News Scan for May 20, 2019

News brief

MERS sickens 1 more in Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) yesterday reported one more MERS-CoV case, which involves a patient from Al Kharj. Also, the World Health Organization (WHO) provided new details about nine cases reported in Saudi Arabia from Apr 9 to Apr 30, including five that were part of ongoing clusters in three different cities.

The newest case-patient from Saudi Arabia is a 22-year-old woman who didn't have contact with camels and whose exposure to MERS-CoV (Middle East respiratory syndrome coronavirus) is listed as primary, meaning she wasn't likely exposed by another known patient. The MOH noted the case in its epidemiologic week 21 report. Al Kharj is in Riyadh province, located in the central part of the country.

The Saudi Arabian MOH has confirmed 140 MERS cases so far this year.

Meanwhile, the WHO said in a May 17 update that the five cluster-linked cases include three in Khafji in the Eastern region, one in Ad Darb in Jizan region, and one in Al Kharj. The cases not tied to clusters involved four patients in three other cities: Medina (2), Riyadh (1), and Taif (1).

Of the nine patients described in the WHO report, all but one were men. Patient ages range from 34 to 83, and all but two had underlying medical conditions. None was a healthcare worker, and two had contact with camels or camel milk, a known risk factor for contracting the virus. One of the cluster-related cases appears to be an asymptomatic infection. Three of the patients died from their infections.

The WHO said that, from 2012 through Apr 30 it has received reports of 2,428 lab-confirmed MERS-CoV cases, at least 839 of them fatal. The vast majority have been in Saudi Arabia.
May 19 Saudi MOH update
May 17 WHO update


Trial supports shorter antibiotic therapy for orthopedic implant infections

The results of a randomized clinical trial conducted by Swiss researchers suggest that 4 weeks of antibiotic therapy is non-inferior to 6 weeks in patients with orthopedic implant infections. The findings appear in the Journal of Antimicrobial Chemotherapy.

In the single-center trial, researchers with Geneva University Hospitals analyzed 123 patients who had an infected implant surgically removed. The patients were randomized 1:1 to receive either 4 or 6 weeks of systemic antibiotic therapy. The most common type of infection included orthopedic plate infection (44), prosthetic joint infection (38), and infected nail implants (11). The antibiotic regimen for each patient was selected by the treating surgeon in consultation with an infectious diseases expert.

The primary outcome was remission of infection at the operative site, and the secondary endpoint was the occurrence of any adverse events related to antibiotic therapy. The non-inferiority margin was 10%.

Of the 123 cases in the intention-to-treat population, 120 episodes (98%) were cured microbiologically and 116 (94%) clinically after a median follow-up period of 2.2 years. Recurrence of clinical infection occurred in four patients in the 4-week arm and three patients in the 6-week arm (Pearson X² test; P = 0.74); in all cases, this occurred at around 2 months following the end of antibiotic treatment. These results were formally in line with the non-inferiority hypothesis, as the two-tailed 95% confidence intervals [CIs] largely excluded the 10% margin (1.5%, 95% CI, −9.8% to 6.8%). The study could not meet the non-inferiority hypothesis in terms of adverse events, however.

The authors of the study conclude, "Our randomized trial confirms the opinion of several experts who have suggested that results are likely similar for patients with surgically debrided OM [osteomyelitis] treated with 4 versus 6 weeks of antibiotic therapy.As there are many advantages, and apparently no disadvantages, patients with orthopaedic implant infections might benefit from this shorter antibiotic treatment."
May 18 J Antimicrob Chemother study


Australian researchers to use artificial intelligence against AMR

A multidisciplinary team of scientists and medical researchers in Australia has launched a new project to put artificial intelligence (AI) to work against antimicrobial resistance (AMR).

Combining machine learning with data streams from people, animals, and the environment, the OUTBREAK (One-health Understanding Through Bacterial REsistance to Antibiotics Knowledge) project will create a spatial and temporal map of AMR in Australia, using a One Health approach. The ultimate aim of the technology is to predict possible AMR outbreaks, trace the origins of outbreaks, and evaluate the risks and cost-effectiveness of treatments and intervention strategies.

"Every city, town, region and country will have a different AMR fingerprint and therefore different risks," chief investigator Steven Djordjevic, PhD, said in a press release from the University of Technology Sydney (UTS), one of 14 institutions collaborating on the project. "Our vision, ultimately, is a worldwide AI-powered network for AMR surveillance and mitigation, led by Australian research and industry."

The team will include experts in genomics and metagenomics, microbiome and computational biology, zoonotic diseases, biosecurity, pharmacy, risk management, and machine learning.

The project is supported by a $1 million grant from the Medical Research Future Fund, with the possibility of $5 million in additional funding.
May 17 UTS press release

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