Stewardship / Resistance Scan for Sep 17, 2019

News brief

Study underscores need for early diagnostic tests in severe sepsis

US and Canadian researchers, writing in the Annals of Internal Medicine today, said they have determined that, among patients with severe manifestations of sepsis, initiation of empirical antimicrobial therapy significantly reduces the sensitivity of blood cultures drawn shortly after treatment began—underscoring the need for early diagnostic blood tests.

Administering antimicrobial agents such as antibiotics before obtaining blood cultures could decrease the time it takes for patients to receive life-saving drugs and improve outcomes—especially in patients who have severe sepsis, or an infection in the bloodstream—but scientists are unsure how this strategy affects diagnostic sensitivity.

To determine the effects of early antimicrobial initiation, the team analyzed data on 325 patients in seven North American emergency departments who had severe manifestations of sepsis. They found that 31.4% of the patients tested positive for pathogens in their blood before early antimicrobial therapy was begun, but only 19.4% tested positive afterward. The absolute difference in the proportion of positive blood cultures between pre- and post-antimicrobial testing was 12.0%, and the sensitivity of post-antimicrobial culture was only 52.9%.

The authors point out that international guidelines call for early (before-therapy) testing with suspected sepsis. "Our study has, for the first time ever, produced clear evidence supporting current sepsis guidelines and underscores the urgent need for proper sepsis protocols," said David Sweet, MD, senior study author, in a University of British Columbia news release. "Emergency rooms must place more emphasis on sepsis guidelines and make sure they have the resources to implement them."

The study was funded by Vancouver Coastal Health, St. Paul's Hospital Foundation Emergency Department Support Fund, the Fonds de recherche Sante–Quebec, and the Maricopa Medical Foundation.
Sep 17 Ann Intern Med abstract
Sep 17 University of British Columbia news release

CARB-X to fund development of novel antibiotic for gram-negatives

CARB-X announced today that it has awarded $2.2 million to UK-based Procarta Biosystems to develop a new class of antibiotics to treat dangerous gram-negative pathogens.

The money from CARB-X (the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator) will help fund preclinical development of Procarta's lead antibiotic candidate, PRO-202, which is based on the company's novel oligonucleotide transcription factor decoy (TFD) platform. TFDs are designed to kill gram-negative and gram-positive bacteria by preventing expression of genes they need to survive and cause infection.

If successfully developed and approved, PRO-202 could be used to treat complicated urinary tract and intraabdominal infections caused by gram-negative ESKAPE pathogens (which include Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species).

"CARB-X selects innovative projects that target the most serious drug-resistant bacteria and that could, if successful, be a leap forward in the fight against deadly drug-resistant superbugs," CARB-X executive director Kevin Outterson, JD, said in a press release. "The Procarta project is the type of cutting-edge innovation that can make headway against the global threat of drug-resistant bacteria."

Procarta could receive an additional $7 million if certain project milestones are met. Part of the funding comes from the UK government's Global AMR Innovation Fund.
Sep 17 CARB-X press release

News Scan for Sep 17, 2019

News brief

Massive DRC measles outbreak picks up more speed

A massive measles outbreak in the Democratic Republic of the Congo (DRC) accelerated again over the past few weeks, with spread to new areas, the World Health Organization (WHO) African regional office said yesterday in its weekly outbreaks and emergencies report.

Since the WHO's last update on the outbreak on Aug 4, the DRC has reported 72,607 more suspected cases, 1,744 more deaths, and 24 newly affected health zones. Activity has peaked twice, in late April and in late July. And since late August, incidence has gradually been increasing, with 24 of the country's 26 provinces reporting measles cases during that period. Four hot spots, however, account for 45% of recent cases: Kwilu, Kasai, Kasai Central, and Kinshasa provinces.

Since the first of the year, the DRC has reported 179,477 suspected cases, including 3,559 deaths. Of lab-confirmed patients, 63% had not been vaccinated or had an unknown vaccination status. Children younger than 5 are the hardest-hit group, making up 76% of the suspected cases and accounting for 88% of the deaths.

In the Ebola outbreak region, North Kivu and Ituri provinces have reported 3,016 and 7,765 cases this year, respectively, with cases in both provinces gradually rising.

The WHO said the massive outbreak is likely due to an accumulation of susceptible children who weren't vaccinated during routine campaigns and were missed during supplemental vaccine campaigns that were held in the wake of outbreaks. It recommends that the country speed the process of implementing the second vaccine dose and strengthen routine vaccination, supplemental vaccination, and surveillance.
Sep 16 WHO African regional office report

CDC wraps up ground bison E coli outbreak probe after 33 cases in 8 states

The Centers for Disease Control and Prevention (CDC) late last week said that an investigation into an Escherichia coli outbreak linked to ground bison products has ended, with 12 more cases and one more affected state added to the event totals.

First announced on Jul 16, the outbreak—liked to meat from a Canadian food company called Northfork Bison Distributions, Inc.—led to 33 cases in eight states, according to a Sep 13 update. The latest illness onset was Aug 11. The event involved two outbreak strains: E coli O103 and E coli O121. Eighteen people were hospitalized, but no deaths were reported.

Whole-genome sequencing on samples from 26 patients and tests on 10 isolates predicted antibiotic resistance to streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Antibiotic resistance testing through the CDC's National Antimicrobial Resistance Monitoring System (NARMS) is under way. The agency said the findings don't affect treatment, given that antibiotics aren't recommended for E coli O103 or O121 infections.

Interviews with sick patients suggested that the ground bison was the source of the outbreak, and the E coli O121 strain was isolated from bison burgers made by the Canadian company. The company recalled products produced from Feb 22, 2019, to Apr 30, 2019.
Sep 13 CDC final update
Jul 17 CIDRAP News scan "Ground bison linked to E coli outbreak in 7 states"

Taiwan reports its first H5N5 avian flu outbreak in poultry

Taiwan today reported its first detection of highly pathogenic H5N5 avian flu, which was found on a duck farm in Kaohsiung, a city on the southwest coast, according to a government statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

Testing suggests the virus is related to the H5N5 strain found in European wild birds, as well as on a few farms, from 2016 to 2018, according to the report. Tests on farms in a 3-kilometer zone around the Taiwan outbreak location found no other positives, suggesting no spread of the virus.

Animal health officials called on Taiwan's poultry industry to strengthen its biosecurity measures and for backyard poultry owners to keep a close eye on the health of their birds. So far the source of the virus isn't known, and testing is under way on the samples to further characterize the virus.
Sep 16 AFD post

In another avian flu development in Taiwan, officials reported six more outbreaks in poultry involving the highly pathogenic H5N2 strain that has been fueling outbreaks in the region since 2015.

The events began from Aug 23 to Sep 4, affecting three duck meat farms, two native chicken farms, and a chicken slaughterhouse, according to a notification today from the World Organization for Animal Health (OIE). Locations include Changhua, Yunlin, and Pingtung counties and Taipei. Taken together, the virus killed 3,223 of 42,744 susceptible poultry.
Sep 16 OIE report on H5N2 in Taiwan

Flu tails off in most Southern Hemisphere countries

Flu activity continue to retreat in the Southern Hemisphere, and though geographic activity varied in Australia, in general flu markers were lower than average for this time of year, following peak activity in July, the WHO said today in a regular global flu update.

In temperate South America, the only hot spot is Chile, which has experienced a second wave of flu activity, led by influenza B. Meanwhile, some Central American countries—El Salvador, Honduras, and Nicaragua—reported increased flu activity from all three subtypes.

Elsewhere, Bhutan reported flu levels that are above the alert threshold, higher than the past two seasons, with H3N2 and influenza B cocirculating. In temperate North America flu is still at interseasonal levels.

At the global level of flu samples tested since the last half of August, 57.4% were influenza A, and of subtyped influenza A viruses, 35.8% were 2009 H1N1 and 64.2% were H3N2.
Sep 16 WHO global flu update