Stewardship / Resistance Scan for Nov 05, 2018

News brief

Rate of drug-resistant organisms in Canadian hospitals remains steady

A point prevalence survey conducted at Canadian hospitals shows that national prevalence rates for infection or colonization with antimicrobial-resistant organisms (AROs) saw little change from 2010 to 2016, according to a study today in Infection Control and Hospital Epidemiology.

The survey of adult inpatients in Canadian hospitals with more than 50 beds was conducted in February 2016. Patients colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA), Clostridioides difficile infection (CDI), vancomycin-resistant Enterococcus (VRE), extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CREs) were included. Previous surveys had been conducted in 2010 and 2012.

In total, 160 hospitals from 9 of 10 provinces with 35,018 adults patients participated in the survey. Hospitals reported a total of 3,117 patients colonized or infected with at least one ARO, for a prevalence of 8.9 per 100 patients. Median prevalence per 100 patients was 4.1 for MRSA, 1.1 for CDI, 0.8 for VRE, 0.8 for ESBLs, and 0 for CREs. Hospitals in western Canada had the highest median prevalence of MRSA and VRE, while hospitals in central Canada had a higher median prevalence of CDI. Among the 106 hospitals that participated in all three surveys, no significant changes were detected in the prevalence of any of the AROs from 2012 to 2016.

Although CREs remained infrequently identified, they were reported from more hospitals in 2016 (15%) compared to 2012 (7%). The authors of the study also note that the true prevalence of VRE in Canadian hospitals is likely higher because routine screening for VRE on admission decreased from 94% in 2010 to 74% in 2016.

The authors say ongoing national surveillance for AROs will be important for evaluating potential changes in the epidemiology of diseases caused by these bacteria.
Nov 5 Infect Control Hosp Epidemiol study


Spanish study: Nearly 20% of pharmacies dispense antibiotics without  prescription

A study today in the Journal of Antimicrobial Chemotherapy reports that nearly 20% of pharmacies in a region of Spain dispense antibiotics without a prescription, especially under patient pressure.

In the cross-sectional "simulated patient" study, conducted in two provinces of northwestern Spain from December 2016 through January 2017, four actors visited 977 pharmacies simulating symptoms of a respiratory infection. Each visit began with a request for medication to relieve symptoms, then gradually escalated to a request for stronger medication than what was originally offered, followed by a request for an antibiotic and a specific request for amoxicillin. The result of the demand process was recorded, along with other data (including the area where the pharmacy was located and the sex and education level of the person dispensing the antibiotic).

An antibiotic was obtained in 18.83% (95% confidence interval [CI], 16.5% to 21.4%) of the visits, with the number of antibiotics dispensed increasing with the level of pressure. Analysis of the effect of independent variables showed that there was greater likelihood of antibiotic dispensing in rural areas (odd ratio [OR], 1.79; 95% CI, 1.20 to 2.68) or semi-rural areas (OR, 1.66; 95% CI 1.13 to 2.44) than in urban areas. No association was found with the sex or training of the person who dispensed the antibiotic. 

The authors of the study say the findings indicate that interventions aimed at reducing dispensing of non-prescribed antibiotics should be carried out, with a priority placed on rural pharmacies. Spain has one of the highest rates of antibiotic consumption in the European Union.
Nov 5 J Antimicrob Chemother study

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CDC: Suspected AFM cases rise to 219

The US Centers for Disease Control and Prevention (CDC) today said it and state health partners are investigating 28 more suspected acute flaccid myelitis (AFM) cases, lifting the national number of suspected cases for 2018 to 219.

Also, the CDC said 8 more suspected cases have been confirmed as AFM, raising that total to 80. Diagnosing AFM is based on a thorough review of a patient's clinical syndrome and radiographic findings. One more state reported a confirmed case, raising the total of states reporting illnesses this year to 25.

In October, the CDC said it and its partners were investigating a jump in AFM cases, though still very rare, that's similar to spikes reported in 2014 and 2016. Children make up most of the cases, and symptoms include sudden onset of polio-like symptoms that include limb weakness and decreased muscle tone. Despite intensive investigations, no consistent common cause has been found, but researchers are exploring possible roles for infectious diseases such as enterovirus D68 (EV-D68) and environmental toxins.

The CDC will host a Clinical Outreach and Communication Activity (COCA) call on AFM for clinicians on Nov 13 at 2 pm Eastern Time.
Nov 5 CDC AFM investigation update
Oct 31 CDC COCA call information


CDC updates guidance on allocating pandemic vaccine

The CDC recently updated its interim planning guidance for allocating pandemic influenza vaccine during a flu pandemic, which weaves in its updated pandemic severity categories and lessons learned during the 2009 H1N1 pandemic.

The 25-page document, posted on Oct 26, also covers the possibility that two doses of vaccine or an adjuvant may be needed to provide immunity.

CDC's interim plan has a tiered allocation system, which can be refined based on vaccine quantity available. A change in the update is the addition of pharmacists and pharmacy technicians to the top tier, given that they would play a key role in antiviral dispensing and because many pharmacists would be giving pandemic vaccine immunizations.

The update also based its population group numbers on 2015 US Census estimates.
Oct 26 CDC interim planning guidance on allocating pandemic vaccine

High-path avian flu strikes birds in Vietnam and South Africa

Two countries recently reported new highly pathogenic avian influenza outbreaks, including Vietnam with H5N6 in village birds and South Africa with H5N8 at a commercial ostrich farm.

Vietnam's outbreak began on Oct 29 in a village in Nghe An province in the north, according to notification from the World Organization for Animal Health (OIE). The virus killed 280 of 1,500 poultry and authorities culled the survivors as part of the response to the event.

The latest outbreak from Vietnam comes just 3 days after the country reported another H5N6 outbreak in village birds in Phu Yen province in the south.

Elsewhere, South Africa's agriculture ministry reported an H5N8 outbreak at a commercial ostrich farm in Western Cape province in the south of the country, according to a separate report from the OIE. The event began on Sep 15, killing 2 of 1,014 birds. The remaining ones are slated for destruction.

South Africa has had several H5N8 outbreaks since the middle of 2017, and it reported its last outbreak involving the strain on Sep 17.
Nov 5 OIE report on H5N6 in Vietnam
Nov 2 OIE report on H5N8 in South Africa

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