New MERS case reported in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) recorded a new case of MERS-CoV yesterday in Sakakah, a city in the northwestern corner of the country.

Officials diagnosed a 53-year-old Saudi man as having MERS-CoV (Middle East respiratory syndrome coronavirus) after he presented with symptoms of the virus. He is in stable condition, and the MOH said the source of his infection was "primary," meaning it is unlikely he contracted the virus from another person.

The new case brings Saudi Arabia's MERS-CoV total since 2012 to 1,837, including 744 deaths. Two people are still being treated for their infections.
May 2 Saudi MOH report


Mineral licks may play host to disease-causing prions

A study published yesterday in PLoS One shows that mineral deer licks in Wisconsin served as reservoirs for prions, potentially explaining the spread of chronic wasting disease (CWD) among American cervids.

To conduct the study, scientists took environmental samples (including soil and standing water) on and around 11 mineral deer licks in south-central Wisconsin in 2013. They detected CWD-causing prions in 9 of the 11 mineral licks, higher concentrations in water samples than soil samples. Further testing of fecal droppings from white-tailed deer confirmed the animals were depositing prions near the mineral licks.

"This finding suggests that mineral licks may serve as reservoirs of CWD prions that contribute to disease transmission to susceptible animals. Although the levels of CWD prions in the samples analyzed appears low, we note that the association of prions with clay minerals often present at mineral licks can dramatically enhance disease transmission via the oral route of exposure," the authors said.

CWD is a fatal neurodegenerative disease found in deer, moose, and elk in the United States, Canada, and Scandinavia.
May 2 PLoS One study


Tainted rattlesnake supplements renews CDC Salmonella warning

An investigation into a salmonellosis infection in a Texas resident in 2017 found Salmonella Oranienburg in a bottle of rattlesnake supplements from his or her home, and though advanced testing didn't match the product strain to the patient's illness, it was a close genetic match to a patient in Kansas who got sick after taking rattlesnake supplements. Researchers from the US Centers for Disease Control and Prevention (CDC) and their partners in Texas and Kansas reported their findings today in the latest edition of Morbidity and Mortality Weekly Report (MMWR).

Rattlesnake pills contain dehydrated and pulverized rattlesnake meat and are marketed without Food and Drug Administration approval for conditions such as cancer, HIV, and acne. They have been linked to Salmonella infections before, and the CDC warned about the risk of contamination—especially for people with underlying health conditions—in November when it announced the Kansas patient's illness.

During the initial investigation into the Kansas illness, the patient did not reveal taking rattlesnake pills when asked about vitamins and supplements. However, after whole-genome sequencing suggested a match between the pills from the Texas patient's home and the Kansas patient's illness, health officials reinterviewed the patient about less common supplements, the patient reported having traveled to Mexico and purchasing rattlesnake pills. The patient believed the pills were homemade and reported taking five of them. There were no more pills for testing.

No other Salmonella illnesses related to the strain found in the Kansas patient or the Texas supplement sample have been identified.

The report said reptiles and their meat have been known to carry Salmonella species and that most related human infections were from S arizonae. It noted that the Kansas case marks the first known human infection with Salmonella Oraneinburg.
May 4 MMWR report
Dec 19, 2017, CIDRAP News scan "CDC: Rattlesnake pills contained Salmonella"


Ebola causes retinal lesions, damage to photoreceptors

Survivors of Ebola virus disease (EVD) can have myriad lasting symptoms, including extensive vision and eye problems. A new study in JAMA Ophthalmology studied 14 survivors of the disease, with more than 80% of the patients exhibiting extensive retinal scarring.

Researchers used a number of tools, including swept-source optical coherence tomography (OCT), Humphrey visual field analysis, and spatial analysis to capture ophthalmological images of 27 eyes of survivors, who had a median age of 37 years. They documented 141 Ebola retinal lesions.

"A collapse of the overlying retinal structures was detected in larger lesions, corresponding visual field defects respected the horizontal raphe, and perilesional areas of dark without pressure (ellipsoid zone hyporeflectivity) accompanied 89% of lesions," the authors wrote. By using OCT, the authors were able to determine damage to the eye's photoreceptors for the first time.

The authors suggest that EVD survivors should undergo extensive vision and ocular testing; more ocular images of lesions will theoretically help explain Ebola pathogenesis in the eye.

Last year, researchers from the University of Liverpool were the first to establish that EVD survivors suffered from unique retina scarring. They published their study in Emerging Infectious Diseases.
May 3 JAMA Ophthalmol study
Jun 19, 2017, Emerg Infect Dis report


Group publishes infection prevention and control guide for clinics

A healthcare delivery shift from hospitals to outpatient clinics — along with an increasing number of procedures done in clinic settings — brings a greater risk of healthcare-related infections, which prompted a team from the University of Texas to publish the first step-by-step guide for improving infection prevention and control (IPC) practices in clinics. The report appears in the latest issue of Open Forum Infectious Diseases.

Earlier recommendations were broad or were issued in the wake of outbreaks and epidemics, and the new report offers a more proactive systemized approach, the authors said.

Many clinics don't have resources to launch a robust IPC program, so the group suggests focusing on high-priority areas such as injection safety, sterilization, and high-level disinfection.

The first step consists of pulling together a multidisciplinary oversight committee, then form an infection prevention team to get a handle on the scope of services performed and prioritize high-risk activities and areas using a standardized survey tool such as a CDC checklist.

Other steps covered in the report include education, hand hygiene, environment (cleaning, sterilization, and disinfection), injection safety, construction (eg, sinks, hand hygiene facilities), waiting room considerations, occupational health, and pandemic preparedness.

Glucose meters are cited as a high priority for disinfection standardization and training due to their historic link to bloodborne pathogen transmission.

Authors also address monitoring IPC compliance with survey tools and establishing regular staff communication procedures, such as a website that contains all the current policies, forms, health alerts, and resources.
May 1 Open Forum Infect Dis report
May 2 University of Texas Health Science Center at Houston press release

Stewardship / Resistance Scan for May 03, 2018

News brief

Survey notes possibilities, barriers in nurses' stewardship role

An online survey of 180 nurses found that nursing professionals are well positioned to be integrated into antibiotic stewardship programs, but clinical practice and hospital culture influence perceptions of their role—and barriers include nurses not included in rounds, interdisciplinary power differentials, and nursing input not actively sought—according to a study yesterday in the American Journal of Infection Control.

The survey assessed 10 practices that fall within the responsibility of inpatient nurses and contribute to stewardship efforts.

Nurses were highly confident assessing for an adverse drug reaction history, obtaining cultures before antibiotic prescribing, and participating in patient education. They were less confident in reviewing microbiology results to determine antibiotic appropriateness. Clinical practice and hospital culture influenced perceptions of their stewardship role. Reported barriers to stewarding included exclusion from rounds, power differentials, and lack of coworkers not seeking their input.

The authors conclude, "Barriers to nurse engagement were identified and could be addressed by improving education in microbiology and principles of antibiotic use along with more consistent inclusion of nurses in bedside rounds while also cultivating an environment where nurse contribution is actively sought."
May 2 Am J Infect Control study


Study analyzes snapshot of K pneumoniae isolates in Germany

Whole-genome sequencing (WGS) of Klebsiella pneumoniae isolates from German hospital patients suggests the prevalence of classical K pneumoniae strains with widely distributed carbapenemase genes, researchers reported yesterday in Antimicrobial Resistance and Infection Control.

For the study, researchers with the Robert Koch Institute in Berlin compiled a representative subset of 107 carbapenemase-producing K pneumoniae isolates collected from 2008 through 2014 at hospitals throughout the country. The isolates possessed the four most prevalent carbapenemase types in Germany—KPC-2, KPC-3, OXA-48, and NDM-1.

WGS data showed that the isolates belonged to 21 different sequence types (STs) of K pneumoniae, with 27 of 34 (80%) KPC-2-producing isolates belonging to ST258—a prominent lineage in healthcare settings—and 21 of 26 (81%) KPC-3-producing isolates belonging to ST512 (a variant of ST258). The most prevalent carbapenemase type, OXA-48 (42 isolates), revealed 15 different STs, and the 5 NDM-1 producers were assigned to 4 STs.

One OXA-48 isolate in the collection contained an almost complete set of virulence genes and belonged to ST23, a hypervirulent strain which is frequently found in Asia. That strain appeared to be representative of an entire cluster of infections in a single German healthcare center in 2012.

"The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolate outside Asia is highly worrisome and requires intensive molecular surveillance," the authors write.
May 2 Antimicrob Resist Infect Control study


FDA panel OKs plazomicin for complicated urinary tract infections

A US Food and Drug Administration (FDA) advisory committee has voted unanimously in favor of Achaogen's plazomicin, an intravenous antibiotic, for the treatment of adults who have complicated urinary tract infections but not for the treatment of bloodstream infections.

San Francisco–based Achaogen said the FDA Antimicrobial Drugs Advisory Committee voted 15-0 that the company had "provided substantial evidence of the safety and effectiveness of plazomicin for the treatment of complicated urinary tract infections," but 11-4 against the same criterion for bloodstream infections in patients with limited or no treatment options.

"We are encouraged by the Committee's unanimous vote in favor of plazomicin for complicated urinary tract infections (cUTI). The discussion underscored the real-world challenges that healthcare providers face every day given limited or inadequate treatment options for certain pathogens," said CEO Blake Wise in the company release.

The FDA is not bound by the committee's votes but takes its input into consideration when reviewing marketing applications. Plazomicin has a Prescription Drug User Fee Act date of Jun 25. If the FDA approves the drug by this date, Achaogen expects to launch plazomicin in the United States soon thereafter, the company said.

Achaogen announced on Jan 2 that the FDA had accepted its New Drug Application for priority review for plazomicin.
May 2 Achaogen news release
Jan 2 Achaogen press release

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