Stewardship / Resistance Scan for Oct 16, 2018

News brief

Study finds standard washing doesn't remove C diff from hospital sheets

A team of researchers from the United Kingdom report that Clostridioides difficile spores can survive on hospital sheets even after being washed with high-temperature water and industrial detergents, and that those spores could be contributing to outbreaks of C difficile infection (CDI) in hospitals.

In a study published today in Infection Control and Hospital Epidemiology, researchers from De Montfort University inoculated swatches of cotton sheets with a strain of C difficile, then laundered them with uncontaminated swatches in a simulated washer extractor cycle using an industrial bleach detergent. A control wash with no detergent was also conducted. In addition, they assessed spore survival on swatches of hospital sheets that were naturally contaminated with C difficile and washed, dried, and pressed at a commercial healthcare laundry according to National Health Service standards.

The results revealed that both the simulated and in-situ laundering processes failed the microbiological standards of containing no pathogenic bacteria. Even in the simulated washer extractor cycle with detergent, some spores from the two strains of C difficile survived the process and contaminated the sterile swatches. And in the naturally contaminated sheets, the commercial laundering process only reduced the spore load by 40%. Subsequent ribotyping of C difficile isolates recovered before and after washing showed that they were indistinguishable, indicating that spores recovered after washing were present before washing and were not a result of contamination during the washing cycle.

"The surviving spores may contribute to environmental contamination when the sheets are used for bed making in the healthcare environment," the authors of the study write. "Processing infected linen in commercial washer extractor cycles could disseminate low levels of C. difficile spores and may be contributing to sporadic outbreaks of CDI."

The authors say further research is needed to establish the role that hospital bedsheets may play in CDI outbreaks, and to determine what is needed to fully remove C difficile spores from bedsheets during the laundry process.
Oct 16 Infect Control Hosp Epidemiol abstract


Two tests do well in detecting colistin-resistant Enterobacteriaceae

Two commercial tests performed well in screening for colistin-resistant Enterobacteriaceae on rectal swabs, according to a study yesterday in Antimicrobial Agents and Chemotherapy.

Investigators from Paris-Sud University evaluated the performance of Superpolymyxin medium (made by ELITechGroup) and the Chromid Colistin R plates (made by bioMerieux) to screen for colistin-resistant Enterobacteriaceae from contaminated rectal swabs. Stools were tainted with a total of 94 enterobacterial isolates (Escherichia coli, Klebsiella pneumoniae, Salmonella enterica, and Enterobacter cloacae), including 53 colistin-resistant isolates.

Colistin is a "last resort" antibiotic used for some multidrug-resistant infections.

The sensitivity of detecting colistin-resistant Enterobacteriaceae was 86.8% (95% confidence interval [CI], 74.0% to 94.0%) using both tests, but the isolates that were not detected differed between the two media. Specificity was 97.9% (95% CI, 87.3% to 99.9%) for Superpolymyxin and 100% (95% CI, 90.4% to 100% for Chromid.

The researchers conclude that both tests "provide a useful tool to screen for colistin-resistant Enterobacteriaceae from patient samples (rectal swabs) regardless of the level and mechanism of colistin resistance."
Oct 15 Antimicrob Agents Chemother abstract


Patent filings for AMR point-of-care tests are declining, with funds lacking

Patent filings for point-of-care (POC) diagnostic tests for antimicrobial resistance have been slowly declining since reaching their peak in 2014, according to a study commissioned by the Longitude Prize, a UK program launched in 2014 to spur the development of such tests. The 14-page study was conducted by two intellectual property firms and released on Oct 14 at the World Health Summit in Berlin.

According to a blog post yesterday from Longitude Prize, which has awarded funding to 29 teams to develop POC tests to address antibiotic resistance, researchers looked at what patents are being filed and what technology is being developed, with an eye toward market implications.

Following a drop in filings in 2008 that seemed related to the global financial crisis, filings reached 118 globally in 2014. By 2015, however, the number fell to 94 patents, and researchers don't yet have a clear picture for 2016 and 2017 because of an 18-month delay in filing publication. The team notes that much of the new funding for antimicrobial resistance had targeted new antibiotics, with limited funds for new diagnostics.

Among other findings, the United States dominated the filings for patents for new tests, with 60%, followed by the United Kingdom with 8%. Japan, Australia, India, and South Africa all saw upward trends. Innovations for POC tests are led by private companies, accounting for 60% in the United States and Europe, and academic institutions were responsible for 32%.

At the same time, the percentage of patent filings related to bacterial tests have increased over the same period, while patent filings for World Health Organization priority pathogens have tailed off after an increase between 2009 and 2012, possibly because developers are focusing on more broadly applicable tests.

In addition, Longitude Prize teams say they're struggling to attract adequate funding and investment to bring the tests to market and validate them for regulatory bodies, and investors say prize expectations are too low to ensure a return on investment. "This is a warning to policy makers that initially there will be a need to ring-fence funds to make sure that new products are purchased," the Longitude Prize staff wrote in the blog post.
Oct 15 Longitude Prize blog post
Oct 12 Longitude Prize report
Dec 22, 2017, CIDRAP News story "Four groups get Longitude funds for point-of-care tests"


Market study finds new antibiotics often not widely distributed globally

Antibiotics launched since 1999 took awhile to attain fairly wide geographic dispersal and often targeted common conditions rather than antibiotic-resistant infections, according to a study today in PLoS One.

Of 25 new antibiotics reaching the market from 1999 through 2014, only 12 had registered sales in more than 10 countries. Those with the widest geographic availability had sales in more than 70 countries within 10 years, and in 30 countries within 3 years.

Just 13 (52%) of the new antibiotics had an indication for infections caused by antibiotic-resistant bacteria, with little diversity as far as the target pathogen and indication: 18 were for community-acquired respiratory tract infections, 14 for skin and skin-structure infections, and 12 for urinary tract infections (obviously, several had multiple indications). None targeted gram-negative bacteria, which are among the most troublesome.

The new antibiotics were largely produced in Japan (11 drugs) and the United States (6). Seven were launched in Japan and 12 in the US market. The antibiotics with the greatest geographic availability by 2014—ertapenem, linezolid, moxifloxacin, and tigecycline, which all reached more than 60 countries—originated from European or US companies and were launched in those regions. In general, drugs launched in Japan were less likely to be available in other nations, though antibiotics for drug-resistant infections tended to have greater geographic distribution.

The authors conclude, "Our findings show great variation in geographic availability of antibiotics, indicating that availability in multiple regions and country income classes is possible, but rarely seen within a few years of market authorization."
Oct 16 PLoS One study

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News Scan for Oct 16, 2018

News brief

Five more Ebola cases recorded in Beni, DRC

Late yesterday afternoon and today the Democratic Republic of the Congo (DRC) announced five more cases of Ebola virus disease in Beni and Butembo, the current epicenter of outbreak activity.

All three cases announced yesterday resulted in community deaths that involved safe and dignified burials in Beni, the country's health ministry said. Today two cases, one each in Beni and Butembo, were reported.

The outbreak total now stands at 216 cases, including 139 deaths. Thirty-two suspected cases are still under investigation.

From Oct 8 to Oct 14, officials reported 33 new confirmed cases, 24 deaths, and 175 suspected cases investigated, the DRC said. That increase represents both the second wave of virus activity in Beni and increased surveillance in the region.

Today the DRC said there are more signs of community involvement in Beni, including people self-reporting to Ebola treatment centers. Officials also said that all contacts of two cases in Tchomia have passed through the 21-day follow-up period without incident. Tchomia is near the Ugandan border, on the shores of Lake Albert.

Yesterday DRC officials said 73 patients have been treated with experimental Ebola treatments, including mAb 114, Regeneron monoclonal antibodies, remdesivir, Zmapp, or Regeneron monoclonal antibodies. Of those 73 patients, 32 are cured and have been discharged, 21 have died, and 20 are still hospitalized.

The treatments are being used in conjunction with Merck's unlicensed  Ebola vaccine. Since Aug 8, a total of 17,976 people have been vaccinated, including 7,620 in Beni.

Tomorrow the World Health Organization will convene a meeting to determine if the current outbreak warrants the declaration of a public health emergency of international concern.
Oct 15 DRC update
Oct 16 DRC update


New case of MERS recorded in Saudi Arabia

Today the Saudi Arabian Ministry of Health (MOH) recorded a new case of MERS-CoV for epidemiologic week 42, which is this week.

A 64-year-old man from Afif, Riyadh region, is hospitalized for MERS-CoV (Middle East respiratory syndrome coronavirus) infection. His case is listed as "primary," which means it is unlikely he contracted the virus from another person. The man did not have any contact with camels.

Since 2012, at least 2,262 cases of MERS have been recorded, including 803 fatalities. The vast majority of cases have occurred in Saudi Arabia.
Oct 16 MOH update


South Korea declares end to MERS outbreak

In related news, today officials in South Korea officially declared an end to that country's MERS outbreak, the first to hit South Korea in 3 years, Korean news agency Yonhap reported.

The announcement was made at the conclusion of 28 days without any new infections, twice the maximum length of the MERS-CoV incubation period. Only one patient was identified in this outbreak, a 61-year old man diagnosed on Sep 8 with MERS-CoV infection after spending 3 weeks on a business trip to Kuwait.

Twenty-one patients who had close contact with the patient all tested negative for the disease, according to the Korea Centers for Disease Control and Prevention.

In 2015, South Korea experienced a MERS outbreak that resulted in 38 deaths and 186 cases.
Oct 16Yonhap story
Sep 12 CIDRAP News Story "WHO details South Korea's imported MERS case


WHO: Southern Hemisphere flu activity tapering off in most locations

Southern Hemisphere flu activity continues to taper off, except for Southern Africa, where high levels of flu from both influenza B lineages are reported, the World Health Organization (WHO) said in its latest global flu update. As the region nears the end of its typical flu season, flu activity seems to have peaked in Australia and New Zealand without levels passing seasonal thresholds during the entire season.

In some parts of the world, flu levels are on the rise, including in India, where 2009 H1N1 activity is increasing, and in some Southeast Asia locations like Cambodia, Laos, and Thailand. Also, some Caribbean and Central American countries—such as Cuba, Haiti, El Salvador, and Nicaragua—are reporting rising activity.

Northern Hemisphere flu detections remained at interseasonal levels.

Globally, of specimens that tested positive for flu during the last half of September, 84.2% were influenza A. Of subtyped influenza A viruses, 74% were 2009 H1N1. Of characterized influenza B viruses, 49% were Yamagata lineage and 51% were Victoria lineage.
Oct 15 WHO global flu update

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