NEWS SCAN: 'Last resort' antibiotic use, global polio progress, possible DeCoster charges, measles in Pakistan

May 17, 2012

Increase seen in use of 'last resort' antibiotics for resistant pathogens
Antibiotics that remain effective against multidrug-resistant (MDR) and carbapenem-resistant (CR) Gram-negative pathogens are being used more frequently in recent years as these pathogens increase in prevalence, a study from Salt Lake City found. The researchers, writing in Public Library of Sciences (PLoS) One yesterday, retrospectively examined the use of the polymyxins and tigecycline in 127 Veterans Affairs (VA) medical centers across the country from October 2005 through September 2010. Use of the drugs overall was low, at 0.8 and 1.6 days of therapy per 1,000 patients-days, respectively. The frequency of their administration varied by geographic region but increased over the study period in all regions except the Northeast, where polymixin use stayed stable. Use of the agents was uneven across facilities: 75% of all polymyxin use occurred at just eight centers, and 75% of all tigecycline use occurred at 26 centers. There were 1,081 MDR or CR isolates during 747 hospitalizations associated with polymyxin use (1.4/hospitalization), compared with MDR or CR isolates during 500 hospitalizations for tigecycline (1.3/hospitalization) (P = 0.06). A PLoS press release states, "While this is the first study assessing use of these drugs in the United States on a large scale, the trend is almost certainly not limited to the VA." Lead author Makoto Jones, MD, concluded in the press release that, to address this trend, "a clear strategy of infection control, antibiotic development, and antibiotic stewardship will be necessary."
May 16 PLoS One study
May 16 PLoS press release

Global polio cases halved in 2011
Global polio cases dropped by half in 2011 and India was officially declared polio free in February, the US Centers of Disease Control and Prevention (CDC) said today in Morbidity and Mortality Weekly Report (MMWR) as it highlighted successes in slowing the spread of the disease. The agency said 650 polio cases were reported worldwide in 2011, compared with 1,352 in 2010, a 52% decrease. Of those 650 cases, 341 (53%) were from the four then–polio endemic countries: Afghanistan, Pakistan, Nigeria, and India. In addition, 230 (35%) were from previously polio-free countries in which imported wild polio virus (WPV) led to reestablished transmission for 12 months or more (Angola, Chad, and the Democratic Republic of the Congo), and 79 (12%) were from nine countries affected by outbreaks. Compared with 2010, WPV cases increased in 2011 in Afghanistan (a 69% increase), Nigeria (66%), and Pakistan (27%). By the end of 2010, the latest year for which data are available, full infant vaccination coverage was estimated to be 86% globally but lowest in the Southeast Asia region (77%) and highest in the European region (96%). The CDC also reported 302 supplementary immunization activities using oral polio vaccine in 53 countries in 2011.
May 18 MMWR report

Former egg magnate DeCoster may face criminal charges for 2010 outbreak
Attorneys for retired egg industry magnate Austin "Jack" DeCoster, his son Peter, and Quality Egg chief financial officer Patsy Larson said that a federal grand jury is weighing whether to file criminal charges against the trio because of a 2010 Salmonella outbreak linked to Quality Egg and Hillandale Farms that sickened at least 1,900 people nationwide, the Associated Press (AP) reported yesterday. In recent documents filed in a civil case in California, DeCoster's defense lawyers said the grand jury has been meeting in Iowa to determine whether fraud or other crimes were committed in the production and testing of eggs. Officials blamed the outbreak in large measure on Quality Egg, which supplied Hillandale with chickens and feed and had more illnesses linked to its eggs than did Hillandale, the AP said. Quality Egg operated as Wright County Egg, based in Galt, Iowa. A spokesman for the US Attorney's Office for the district in Iowa where the farms are located said he could not confirm the investigation. The outbreak led to the recall of 550 million eggs.
May 16 AP story

Pakistan measles outbreak linked to regional insurgence
A recent measles outbreak that has killed at least 12 children and one adult in Pakistan's North Waziristan's tribal agency has been exacerbated by conflict between militants and the army, IRIN, the UN's humanitarian news service, reported yesterday. The area, which is poor, mountainous, and largely inaccessible, borders Afghanistan and is a stronghold of the Taliban and associated militants. "Long curfews, road blockades and also the power cuts that take place mean the vaccines we receive expire," said Muhammad Ali Shah, director of the main hospital in Miramshah. Shah could not estimate the total number of cases in the region but said the hospital is seeing 5 to 10 measles cases a day and has not previously had more than one or two measles deaths a year.
May 16 IRIN report

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