Stewardship / Resistance Scan for Jan 10, 2018

News brief

CDC says C diff cases in long-term care facilities have dropped sharply

A study yesterday by experts from the US Centers for Disease Control and Prevention (CDC) found that the incidence of Clostridium difficile in long-term care facilities decreased 17.5% annually from 2011 to 2015 at 10 US sites, along with a concomitant decline in inpatient fluoroquinolone use.

C difficile infection, a largely healthcare-related disease, can cause severe symptoms and death, the CDC says, with states reporting increased cases in US hospitals in recent years.

Writing in the American Journal of Infection Control, the CDC researchers said they analyzed data from 10 labs serving the agency's Emerging Infections Program (EIP) in 10 states during the 5-year period. The number of C difficile infections in long-term care facilities dropped from 3,151 in 2011 to 1,909 in 2015, for an overall decrease of 49%. The decline ranged from 6% to 65% by EIP site. The adjusted annual decrease across the country was 17.5%.

The researchers reported that the rate of the NAP1/027 epidemic strain likewise dropped, from constituting 29% of all C difficile strains in 2011 to accounting for only 18% in 2015. Fluoroquinolone use dropped a full 25 days of therapy per 1,000 patient-days.

The authors concluded, "A concomitant decline in inpatient fluoroquinolone use and the C difficile epidemic strain NAP1/027 among persons aged ≥65 years may have contributed to the decrease in long-term-care facility-onset C difficile infection incidence rate."
Jan 9 Am J Infect Control study

Study notes high antibiotic use in nursing homes linked to confusion

A study today in the Journal of the American Geriatrics Society reports high antibiotic use in nursing homes, especially for urinary tract infections (UTIs), with patient confusion tied to antibiotic treatment for suspected UTI.

Researchers reviewed the charts of 450 residents of five nursing homes in northern Queensland, Australia, from Aug 28, 2015, through Jun 21, 2016, to determine the prevalence of documented UTI, nonspecific and specific UTI symptoms, antibiotic use, and other factors.

They found that UTI accounted for 33% of all infections treated with antibiotics and 40% of all infections treated with antibiotics in the past 30 days. They also found that 20% of residents had received antibiotics in the past 30 days, 45% of which were for UTI. At the time of review, 40 residents (9%) were currently on antibiotics, of which 16 (40%) were for a UTI.

The investigators also found that new or worsening confusion was found to be strongly associated with urinary frequency (odds ratio [OR], 33), current UTI antibiotic prescription (OR, 15), and having a full blood count measured (OR, 8.6).

Lead author Sean Mayne, MD, of James Cook University, in Cairns, Australia, said in a Wiley news release, "Suspected UTI is the most common reason for antibiotic prescription in nursing home residents, often a presumptive diagnosis based on non-specific symptoms, which makes it a key target for reducing inappropriate antibiotic prescriptions."
Jan 10 J Am Geriatr Soc study
Jan 10 Wiley news release

UN Environment-WHO collaboration to tackle environmental health issues

United Nations (UN) Environment and the World Health Organization (WHO) have established a new collaboration to accelerate steps to curb environmental health risks—including antimicrobial resistance—that cause an estimated 12.6 million deaths a year, the two agencies said in a press release today.

Today in Nairobi, Erik Solheim, head of UN Environment, and WHO Director-General Tedros Adhanom Ghebreyesus, MD, signed an agreement to ramp up joint efforts to combat air pollution, climate change, and antimicrobial resistance, as well as to improve coordination on waste and chemicals management, water quality, and food and nutrition issues.

Although the two agencies cooperate on a range of concerns, today's measure represents their most significant formal agreement across the spectrum of environment and health issues in more than 15 years, according to the release. "There is an urgent need for our two agencies to work more closely together to address the critical threats to environmental sustainability and climate—which are the foundations for life on this planet," said Solheim.

The two agencies will develop a joint work program and hold annual meetings to evaluate progress and make recommendations. The collaboration creates a more systematic framework for joint research, development of tools and guidance, capacity building, global and regional partnerships, and other approaches.
Jan 10 UN Environment news release

News Scan for Jan 10, 2018

News brief

DRC study shows evidence of Ebola exposure outside of outbreak zones

About 11% of a population sampled in the Democratic Republic of the Congo (DRC) had Zaire Ebola virus (EBOV) immunoglobulin G antibodies, providing serological evidence of Ebola prevalence in populations not currently experiencing an Ebola outbreak.

The data are contained in a new study published today in the Journal of Infectious Diseases. In 2007, researchers randomly selected 14 villages in central DRC where they collected serological samples from 3,415 participants.

At the time of the study, DRC had seen three Ebola outbreaks (1976, 1977, and 1995) and a small outbreak was taking in place in rural areas near the study sites. The researchers found that 11% of participants had antibodies to Ebola, and those who lived in villages near the current outbreak were 1.6 times more likely to test positive for antibodies to the virus.

Being older than 15 years of age and being male were positively associated with having Ebola antibodies, the study authors said. Hunting, visiting areas forests, and contact with rodents were also positively associated with serological evidence of Ebola.

"Because the symptoms can be nonspecific and range from flu-like symptoms to acute hemorrhagic fever, it is probable that there are many cases that go unrecognized, unreported, and attributed to other common illnesses such as malaria, typhoid, or influenza," the authors concluded. "Our analyses suggest that individuals outside known outbreak zones in central DRC may be exposed to EBOV."
Jan 10 J Infect Dis study

USDA proposes changes in egg product inspection rules

The US Department of Agriculture (USDA) Food Safety and Inspection Service (FSIS) yesterday proposed a new rule aimed at modernizing the inspection of egg products, which would require processors to meet sanitation requirements that apply to meat and poultry regulations and require finished egg products to be free of detectable pathogens.

In a press release, the USDA said the rule proposes that plants that process egg products develop Hazard Analysis and Critical Control Points (HACCP) and Sanitation Standard Operating Procedures (Sanitation SOPs), as well as meet other requirements. The proposal would eliminate current rules that don't align with meat and poultry regulations.

It said the proposed rule changes would make egg products safer while removing unnecessary obstacles to innovations. Under the HACCP system, plants could tailor food safety systems to their facilities and equipment, and by removing other regulations, egg product plants could have the flexibility and incentive to develop new ways to enhance food safety.

With the new rules, FSIS would be taking over jurisdiction of egg substitutes, which pose the same risk as egg products and will be treated with the same level of scrutiny and care.

Acting Deputy Under Secretary for Food Safety Carmen Rottenberg, JD, said, "This proposed rule will ensure the same level of inspection and oversight of all regulated products as we carry out our public health mission."

Once the rule is published in the Federal Register, there will be a 120-day comment period.
Jan 9 USDA press release

Ferret study reveals more clues about severity of 1918 pandemic flu virus

Experiments with ferrets to better understand the pathogenicity of the 1918 H1N1 pandemic flu virus found that it can spread to body tissues beyond the respiratory system, where it can trigger inflammatory cytokine responses. Researchers from the National Institute of Allergy and Infectious Diseases Rocky Mountain Laboratories in Hamilton, Mont., and Erasmus Medical College in the Netherlands reported their findings today in the Journal of Infectious Diseases.

Of all known flu pandemics, the 1918 pandemic was most severe, causing millions of deaths worldwide. Aside from viral pneumonia, which often led to secondary bacterial infections, one non-respiratory complication that stood out was encephalitis lethargica.

After intranasally inoculating the ferrets with the 1918 pandemic virus, the researchers looked at virologic, histologic, and immunologic patterns in respiratory tract, nervous system, and other body tissues at 1, 3, 5, and 7 days after infection.

The team found high virus titers in respiratory tissues, and lower levels in most extra-respiratory tissues. They saw evidence of active virus replication in the respiratory tract, peripheral and central nervous system, and liver. Also, they detected cytokine upregulation in respiratory tissues, olfactory bulb, spinal cord, liver, heart, and pancreas.

The researchers concluded that the spread of 1918 virus outside the respiratory tract and its impact on cytokine response probably contributed to the severity of the disease. They also said their findings support a link between the virus and central nervous system complications.
Jan 10 J Infect Dis abstract