News Scan for May 17, 2017

News brief

Two more MERS cases linked to hospitals in Saudi Arabia

The Saudi Arabian Ministry of Health (MOH) said today two more cases of MERS have been detected in patients who had been exposed at healthcare facilities in Bishah and Riyadh.

A 57-year-old expatriate male in Bishah is in stable condition after being diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus). The patient is a healthcare worker and is asymptomatic.

A 38-year-old expatriate man from Riyadh was also diagnosed with MERS. He was not a healthcare worker, but he did contract the virus in a healthcare setting. He is currently in critical condition.

The latest infections raise Saudi Arabia's number of MERS cases since the disease was first detected in humans in 2012 to 1,609, which now includes 666 deaths. Five people are still being treated for their infections.

An MOH report yesterday described another newly diagnosed patient, but that update remains in Arabic.
May 17 Saudi MOH report


Health worker survey reveals many work during flu illness

An Internet survey of healthcare workers during the 2014-15 flu season found that about 40% of them worked while they were sick with influenza-like illness (ILI). A research team led by the US Centers for Disease Control and Prevention (CDC) reported its findings yesterday in the American Journal of Infection Control.

Since 2009 CDC researchers have surveyed health providers to estimate flu vaccine coverage in the group, and for the 2014-15 season they included extra questions about working while sick and about missing work while experiencing ILI. The final analysis included 1,914 healthcare workers, of which 21.6% (414) said they had been sick with ILI.

Of those who said they had been ill, 41.4% said they had worked while sick, for a median duration of 3 days. Of eight different occupation types, pharmacists and physicians had the highest frequency of working while they had ILI. Hospital-based health providers were more likely to work while sick compared with those not working in a hospital.

The most common reasons for working while sick were a perception of still being able to perform their duties and not feeling bad enough to miss work. For those who worked at long-term care facilities, the most common reason was inability to afford lost pay.

Being vaccinated against flu during the 2014-15 flu season was also associated with working while sick, according to the findings.

To reduce levels of health-worker–associated flu transmission, the researchers said that misconceptions about working while sick and sick leave policies both need to be addressed.
May 16 Am J Infect Control abstract


Study: Nursing movements contribute to N95 face seal leakage

Movements during routine nursing procedures can increase the risk of face seal leakage of N95 respirators, according to a study that involved nursing students who wore backpack aerosol spectrometers that measured particles that entered the mask.

Researchers from Hong Kong reported their findings yesterday in the American Journal of Infection Control. Their goal was to assess if properly sealed respirators provide consistent protection for the wearer.

The study group consisted of 120 nursing students who were equipped with the best-fitting respirators among three common models using the quantitative fit test (QNFT). They performed nursing procedures such as breathing, talking, and bending over for 10-minute periods while wearing the portable spectrometers to detect particles inside the respirator.

Fit factor determined by QNFT dropped significantly after nursing procedures, and the researchers also saw significant differences in particle concentration of different sizes inside the respirators, as detected by the backpack spectrometers, before, during, and after the procedures.

The team concluded that body movements during nursing procedures might increase the risk of face seal leakage of N95 respirators  and that more research is needed to improve respiratory protection for users, including the development of new prototypes that offer a better fit.
May 16 Am J Infect Control abstract


Research and science groups ask HHS head to protect NIH funding

Related to a US House of Representatives committee hearing today on federal funding for the National Institutes of Health (NIH), leaders of 28 medical, science, and research advocacy groups sent a letter to Health and Human Services (HHS) Secretary Tom Price, MD, asking him to protect the NIH and its Fogarty International Center.

The letter, started by the Infectious Diseases Society of America (IDSA) and the HIV Medicine Association, praised a $2 billion NIH budget increase for fiscal year 2017 but aired deep concerns over the White House's proposed cuts to medical research funding for fiscal year 2018, including the elimination of the Fogarty Center, known for its international research collaboration and role in training scientists to protect domestic and global health security.

In a press release from the IDSA, its president, William Powderly, MD, said erosion in medical research funding threatens the ability to diagnose, prevent, treat, and control diseases and will discourage new scientists from entering the field. "Work supported by the National Institutes of Health, to develop new diagnostics, vaccines, and therapies against emerging infectious diseases as well as the growing threat of antimicrobial resistance has never been more vital," he said.

The topic of today's oversight hearing was advances in biomedical research, and the primary witness was NIH Director Francis Collins, MD, PhD. He and others from the NIH, including Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID), appeared before the House subcommittee on Labor, Health and Human Services, Education, and Related Agencies.
May 16 letter to Tom Price
May 15 IDSA press release
House committee hearing background

Stewardship / Resistance Scan for May 17, 2017

News brief

Study finds dramatic impact tied to stewardship at a small, rural hospital

Implementation of an antimicrobial stewardship program (ASP) at a rural community hospital in Georgia significantly reduced Clostridium difficile infections (CDIs), antimicrobial use, and overall drug costs, researchers reported yesterday in the American Journal of Infection Control.

Researchers from the Mayo Clinic evaluated the performance of an ASP implemented at a small Georgia hospital with no previous ASP experience and an average occupied bed census of fewer than 100. The ASP was led by an infectious disease (ID) physician, used a prospective audit and feedback strategy with a targeted list of 12 antimicrobial agents, and included an educational grand rounds lecture series and algorithms to aid the selection of empirical antibiotics for specific infectious disease syndromes.

The targeted agents were amikacin, aztreonam, cefepime, ceftaroline, daptomycin, doripenem, ertapenem, fosfomycin, imipenem, linezolid, meropenem, and tigecycline. The researchers calculated rates of C difficile infection (CDI), total targeted antimicrobial costs, and drug usage rates prior to ASP implementation (January 2013 through September 2014) and after implementation (October 2014 through December 2015).

They found that nosocomial CDI rate declined from 3.35 cases per 1,000 occupied bed days (OBDs) at the end of the fourth quarter in 2013 to 1.35 cases per 1,000 OBDs at the end of the fourth quarter in 2015. Total targeted antimicrobial costs decreased by 50%, from $16.93 per patient day in 2013 to $8.44 per patient day in 2015, and annual savings in drug costs alone were estimated at $280,000, primarily because of the decreased use of 5 of the 12 targeted antimicrobials. Use of all antimicrobial agents decreased 10%.

"Our quality initiative shows that a new ASP can result in dramatic reduction in CDI rates, drug utilization rates, and antimicrobial cost savings within 1 year despite…perceived challenges in a small rural hospital," the authors write.
May 16 Am J Infect Control study


Researchers find rapid respiratory virus testing aids stewardship 

In another study in the American Journal of Infection Control yesterday, Canadian researchers found that integrating point-of-care respiratory virus testing with an ASP audit and feedback intervention was associated with a 32% reduction in antibiotic days per patient in patients with viral respiratory tract infections.

From December 2015 through April 2016, the researchers conducted a prospective audit and feedback intervention for all adult inpatients who had a positive polymerase chain reaction (PCR) finding for a respiratory virus at two acute care hospitals in Vancouver. Inclusion of patients for an ASP consult was based on two criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia). For patients who met the inclusion criteria, the ASP team reviewed the case with the treating physician to determine if antibiotics for community-acquired pneumonia were required and to assess the need for the antiviral drug oseltamivir (Tamiflu).

To assess the impact of the intervention, the researchers conducted a quasi-experimental before-and-after intervention study. The primary outcome of interest was duration of antimicrobial therapy after viral diagnosis. Secondary outcomes included intensive care unit admission, mechanical ventilation, re-prescription of antibiotics within 14 days, and readmission, mortality, and C difficile infection within 30 days.

Overall, 92 patients were included in the prospective cohort and 118 in the retrospective cohort, with 76% (70/92) of the prospective cohort and 83% (98/118) of the retrospective cohort on antibiotics at the time of PCR testing. The prospective cohort had an average of 1.3 fewer days on antibiotics than the retrospective cohort after the PCR results were reported, and within the prospective cohort, patients whose ASP recommendation was accepted versus rejected had on average 3.6 fewer days on antibiotics. ASP recommendations were accepted 77% of the time.

In addition, patients found to have a positive influenza result were more likely to start oseltamivir in the prospective cohort than the retrospective cohort (95% vs. 72%). No significant differences were identified in secondary outcomes.

"Virology testing has advanced rapidly over the last decade, but the full value of such testing may not be realized if the results do not change [clinical] management," the authors write. "Using antimicrobial stewardship as a bridge to connect virology reporting with the treating physician facilitated a reduction in duration of antibiotic treatment and optimized oseltamivir therapy."
May 16 Am J Infect Control study


Resistant Acinetobacter outbreak in long-term care facility detailed

Austrian researchers report the detection of an outbreak of two multidrug-resistant (MDR) Acinetobacter baumannii strains among patients at an Austrian long-term care facility in a study yesterday in Antimicrobial Resistance and Infection Control.

The researchers conducted the point-prevalence study in August 2015, taking inguinal and perianal swabs from 38 patients at two wards caring for patients with disorders of consciousness and screening them for asymptomatic colonization by MDR gram-negative bacteria. Microbiological sampling was repeated 6 months later.

In the initial survey, 50% of the patients (19/38) were found to harbor MDR gram-negative isolates, with 13 found to be colonized with A baumannii isolates that were resistant to three antimicrobial classes but susceptible to carbapenems. Five other patients were found to be colonized with A baumannii that was not characterized as MDR. Of the 18 patients initially colonized with any A baumannii isolate, 10 were still colonized after 6 months.

All but one of the MDR A baumannii isolates were found in patients from ward 2. In an attempt to isolate a source of the bacteria, swabs were taken from hospital items and surfaces in ward 2, and investigators found A baumannii isolates on a patient elevator into a bathtub and on a chair for visitors in a patient room. PCR testing indicated the A baumannii isolates belonged to two clusters (A and B), and that the isolate from the chair was identical to 15 patient isolates and was connected to cluster A, which was the larger of the two.

The authors of the study suggest that since the isolate on the chair was identical to 15 of the patient isolates, and the colonized patients had been at the ward longer before the study than the non-colonized patients, there is a good chance that cross-transmission between patients by staff had taken place.

In response to the outbreak, the facility has strengthened standard hygiene precautions and infection control practices and will screen all patients on both wards for MDR bacteria twice a year.
May 16 Antimicrob Resist Infect Control study

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