Stewardship / Resistance Scan for May 30, 2017

News brief

Gonorrhea isolates from Hawaii outbreak show high resistance profile

A new report in Clinical Infectious Diseases is providing some additional detail on a cluster of genetically related Neisseria gonorrhea isolates with high-level azithromycin resistance and decreased ceftriaxone susceptibility previously detected in Hawaii.

After demonstrating elevated minimum inhibitory concentrations (MICs) for azithromycin and ceftriaxone in antimicrobial susceptibility testing by the Hawaii Department of Health, the eight N gonorrhea isolates collected from seven patients on Oahu from April 2016 through May 2016 were sent to the University of Washington and the US Centers for Disease Control and Prevention (CDC) for further testing. That testing confirmed that all isolates showed high-level azithromycin resistance and five had reduced susceptibility to ceftriaxone. All isolates were also beta-lactam positive and resistant to penicillin, tetracycline, and ciprofloxacin. Genomic analysis revealed that the isolates were genetically related

The seven patients included six males and one female. All patients were successfully treated. Eight recent unique partners were reported by the patients, with two male patients identifying the same female sex worker from a Honolulu massage parlor as a recent contact. Only one of the eight partners was diagnosed and treated for gonorrhea.

The cases were first reported by the CDC in September 2016.

The authors of the study say they believe these are the first gonococcal isolates identified in the United States with both high-level azithromycin resistance and reduced ceftriaxone susceptibility. Because gonorrhea has developed resistance to previously recommended antimicrobials, the CDC currently recommends only the combination of ceftriaxone and azithromycin as the standard treatment for the sexually transmitted disease. The concern is that widespread transmission of such strains could complicate treatment.

The authors warn that clinicians should be on high alert so that any suspected gonorrhea treatment failures can be identified and reported to local health departments and the CDC.

"Rapid detection and effective treatment may prevent sequelae, allow partners to be identified and treated in a timely manner, and prevent or slow further transmission of resistant strains," they write.
May 26 Clin Infect Dis abstract
Sep 21, 2016, CIDRAP News story

Tests find cleaning-disinfection products work well on MDR pathogens

A study that compared seven different commercial products for cleaning and disinfecting hospital rooms found that nearly all were effective against three multidrug-resistant (MDR) outbreak pathogens, except for one that contained hydrogen peroxide.

Dutch researchers focused on three bacterial strains known to cause MDR outbreaks at hospitals in the Netherlands: vancomycin-resistant enterococci (VRE), Klebsiella pneumoniae OXA-48, and Acinetobacter baumannii. The team published its findings yesterday in the American Journal of Infection Control.

Each ready-to-use cleaning and disinfecting product had a different active ingredient, and testing involved both wiping and spraying. Researchers assessed how well the products reduced microbial count and protein on tiles that were similar to those found in hospital settings.

All products reduced microbial count by more than 5 log10 with 5-minute exposure times, except for a hydrogen peroxide–based spray, which showed lower reduction against VRE. For the six other products, researchers saw no significant differences in bacterial load reduction between use of a wipe or a spray.
May 29 Am J Infect Control study

News Scan for May 30, 2017

News brief

MERS infects one more in Saudi Arabia

Saudi Arabia has announced one new MERS-CoV case over the past 4 days, according to updates from the country's Ministry of Health (MOH).

The case involves a 60-year-old Saudi man from Medina, the country's second holiest city, whose MERS-CoV (Middle East respiratory syndrome coronavirus) infection was announced yesterday. The man is hospitalized in stable condition. He is not a health worker, and an investigation so far reveals primary exposure to the virus, meaning the man probably didn't contract it from another infected person.

The latest case pushes Saudi Arabia's total number of MERS-CoV illnesses since the virus was detected for the first time in humans in 2012 to 1,616, which includes 668 deaths. Four people are still being treated for their infections.
May 29 Saudi MOH statement

PAHO reports 38,000 new chikungunya cases

Led almost entirely by newly reported cases in Brazil, the Pan American Health Organization (PAHO) reported 38,282 new chikungunya cases late last week, an 80% increase in the yearly total.

The new cases lift the number of 2017 cases to 86,433, according to the May 26 update. The previous weekly reports reflected increases of 16,436 and 142 cases, respectively.

Brazil, reporting on 3 weeks' worth of cases, noted 37,939 new infections and 80,949 for the year, or 94% of the cases reported so far in 2017. Peru had the second-largest increase, with 200 new cases and 997 total. The number of deaths from the disease climbed from 9 to 13, and all of them have been in Brazil.

Since the chikungunya outbreak began in late 2013 on the Caribbean island of St. Martin, the virus has sickened at least 2,473,460 people.
May 26 PAHO update

Duck production resumes in France; H5N8 hits birds in Russia, Germany

After a 6-week pause in duck production because of avian influenza outbreaks that targeted southwestern France for the second year in a row, farmers yesterday resumed operations, Reuters reported, citing an official from a foie gras industry group.

Officials estimate that 12 million birds were lost to culling or the break in production, with the overall cost of the outbreak reaching $391 million. Most of the French outbreaks were caused by highly pathogenic H5N8, which struck several other European countries, and showed up in the Middle East and Africa along migratory flyways. France also battled a host of low-pathogenic avian flu strains.
May 29 Reuters story

In other outbreak developments, Russia today reported two more H5N8 outbreaks in backyard birds, according to a report today to the World Organization for Animal Health (OIE). One of the events began on May 12 in Nizhegorod Oblast, and the other started on May 18 in the Udmurt Republic. Both are in western Russia. Taken together, the two outbreaks killed 138 of 282 susceptible birds, and authorities destroyed the remaining ones. Russia has reported several recent H5N8 outbreaks.

Elsewhere, Germany reported three H5N8 detections in wild birds, which were found dead between Dec 12, 2016 and May 9, 2017, the OIE reported on May 26. Of three dead birds, two were found in Lower Saxony state and one was found in North Rhine-Westphalia state, both in the northwestern part of the country.
May 30 OIE report on H5N8 in Russia
May 26 OIE report on H5N8 in German wild birds

Study: Maternal flu vaccine may protect infants against more than flu

The benefits of vaccinating women against flu during pregnancy may extend beyond influenza to protecting young infants against acute respiratory infections from bacterial causes, a research team based in South Africa reported yesterday in Clinical Infectious Diseases.

The investigators based their findings on a secondary analysis of a 2011-12 double-blind randomized clinical trial on the efficacy of flu vaccination of pregnant women that followed babies during their first 6 months of life. The study included 1,026 babies born to mothers who had received the flu vaccine and 1,023 infants of mothers immunized with placebo.

When researchers looked at all-cause acute lower respiratory tract infection (ALRI), hospitalization incidence was lower in the babies of moms who had received the flu vaccine. Of 30 ALRI hospitalizations in the first 3 months of life, 9 were in the flu-vaccine group and 21 were in the placebo group, for a vaccine efficacy of 57.5%.

However, for infants older than 3 months, ALRI incidence was similar in both groups, corresponding with drop-off in maternal antibody protection.

Of 44 hospitalized babies in the group who were tested for flu, 1 was positive.

Researchers concluded that flu vaccination during pregnancy might also protect against bacterial infections in early infancy, given that flu might predispose patients to secondary illness.
May 29 Clin Infect Dis abstract