Stewardship / Resistance Scan for Nov 29, 2017

News brief

Antibiotics given to moms during labor might affect babies' microbiomes

Antibiotics administered to mothers during labor to prevent group B Streptococcus infections appear to alter the gut microbiome of newborns, according to a small study yesterday in Scientific Reports.

The effects appeared to resolve within 12 weeks.

Researchers from McMaster University in Hamilton, Ont., compared "bacterial community succession," or the growth of gut bacteria in 53 infants with no antibiotic exposure with 14 infants whose mothers received the preventive antibiotics during delivery. The team tested the development of the infants' gut microbiome at 3 days, 10 days, 6 weeks, and 12 weeks from birth.

"Our research indicates there is a delay in the expansion of the dominant infant gut colonizer, called Bifidobacterium, when infants are exposed to antibiotics," said Jennifer Stearns, PhD, the study's lead author, in a McMaster news release. The bacterial differences between the two groups all but disappeared by 12 weeks.

"It's a good sign that bacterial groups recover by 12 weeks but it's still unclear what these findings mean for infant health, especially since early infancy is such an important developmental time," Stearns said.

About a fourth to a third of pregnant women test positive for group B Streptococcus during routine screening, and most receive antibiotics during labor to prevent transmitting the bacterium to their infants at birth, according to the release.
Nov 28 Sci Rep study
Nov 28 McMaster University press release

Duke publishes guide for gathering key ASP data

Duke University has published a metrics guide on developing patient outcome measures and measurement tools for antibiotic stewardship programs (ASPs), the Duke Antimicrobial Stewardship Outreach Network (DASON) said in a Nov 27 news release.

The guide, produced through a partnership with the US Centers for Disease Control and Prevention Foundation and Merck, aims to address a need for strong stewardship metrics "that reflect the impact of ASPs on patient safety and optimized care," DASON said. Despite the importance of data to drive decision making, most facilities have limited access to local data and thus limited ability to assess the impact of ASPs, the center said.

DASON convened a panel of experts to assess metrics used or proposed in the medical literature, as well as unpublished data. The panel then identified the best metrics to (1) improve antimicrobial prescribing practices, (2) improve patient care, and (3) aid in targeting ASP efforts, as well as those that can be feasibly monitored in any hospital that has an electronic health record. Scientists then tested the candidate metrics at five pilot sites.

"Working closely with these pilot partner sites, the feasibility of data capture and analysis as well as the utility of each candidate metric to guide local stewardship activities was assessed during on-site visits, frequent communication with the stewardship teams, and formal survey techniques," DASON said. "This Guide reflects the outcome from this development and feasibility project."

The guide includes a technical manual, a report tool, data table guidelines, sample feedback reports, and other resources.
Nov 27 DASON news release
Nov 27 DASON ASP metrics guide

Study shows EMS-administered antibiotics don't help with sepsis

Having emergency medical services (EMS) personnel administer antibiotics to suspected sepsis patients in the ambulance en route to the hospital did not improve survival, regardless of illness severity, Dutch researchers reported yesterday in The Lancet Respiratory Medicine.

After training EMS personnel to recognize sepsis, the investigators conducted a randomized controlled open-label trial involving 10 large regional ambulance services serving 34 secondary and tertiary care hospitals in the Netherlands. They compared the effects of early administration of the antibiotic ceftriaxone in the ambulance with usual care (the control group).

The study involved 2,672 patients, 1,535 in the intervention group and 1,137 in the control group. Patients in the intervention group received antibiotics a median of 26 minutes before arriving at the hospital emergency department.

At day 28, 120 patients (8%) had died in the intervention group and 93 (8%) in the control group. In addition, 102 patients (7%) in the intervention group and 119 (10%) in the control group were readmitted to a hospital within 28 days, but the difference was not statistically significant. The researchers reported seven mild allergic reactions that could not be attributed to ceftriaxone.

The authors conclude, "In patients with varying severity of sepsis, EMS personnel training improved early recognition and care in the whole acute care chain. However, giving antibiotics in the ambulance did not lead to improved survival, regardless of illness severity."

An accompanying commentary suggests that researchers should perform a randomized controlled trial involving only the most severe cases, and antibiotics with a narrower mechanism of action be used.
Nov 28 Lancet Respir Med study
Nov 28 Lancet Respir Med commentary

News Scan for Nov 29, 2017

News brief

Another case of MERS reported in Bisha

The Saudi Arabian Ministry of Health (MOH) today reported a new case of MERS-CoV in Bisha, the third within the last week.

A 67-year-old Saudi woman is in stable condition after presenting with symptoms of MERS-CoV (Middle East respiratory syndrome coronavirus) infection. Her source of infection is listed as "primary," meaning it's unlikely she contracted the virus from another person.

Saudi Arabia's MERS-CoV case count since 2012 has now reached 1,751, including 708 deaths. Six patients are still being treated, according to the MOH.
Nov 29 MOH report

Nigeria reports more suspected, confirmed yellow fever cases

The number of yellow fever cases in an outbreak in Nigeria has risen to 276 suspected or confirmed infections, according to the latest update from the Nigeria Center for Disease Control (NCDC). The number of confirmed cases has doubled, from 15 to 30, with a fourth state—Kano—reporting a new case. The other states with confirmed cases are Kwara, Kogi, and Zamfara, though a total of 14 states have reported suspected infections.

So far, 45 deaths have been reported, including 7 among the confirmed cases.

The outbreak began in September with the confirmation of a yellow fever infection in a girl from Kwara state. An earlier report from the World Health Organization said an investigation found suboptimal vaccine coverage in a number of states. In October, Nigeria launched a yellow fever vaccination campaign that targeted 840,000 people in Kwara and Kogi states.
Nov 21 NCDC yellow fever update
Nov 13 CIDRAP News scan "Nigeria's number of confirmed yellow fever cases climbs to 15"

Nigeria confirms 14 new monkeypox cases

In a separate update, the NCDC confirmed 14 new monkeypox cases in the past week, bringing the outbreak to 56 confirmed cases, making it Africa's largest.

So far there have been no deaths recorded during the outbreak, and the NCDC said the number of suspected cases has declined over the last month.

Three new states, Imo, Katsina and Nasarawa, reported cases of the smallpox-like virus. A total of 155 suspected cases have been reported across much of Nigeria.

Monkeypox is spread through contact with an infected animal, and can be caused by consuming undercooked bush meat. Nigerians are advised to stay away from sick animals and practice good hygiene.
Nov 23 NCDC situation report

New H5N6 reassortant found in Japanese avian flu outbreak

One day after South Korea announced the detection of a new highly pathogenic H5N6 reassortant in a recent influenza outbreak, scientists at Japan's Tottori University announced a similar findings in isolates recently collected from the country's Shimane prefecture, suggesting that the spread of the new virus might be wider than previously thought.

In a university press release, translated and posted by Avian Flu Diary (AFD), an infectious disease news blog, researchers said the reassortant H5N6 virus they found was collected from a dead wild swan. Full-length genetic analysis found that it is different from the H5N6 virus that sparked outbreaks last winter in Japan and is a reassortant of an N6 avian influenza strain widely distributed in Eurasian waterfowl and other H5N8 viruses that struck many countries last season.

The analysis also found no genetic evidence to suggest the virus is able to spread directly to humans. Also, tests confirmed that the reassortant is highly pathogenic in birds. The report said more work will be done to compare the virus with earlier H5N6 strains, to compare the Japanese virus with South Korean isolates, and to analyze the reassortant virus in greater detail.

During last winter's outbreaks, animal health officials in Greece found a different H5N6 strain that on early analysis appeared to be a reassortant of highly pathogenic H5N8 and endemic Eurasian viruses.
Nov 29 AFD post
Nov 27 CIDRAP News story "H5N6 avian flu reassortant found in recent Korean outbreak"

Pneumococcal vaccine costs keep rising

The cost of the pneumococcal vaccine Prevnar 13 is rising steadily, Kaiser Health News (KHN) reported today.

Pfizer Inc., the only pharmaceutical company that produces a pneumonia vaccine, has raised the price of Prevnar 13 steadily since 2010, when the vaccine was approved by the Food and Drug Administration. The vaccine is administered four times before a child is 2 years old. The vaccine is also recommended for adults age 65 and older. In the last 8 years, the price has gone up by 50%.

In 2010, a single shot cost $109; by next year Pfizer said the cost will be $180.

Because the vaccine is recommended by the Advisory Committee on Immunization Practices (ACIP), most insurers cover the costs without the patient knowing. But providers say the rising costs make keeping enough vaccine in stock difficult. Providers have to buy Prevnar 13 upfront, then wait for insurance reimbursements.

Pfizer countered that its product is valuable, ACIP-recommended, and is shelf-stable for 3 years.
Nov 29 KHN report