care facility."

On Mar 5, the World Health Organization said 20 people in nine states were tied to the outbreak.
May 24 MMWR report
Mar 5 CIDRAP News scan

News Scan for May 23, 2019

News brief

CDC ends Salmonella investigation into tainted tuna after 15 cases noted

The Centers for Disease Control and Prevention (CDC) yesterday closed its investigation into a multistate Salmonella outbreak tied to frozen tuna after confirming two new cases.

A total of 15 people in eight states were sickened in an outbreak tied to Jensen Tuna products. There were two hospitalizations in the outbreak, and no deaths. North Dakota and Washington state each reported 4 cases, New York had 2 cases, and Colorado, Connecticut, Illinois, Iowa, and Minnesota each had 1.

Illnesses in this outbreak began from Jan 8 through Mar 31, with case-patients ranging in age from 24 to 85 years, with a median age of 40. Nine of 12 people interviewed said they ate sushi from a restaurant or grocery store in the week before they came ill.

"Of the nine people with information about their sushi exposure, all nine (100%) reported eating a sushi item containing raw tuna or raw 'spicy tuna,'" the CDC said. The CDC recommends people ordering spicy tuna or raw tuna sushi ask restaurants if they are using Jensen Tuna.

Jensen Tuna, of Houma, Louisiana, voluntarily recalled frozen ground tuna products imported from Vietnam that may have been contaminated with Salmonella Newport on Apr 15.
May 22 CDC


Inovio launches first clinical trial of Lassa fever vaccine

Inovio this week announced the launch of the first clinical trial of a DNA vaccine against Lassa virus that it is developing with support from the Coalition for Epidemic Preparedness Innovations (CEPI).

In a news release, the company said it has dosed the first participants in the phase 1 trial of INO-4500, which will enroll about 60 volunteers.

Preclinical studies funded by the National Institute of Allergy and Infectious Diseases (NIAID) showed the vaccine provided 100% protection in nonhuman primates challenged with Lassa virus. In 2018, Inovio received a $56 million grant from CEPI to advance vaccine candidates against Lassa and Middle East respiratory syndrome coronavirus (MERS-CoV) through phase 2 trials. The goal for the Lassa vaccine following the phase 2 trial is to stockpile supplies as soon as possible for emergency use. Currently, there is no licensed vaccine or treatment for Lassa fever.

Melanie Saville, MBBS, CEPI's director of vaccine development, said, "With marked increases in the number of cases documented in Nigeria over the last two years and outbreaks occurring annually, Lassa fever remains a serious public health threat across West Africa. We welcome Inovio's work and progress which could pave the way to reducing the great suffering caused by this disease."

Following the phase 1 trial, Inovio expects to advance INO-4500 to a phase 2 field trial in endemic countries in West Africa later in 2019 and 2020.
May 12 Inovio press release


MERS infects man from Riyadh, Saudi Arabia

Saudi Arabia's Ministry of Health today reported another MERS-CoV infection, this time involving a 69-year-old man from Riyadh, the country's capital.

In an update to its epidemiologic week 21 report, officials said an investigation revealed the man had contact with camels, a known risk factor for contracting MERS-CoV.

Saudi Arabia has confirmed 141 MERS cases this year. The World Health Organization said in its most recent update that globally through Apr 30 it has received reports of 2,428 cases, at least 839 of them fatal. The vast majority of the illnesses have been in Saudi Arabia.
May 23 Saudi MOH update

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