News Scan for Jun 18, 2019

News brief

Wrap-up of May MERS cases notes household cluster in Saudi Arabia

The World Health Organization (WHO) Eastern Mediterranean regional office (EMRO) recently published its monthly snapshot of MERS-CoV activity, which covers 14 cases reported for May and one cluster, all in Saudi Arabia.

Of the 14 patients, 4 died from their MERS-CoV Middle East respiratory syndrome coronavirus) infections, all of them men who had underlying health conditions.

A household cluster in Al Kharj included two symptomatic Saudi women ages 22 and 44. Also in May, a 23-year-old Saudi woman who worked as a healthcare worker in Riyadh contracted the virus.

The WHO said the demographic and epidemiologic characteristics of recent cases haven't changed. The new cases push the global MERS-CoV total through the end of May to 2,442 cases, at least 842 of them fatal.
WHO EMRO MERS-CoV May situation update


WHO: 1 in 3 people globally cannot access safe drinking water

One third of the world's population does not have access to clean drinking water, while more than half cannot access safe sanitation services, according to a report today by UNICEF and the World Health Organization (WHO).

"Mere access is not enough. If the water isn't clean, isn't safe to drink or is far away, and if toilet access is unsafe or limited, then we're not delivering for the world's children," said Kelly Ann Naylor, UNICEF's associate director of Water, Sanitation and Hygiene, in a WHO press release. "Children and their families in poor and rural communities are most at risk of being left behind. Governments must invest in their communities if we are going to bridge these economic and geographic divides and deliver this essential human right."

The report assessed water access and sanitation globally from 2000 to 2017, and it found that 1.8 billion people have gained access to basic drinking water services since 2000. But an estimated 144 million people still regularly drink untreated water.

Also highlighted in the report are the economic and geographic disparities between urban and rural populations, and those in wealthy versus low-income countries. Seven out of 10 of the 2 billion people in the world who lack basic sanitation live in rural areas, and one-third live in the least economically developed countries.

The authors of the report emphasize that poor sanitation and contaminated water are linked to the transmission of cholera, dysentery, hepatitis A, and typhoid, among other diseases.
Jun 18 WHO news release
Jun 18 full report


Experimental botulism antitoxin safe, effective in adults, study finds

The new botulism antitoxin heptavalent (BAT) therapy was safe and effective in treating exposure to botulinum neurotoxins in adults and pediatric patients, according to a new post-licensure study published in Clinical Infectious Diseases.

The study followed 162 patients, median age 51, treated with BAT for suspected botulism poisoning in the United States from 2014 through 2017.

Of the 162 patients, 113 received a final diagnosis of botulism. Those treated within 2 days of symptom onset with BAT spent far less time in the hospital (5 vs 15.5 days) than those treated more than 2 days after symptom onset. They also spent less time in intensive care (4 vs 12 days) and on mechanical ventilation (6 vs 14.5 days).

Only seven patients reported serious side effects from the treatment. Thirty-one patients (19.1%) had 41 BAT product-related adverse events, the authors said. 

Botulism is a neuroparalytic illness spread by Clostridium botulinum bacteria and, if left untreated, can cause death. Cases can arise sporadically or from known exposures. BAT was licensed for use in the United States in 2013 based on efficacy studies in animal models. The treatment is a mixture of immune globulin fragments derived from horses.
Jun 15 Clin Infect Dis study

Stewardship / Resistance Scan for Jun 18, 2019

News brief

T2Bacteria panel shown to accurately detect ESKAPE bacteria in BSIs

A diagnostic accuracy study has determined that the T2Bacteria Panel rapidly and accurately diagnoses bloodstream infections (BSIs) caused by five common pathogenic bacteria, according to a study today in the Annals of Internal Medicine.

Researchers from several US universities compared results from the panel with those of blood culture for suspected BSI in 1,427 adults at 11 US hospitals from Dec 8, 2015, through Aug 4, 2017.

The T2Bacteria Panel is made by T2 Biosystems of Lexington, Massachusetts. It is designed to identify the most common ESKAPE bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli).

The investigators found that blood culture and T2Bacteria results were positive for targeted bacteria in 39 (3%) and 181 (13%) of patients, respectively. Per-patient sensitivity and specificity of T2Bacteria for proven BSIs were both 90%, and its negative predictive value was 99.7%. If probable BSIs and both probable and possible BSIs were assumed to be true positives missed by blood culture, per-patient specificity of T2Bacteria was 94% and 96%, respectively.
Jun 18 Ann Intern Med abstract


CARB-X announces funding for new antibiotic class

CARB-X announced yesterday that is awarding United Kingdom–based Oxford Drug Design up to $2.55 million with the possibility of $4.24 million more to develop a new class of antibiotics to treat gram-negative bacterial infections using an approach designed to reduce the likelihood of emerging resistance.

The company is working on drugs that inhibit aminoacyl-tRNA synthetases (aaRSs), enzymes that are essential for bacteria survival. Though aaRSs are a clinically validated target family, no inhibitors with systemic activity have reached the market. Also, the company has developed a new class of small-molecule aaRSs inhibitors that are active against gram-negative ESKAPE pathogens. The compounds target more than one synthetase site to decrease the probability of resistance development.

Oxford Drug Design also received £2 million ($2.5 million) from Innovate UK, on behalf of the country's Department for Health and Social Care, to support other aspects of the company's tRNA synthetase inhibitor research portfolio.

Kevin Outterson, JD, executive director of CARB-X, said in a press release from the group that CARB-X partners are making steady supporting innovative antibacterial research and development like the Oxford Drug Design project to treat drug-resistant bacterial infections. "But we know that much more is needed—more investment and global leadership to establish incentives that will ensure that life-saving products reach the market and patients who need them," he added.

Since its inception in 2016, CARB-X, a public-private partnership, has announced awards for 44 projects in 44 countries exceeding $216 million. Its goal is to invest more than $500 million by 2021 in innovative research and development to combat antimicrobial resistance.
Jun 17 CARB-X press release


Researchers detect multidrug-resistant E coli in Alaskan gulls

A study led by US Geological Survey scientists yesterday in Antimicrobial Agents and Chemotherapy highlights the repeated detection of carbapenemase-producing E coli in gulls in Alaska, the first such report in US wildlife.

The researchers collected 939 gull feces samples from seven locations in late spring and summer of 2016. Seven samples, four from the Kenai Peninsula sampled in June and August and three from Anchorage sampled in August, yielded E coli isolates exhibiting non-wild-type susceptibility to meropenem. All three of the Anchorage isolates harbored the blaKPC-2 carbapenemase gene. They also harbored genes associated with resistance to as many as eight antibiotic classes.

The four Kenai E coli isolates harbored the blaOXA-48 carbapenemase gene, and they also harbored genes demonstrating resistance to five antibiotic classes.

The authors conclude, "The isolation of CPE [carbapenemase-producing Enterobacteriaceae] from environmental samples collected in Alaska is both unprecedented and potentially relevant to local public health."

In an accompanying commentary, two experts from the Czech Republic write, "Wild animals are not only useful sentinels mirroring the presence of the AMR [antimicrobial resistance] in the contaminated environment in a particular area, but they also have been recognized as possible reservoirs, melting-pots, vectors and secondary sources of multi-drug resistant bacteria for humans and animals. Wild birds are ubiquitous and their faeces are freely dispersed into the environment, possibly contaminating surface waters and soils where crops are grown.

"However, at this stage it is difficult to assess human health risks of the AMR in wildlife as it requires active surveillance of clinically relevant resistant bacteria in the environment including wildlife which is currently very limited. The use of antibiotics and human to human transmission is clearly the driving force in CPE dissemination."
Jun 17 Antimicrob Agent Chemother study
Jun 17 Antimicrob Agent Chemother commentary

This week's top reads