News Scan for Mar 02, 2020

News brief

Saudi health ministry reports 7 more MERS cases

Over the weekend and through today, Saudi Arabia's Ministry of Health (MOH) reported 7 new MERS-CoV cases: 5 in Riyadh, 1 in Taif, and 1 in Mecca. The new cases bring the February case tally to 18 and the March tally to 1.

The Riyadh MERS-CoV (Middle East respiratory syndrome coronavirus) cases involve men aged 73, 60, 56, 52, and 38 years old. The case in Taif involves a 53-year-old man, and the Mecca case involves a 56-year-old man.

All exposures are listed as primary, meaning the patients are unlikely to have contracted the virus from another person. The MOH said that none of the infected patients were healthcare workers and that only one had reported contact with camels, a known risk factor for MERS. The remaining patients' exposure to camels is unknown.

Infection with MERS-CoV can cause severe illness and death. The virus can transmit between humans but has done so mainly in healthcare settings, according to the World Health Organization (WHO).

As of Jan 31, 2020, the WHO said that it had received reports of 2,519 laboratory-conﬁrmed MERS infections, including 866 associated deaths. The vast majority of these cases occurred in Saudi Arabia.

The WHO said that it expects more cases of MERS-CoV to be reported from the Middle East and that it will spread to other countries by people infected through exposure to camels, animal products such as raw camel's milk, or other humans.
Mar 2 Saudi MOH report
Feb 29 Saudi MOH report

Eleven new polio cases reported in Pakistan and Africa

Two cases of wild polio virus type 1 (WPV1) infection in Pakistan's Punjab province and nine cases of circulating vaccine-derived polio virus type 2 (cVDPV2) in West Africa were reported the week of Feb 26, according to the Global Polio Eradication Initiative (GPEI).

The African cVDPV2 cases occurred in Benin's Plateau province (1 case), Ghana's Bono province (3) and Bono East province (3), and Togo's Lome province (1) and Maritime province (1).

The Togo case is related to a cVDPV2 outbreak affecting Jigawa, Nigeria, the GPEI said.

The 11 new cases bring the global 2020 WPV1 case total to 12, all in Pakistan, and the cVDPV2 total to 15. For all of last year officials recorded 173 WPV1 and 329 cVDPV2 cases.

The risk of further cVDPV2 spread in West Africa is high, according to the GPEI.
Feb 28 GPEI update

Stewardship / Resistance Scan for Mar 02, 2020

News brief

Study: Delaying antibiotics OK in mild to moderate bacterial infections

Withholding antibiotic therapy until diagnosis of bacterial infections (ie, 4 to 8 hours) seems acceptable in patients other than those who may have septic shock or bacterial meningitis and may be a sound antibiotic stewardship approach, according to a meta-analysis of 60 studies published in Clinical Microbiology and Infection.

European researchers explored the effect of time to antibiotic initiation on clinical outcomes in patients in emergency departments (EDs) who had bacterial infections of different severities and sources.

Initiating antibiotic treatment quickly—within 3 hours—is considered crucial in patients with severe bacterial infections such as septic shock and meningitis, but the researchers sought to better understand which patients could withstand delayed treatment in order to improve antibiotic stewardship. Many patients in the ED have common community-acquired infections caused by bacteria sensitive to narrow-spectrum antibiotics, the researchers wrote.

"We conclude that the literature supports prompt administration of effective antibiotics for septic shock and meningitis, but there is no clear evidence showing that a delayed start of therapy is associated with worse outcome for less severe infectious syndromes," the investigators said. "This approach promotes the use of ecologically favourable antibiotics in the ED, reducing the risks of side effects and selection of resistance."

The researchers, who found few studies in the literature on mild to moderate infections, called for stronger evidence from prospective clinical trials.
Feb 28 Clin Microbiol Infect abstract

Combo antibiotic for resistant UTIs shows promise in phase 3 trial

French biopharmaceutical company Allecra Therapeutics announced last week that its investigational combination drug Exblifep met the US Food and Drug Administration and European Medicines Agency's pre-specified primary end point and demonstrated superiority over piperacillin-tazobactam in a phase 3 trial of patients who had complicated urinary tract infections (cUTIs).

The topline results from the phase 3 ALLIUM trial showed that the overall success of Exblifep in cUTI patients was 79.1%, compared with 58.9% for piperacillin-tazobactam. The primary end point in the randomized trial was a combination of clinical cure and microbiologic eradication. The drug was also well tolerated, with 4.3% of patients reporting adverse events, compared with 3.7% of piperacillin-tazobactam patients.

Exblifep is a combination of the novel beta-lactamase inhibitor enmetazobactam with the fourth-generation cephalosporin cefepime. It's intended for treatment of infections caused by multidrug-resistant strains of Enterobacteriaceae and Pseudomonas aeruginosa.

"The superiority demonstrated in the primary endpoint, at test of cure, combined with a comparable safety profile to that of well tolerated and widely used piperacillin-tazobactam support the potential use of cefepime-enmetazobactam as a new empiric and carbapenem- sparing treatment for multi-drug resistant Gram-negative infections," Allecra Chief Medical Officer Patrick Velicitat, MD, said in a company press release.
Feb 25 Allecra Therapeutics press release