Stewardship / Resistance Scan for Nov 21, 2018

News brief

CDC investigating multidrug-resistant Pseudomonas outbreak in Texas

The City of Lubbock, Tex., Health Department and the Centers for Disease Control and Prevention (CDC) are investigating an outbreak of multidrug-resistant Pseudomonas aeruginosa in multiple healthcare facilities.

To date, 27 cases of Verona integron-encoded metallo-beta-lactamase (VIM)-producing P aeruginosa have been identified since the outbreak was discovered in October. The cases were identified by the CDC's Antibiotic Resistance Laboratory Network.

"The cases are not associated with a single facility and there is no obvious epidemiologic link," Katherine Wells, MPH, City of Lubbock director of public health, told CIDRAP News. "We are currently working with CDC to complete PFGE [pulsed-field gel electrophoresis] and WGS [whole-genome sequencing] to look for links. We are also working with acute care hospitals and long-term care facilities to do additional point-prevalence surveys."

VIM is a mobile resistance mechanism that confers resistance to carbapenems and several other classes of antibiotic and can be transferred between bacterial species. VIM-producing P aeruginosa was first reported in France in 1996 and has been documented in other countries, but it is less common in the United States. The organism can cause severe healthcare-associated infections, is difficult to treat, and is associated with high morbidity and mortality.
City of Lubbock VIM resources page


Endoscope linked to hospital outbreak of multidrug-resistant organisms

An epidemiologic investigation by researchers from the University of Pittsburgh has found that an outbreak of multidrug-resistant organisms (MDROs) in hospital patients was linked to contamination of a single, defective bronchoscope, according to a study in Infection Control and Hospital Epidemiology.

The outbreak was discovered in November 2014, when a cluster of patients with bronchoscopically obtained clinical cultures positive for carbapenem-resistant Klebsiella pneumoniae (CR-KP) and multidrug-resistant P aeruginosa (MDR-PA) was identified in the medical intensive care unit (MICU) at University of Pittsburgh Medical Center-Presbyterian Hospital. Of the nine bronchoscopes used in the MICU, only one (named B1) was positive for CR-KP and MDR-PA. To determine the link between bronchoscope B1 and the outbreak, investigators performed molecular typing and WGS on isolates from the patients and the device.

A total of 33 case patients with cultures positive for CR-KP and MDR-PA were identified from July 2014 to December 2014; of these patients, 23 (69.7%) were exposed to bronchoscope B1. Molecular testing and WGS confirmed that isolates from bronchoscope B1 and 19 of the patients were genetically related, providing strong evidence for horizontal bacterial transmission. Ten of the 19 patients were classified as belonging to a "pseudo-outbreak" that occurred because of contamination of patient specimens as they were being withdrawn from the bronchoscope.

Upon removal of B1 from service, the number of patients with newly detected CR-KP or MDR-PA decreased. Borescopy revealed a luminal defect that may have contributed to the establishment of biofilm and subsequent contamination, despite compliance with the manufacturer's recommended reprocessing procedures.

The authors of the study conclude, "In addition to adhering to endoscope reprocessing guidelines, hospital epidemiology programs should prioritize thorough periodic maintenance of endoscopic devices and emphasize scrutiny of endoscopic-derived culture data as an important intervention to hasten recognition of endoscope-associated outbreaks."
Nov 19 Infect Control Hosp Epidemiol abstract

Our underwriters

News Scan for Nov 21, 2018

News brief

Listeria cluster prompts Vietnamese pork roll recall

An investigation into a cluster of listeriosis cases by federal health agencies prompted the recall yesterday of ready-to-eat Vietnamese-style pork patty rolls, according to a notice from the US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS).

The recall applies to seven types of Long Phung brand patty rolls that were produced from May 21 to Nov 16, and they bear the establishment number "EST. 13561" inside the USDA inspection mark. The products were shipped to distributors and retailers nationwide.

The epidemiologic investigation identified four cases between Jul 1, 2017, and Oct 24, 2018. Whole-genome sequencing on samples collected from a Long Phung food facility showed they closely matched Listeria monocytogenes from sick patients. Health officials are working with federal and state partners to determine if more illnesses are related to the products.

The FSIS said it is concerned that the recalled products may still be in consumers' freezers. It urged people who bought the products to throw them out or return them to the place of purchase.
Nov 20 FSIS recall notice


Report details norovirus spread at a 2017 restaurant Thanksgiving feast

An investigation into 18 gastrointestinal illness complaints in people who had eaten Thanksgiving Day dinner at a Tennessee restaurant in 2017 found that point-source contamination occurred after a customer vomited, which probably led to transmission by aerosol, person-to-person, fomite, or foodborne routes. Investigators from the US Centers for Disease Control and Prevention and from Tennessee reported their findings today in the latest issue of Morbidity and Mortality Weekly Report (MMWR).

After a restaurant patron vomited in a private dining room, an employee immediately used disinfectant spray labeled as effective against norovirus to clean up the area. After washing his or her hands, the employee served family-style platters of food and cut pecan pie.

That day the restaurant served 676 people, and it was able to help health officials with the outbreak investigation by providing contact and seating time and location information for 114 customers who had reservations. From that, health officials were able to enroll 137 (20% of the 676) in a case-control study.

Stool specimens confirmed norovirus in two patients as well as in an environmental sample collected from the underside of a table leg near where the customer vomited.

Of the foods that customers ate, only pecan pie was significantly associated with illnesses, but only 16 of 34 patients had eaten it. The vomiting event occurred around noon, and customers who seated during the 11 am to 1 pm period were significantly more likely to become ill.

Researchers concluded that norovirus probably spread through the restaurant by multiple routes and that inadequate employee hand washing probably facilitated foodborne transmission through servings of pecan pie.
Nov 23 MMWR report


MERS sickens another in Riyadh

Saudi Arabia's Ministry of Health (MOH) today reported one more MERS-CoV case for epidemiologic week 47, which involves a 29-year-old woman from Riyadh.

An investigation found she didn't have contact with camels before her MERS-CoV (Middle East respiratory syndrome coronavirus) symptoms began, and she likely didn't contract the virus from another sick patient.

The woman's illness is the fourth case to be reported from Riyadh in November.

Her illness appears to lift the global total to 2,267 cases, at least 804 of them fatal, based on a recent update from the World Health Organization. The vast majority of cases have been in Saudi Arabia.
Nov 21 Saudi MOH update


Miami-Dade County records first locally transmitted dengue case of 2018

Officials from the Florida Department of Health in Miami-Dade County (DOH-Miami-Dade) confirmed earlier this week the state's first case of locally transmitted dengue in 2018.

"DOH-Miami-Dade is working in conjunction with Miami-Dade County's Mosquito Control and Habitat Management Division which has implemented its response protocol to eliminate breeding and adult mosquito activity in the area of the confirmed case," the agency said in a news release.

According to the Miami Herald, Florida has recorded 21 cases of locally acquired dengue in the past decade. The virus, which can be severe, is transmitted by the Aedes aegypti mosquito, the same species that transmits Zika, chikungunya, and yellow fever viruses.

Florida officials are reminding residents of Miami-Dade County to drain standing water, empty and clean birdbaths and pet bowls at least one a week, and wear insect repellent to deter mosquito bites.
Nov 19 DOH-Miami-Dade press release
Nov 19 Miami Herald story

This week's top reads