News Scan for Oct 29, 2020

News brief

Two E coli outbreaks with unknown causes total 44 cases, 1 death

Yesterday the Centers for Disease Control and Prevention (CDC) reported two separate Escherichia coli O157:H7 outbreaks in the United States. Neither has an identified source, and one has already proved deadly.

The first outbreak has had 21 cases reported from Jun 6 to Oct 5 across eight states, the most being in California (7) and Ohio (7). So far, there have been eight hospitalizations, including 1 case of hemolytic uremic syndrome (HUS), a type of kidney failure, and 1 death.

The patients range from 2 to 75 years of age, with a median of 24 years. While no common source has been identified, officials discovered an illness cluster spreading from a restaurant.

The other E coli outbreak has 23 cases thus far reported from Aug 17 through Oct across 12 states, with Kansas and North Dakota both having 4 cases, followed by California, Michigan, Missouri, Pennsylvania, and Wisconsin with 2 cases each. Ages range from 5 to 81 years, with a median of 21.

Of the 15 people with further information available, 10 needed hospitalization and 2 have or had HUS. All 13 people interviewed to date reported eating leafy greens, including iceberg lettuce (9), spinach (9), romaine lettuce (8), and mixed bag lettuce (6).

Both outbreaks' strains have been linked to separate romaine lettuce outbreaks in the past, the first having the same strain as a 2018 outbreak and the second having the same as one in 2019, but no conclusions can be made from this, the CDC says. The agency advises people to practice extra hygiene and caution when preparing and cooking food, to avoid unpasteurized products, and to wash hands after using the restroom, changing diapers, and interacting with animals.

Currently, the agency is conducting interviews with the ill, and the US Food and Drug Administration (FDA) is investigating food sources, samples, and trace-backs.
Oct 28 CDC outbreak investigation notice A
Oct 28 CDC outbreak investigation notice B


Promising phase 3 data for oral carbapenem presented at IDWeek

Data from a phase 3 trial presented last week at IDWeek 2020 by researchers from Spero Therapeutics show that oral tebipenem was comparable in safety and efficacy to intravenous (IV) ertapenem for treating complicated urinary tract infections (cUTIs) and acute pyelonephritis (AP).

In the double-blind phase 3 study, which was conducted at more than 100 hospitals in 15 countries, 1,372 hospitalized patients who had cUTIs or AP were randomized to receive either oral tebipenem pivoxil hydrobromide (TBP-PI-HBr) or IV ertapenem for 7 to 10 days. The primary end point was overall response (composite clinical cure and microbiologic eradication) at the test-of-cure visit on Day 19. The non-inferiority margin was -12.5%.

The results showed that oral TBP-PI-HBr met the primary objective of non-inferiority compared with IV ertapenem, with an overall response rate of 58.8% (264 of 449 patients) versus 61.6% (258/419) for IV ertapenem (treatment difference, -3.3%; 95% confidence interval [CI], -9.7% to 3.2%). Clinical cure rates were greater than 93% in both treatment groups, and microbiologic response rates for target uropathogens were comparable.

Treatment-emergent adverse events were observed in 25.7% of TBP-PI-HBr patients and 25.6% of IV ertapenem patients, and most were mild. Serious adverse events were infrequent in both groups (1.3% for TBP-PI-HBr patients vs 1.7% for IV ertapenem patients).

Spero Therapeutics said earlier this month that it plans to submit a new drug application for TBP-PI-HBr to the FDA in the second quarter of 2021. If approved, it would be the first oral carbapenem to receive approval in the United States.
Oct 24 IDWeek 2020 abstract
Oct 16 Spero Therapeutics press release


H5 avian flu detected at Netherlands broiler farm

The Dutch government today reported a highly pathogenic H5 avian flu outbreak at a broiler farm near the village of Altforst in Gelderland province in the east central part of the country.

No other poultry facilities are within a 1 km radius of the facility, and culling is underway among 35,700 birds at the farm. Sampling is being conducted in other poultry flocks in the greater area.

Last week, Dutch veterinary officials reported H5N8 in two mute swans found dead in Utrecht province. Over the past few months, Russia and Kazakhstan have reported a small but steady stream of H5N8 outbreaks, and the UK government has warned of the threat of the virus spreading from migratory birds to poultry.
Oct 29 Dutch government statement

COVID-19 Scan for Oct 29, 2020

News brief

COVID-19 antibodies last at least 5 months in mild-to-moderate cases

A study yesterday in Science reports that the vast majority of patients with mild-to-moderate COVID-19 have stable levels of antibodies for at least 5 months.

Of 30,082 COVID-19 patients in New York City's Mount Sinai Health System, 27,849 (92.6%) had moderate-to-high antibody titer levels (1:320 and up), which an assay test showed would cause at least 90% of the sera to exhibit neutralizing activity for the spike protein of SARS-CoV-2, the virus that causes COVID-19. Researchers conducted approximate 3-month and 5-month follow-ups with 121 people, where they saw a drop of 764 geometric mean titer to 690 and then to 404 at the last time of testing.

"The sustained antibody levels that we subsequently observed are likely produced by long-lived plasma cells in the bone marrow," said Ania Wajnberg, MD, first author of the paper, in a press release from Mount Sinai Hospital/Mount Sinai School of Medicine. "This is similar to what we see in other viruses and likely means they are here to stay. We will continue to follow this group over time to see if these levels remain stable."

For measuring antibody titers, the researchers used enzyme-linked immunosorbent assay (ELISA). Low levels were 1:80 and 1:160, moderate was 1:320, and high was 1:960 and 1:2,880 and up, with 690 (2.2%) and 1,453 (4.8%), 6,675 (22.5%), and 9,564 (31.8%) and 11.610 (38.6%) people falling into each category, respectively. The quantitative microneutralization assay test showed that approximately 50% of sera in the 1:80 to 1:160 titer range had neutralizing activity, 90% in the 1:320 range did, and all sera in the 1:960 and up range did.

The study noted that people in the higher titer range showed a slow titer decline, whereas those with low to moderate levels saw an initial increase. This is in agreement with earlier observations from the team that indicate seroconversion in mild COVID-19 cases might take longer to mount, according to the news release.
Oct 28 Science study
Oct 28 Mount Sinai press release


Study finds high rate of bloodstream infections in COVID-19 ICU patients

A retrospective study of hospitalized COVID-19 patients in an intensive care unit (ICU) in Rome found that nearly half acquired bacterial or fungal bloodstream infections (BSIs), Italian researchers reported today in the Journal of Global Antimicrobial Resistance.

During the study period (Mar 1 to Apr 15), 57 patients were admitted to the ICU. Fifty-two of those patients had an indwelling central venous catheter, 48 were on mechanical ventilation, and 56 had been exposed to antibiotics in the 30 days prior to the study. BSIs occurred in 28 of the 57 patients (49%), with an incident rate of 373 per 10,000 patient-days. The mean time from ICU admission to BSI occurrence was 13 days.

The most commonly isolated organisms were Enterococcus spp (11 cases), Pseudomonas spp (8 cases), and Candida spp (5 cases). In addition, 17 patients (30%) were colonized by vancomycin-resistant Enterococcus (VRE), with 5 patients already colonized upon admission and 12 patients acquiring VRE during ICU hospitalization.

To compare these findings to historic data from the hospital, the researchers looked at blood cultures from 75 patients admitted to the ICU in the first 6 months of 2019. They found that the prevalence of BSIs in those patients was 13% (10/75) and the prevalence of VRE colonization was 15% (11/75).

"In the pre-COVID-19 period, the prevalence of BSI in patients staying in our ICU was 3.8 times lower than the prevalence observed in our ICU COVID-19 patients," the authors wrote.

They suggest that immune dysregulation in severe COVID-19, extensive use of antibiotics, and less adherence to infection prevention and control measures may play a role in the high incidence of bacterial and fungal infections in COVID-19 ICU patients.
Oct 29 J Glob Antimicrob Resist study

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