News Scan for Oct 23, 2019

News brief

Ebola case count hits 3,250 in the DRC

According to the World Health Organization's (WHO's) Ebola dashboard today, officials in the Democratic Republic of the Congo (DRC) confirmed 2 new cases of Ebola in a 14-month-long outbreak in that country, raising the total to 3,250 infections.

As reported yesterday, 117 of the cases are considered probable infections. The DRC's Ebola technical committee (CMRE) has not yet posted information on the four new cases described yesterday.

Officials are still investigating 441 suspected cases. The death toll stands at 2,171, which is 1 fewer than posted yesterday.
WHO Ebola dashboard

Early findings promising for TB rapid blood test

A new point-of-care test can distinguish active tuberculosis (TB) from similar diseases in less than an hour, which if advanced through development and approved would meet an important public heath need, researchers reported today in Science Translational Medicine.

Diagnosing active TB is difficult, because several other diseases cause similar symptoms, and better prevention and control hinge on having a test to find cases and flag people at risk for infection.

For the study, an international research team led by the Broad Institute, based at Massachusetts Institute of Technology and Harvard University, examined 406 patients with chronic cough divided into three cohorts using a machine learning technique. They identified four blood proteins that could distinguish active TB from similar diseases. Then they created an ultrasensitive assay to screen for the virus in blood samples. The panel could identify TB infections in 317 samples from patients with persistent cough from Africa, Asia, and South America. The test performed well, regardless of HIV infection status.

When the team added a fifth marker to the panel that can detect antibodies against a mycobacterial antigen, the test became even more accurate, with a sensitivity of 86% and specificity of 69%.

The group concluded that although more work and field testing are needed, the test's performance approaches WHO guidelines and shows promise as a test to triage patients.

The test needs to be studied in a larger group of patients, and its developers are hoping enhancements of a new antibody-based technology called Simoa used to boost the test's performance will eventually make it suitable for use in low-resource settings and lower the cost to $2 per test, according to a Broad Institute report. Michael Gillette, MD, PhD, senior scientist at the Broad Institute and critical care doctor at Massachusetts General Hospital, said in the report there's need for a field test to stratify at-risk populations and make a definitive diagnosis. "We aren't there yet by any means, but our study moves us fundamentally closer to that goal."
Oct 23 Sci Transl Med abstract
Oct 23 Broad Institute news report

Ferret study shows promising for new flu antiviral

A new oral antiviral drug against flu tested in ferrets inhibited replication, dropped viral loads, shortened fever duration compared to controls, and didn't appear to prompt antiviral resistance, researchers based at Georgia State University reported today in Science Translational Medicine.

The drug, called EIDD-2801, blocks flu virus RNA polymerase, which plays a key role in the replication of the flu virus genome. According to the study, the drug causes mutations in the viral genome, which then becomes nonfunctional and cannot replicate.

Researchers tested the drug in ferrets, which are currently the most useful animal model for studying human flu infection. They assessed the drug against various flu strains. Aside from the therapeutic effect in infected ferrets, as compared with controls, the group also found that treatment was effective against multiple flu strains in human airway epithelial cells. Deep sequencing confirmed lethal mutagenesis as the drug's underlying activity mechanism and revealed a barrier to the development of antiviral resistance. The group's work also outlined clues for dosing parameters in humans.

The group concluded that EIDD-2810 is a clinical study candidate and a promising monotherapy for seasonal and pandemic influenza.

Richard Plemper, PhD, senior author of the study and professor in the Institute for Biomedical Sciences at Georgia State University, said in a press release from the school, "We believe that this compound has high clinical potential as a next-generation influenza drug that combines key antiviral features."
Oct 23 Sci Transl Med abstract
Oct 23 Georgia State University press release

Stewardship / Resistance Scan for Oct 23, 2019

News brief

High-intensity antimicrobial stewardship may top low-intensity

A new study conducted in a 400-bed community hospital in Toronto shows that high-intensity prospective audit and feedback (PAF) was tied to a greater reduction in antimicrobial use than low-intensity interventions. The study appeared yesterday in Infection Control & Hospital Epidemiology.

According to the study authors, PAF is an evaluation of antimicrobial regimens by an infectious diseases or antimicrobial stewardship (ASP) clinician—with recommendations made to the prescriber to optimize antimicrobial use.

The study was conducted at St. Joseph's Health Centre from 2012 to 2016. Before the intervention, ASP pharmacists performed low-intensity PAF, via recommendations made on a per-patient basis to hospital internists. The high-intensity, rounds–based PAF initiative began in 2014 and included twice-weekly ASP rounds on the internal medicine wards from September 2014 through December 2015.

"Implementation of high-intensity PAF was associated with a 19% (adjusted analysis) reduction in overall antibiotic use compared to low-intensity PAF in our community teaching hospital without any changes in patient clinical outcomes," the authors said.

Prescriptions dropped from 483 defined daily doses (DDD) per 1,000 patient days (PD) during the low-intensity phase to 442 DDD/1,000 PD in the high-intensity phase.
Oct 22 Infect Control Hosp Epidemiol study

High antibiotic prescribing levels, provider variability noted in urgent care

An analysis of visits to urgent care clinics that are part of a large healthcare system found high levels of antibiotic prescribing, much of it for respiratory conditions, with provider variability in prescribing that was also high. A team led by researchers from Intermountain Healthcare in Salt Lake City, Utah, reported their findings today in Clinical Infectious Diseases.

Given that urgent care visits are increasing and are known to involve high rates of inappropriate antibiotic prescribing, the group said its goal was to identify patterns within urgent care settings that are part of a large integrated health system.

The retrospective cohort study took place at Intermountain Healthcare's 38 urgent care clinics from August 2017 through June 2019. Of 1.16 million urgent care encounters, antibiotics were prescribed during 34% of visits, with respiratory conditions accounting for 61% all antibiotics that providers prescribed.

Of visits for respiratory conditions, 50% resulted in antibiotic prescriptions. However, levels by provider varied from 3% to 94%. The group also saw similar prescribing variability among providers for respiratory conditions in which antibiotics weren't indicated and in first-line antibiotic selection for sinusitis, otitis media, and pharyngitis.

They said antibiotic prescribing at Intermountain healthcare's urgent care clinics was similar to the 39% national level.

"Collectively, these findings support the importance of integrating antibiotic stewardship principles into UC settings and developing interventions specifically targeting UC [urgent care] settings," the authors write. They added that tier 2 respiratory conditions—including pharyngitis, sinusitis, and otitis media—accounted for more than half of all respiratory conditions, suggesting that stewardship interventions that target those illnesses have the potential for substantial impact by ensuring appropriate diagnosis, using delayed prescriptions for sinusitis and ear infection, and promoting appropriate antibiotic selection.
Oct 23 Clin Infect Dis abstract