News Scan for Jan 07, 2014

NDM-producing E coli outbreak
Meningitis vaccine IND
Drop in MRSA rates

Biggest US outbreak of highly resistant bacteria tied to Illinois hospital

The largest US outbreak so far of bacteria producing the enzyme NDM (New Delhi metallo-beta-lactamase), which confers resistance to most antibiotics, has been linked to a Chicago area hospital, according to the Chicago Sun-Times and the Centers for Disease Control and Prevention (CDC). The contamination was traced to endoscopic equipment.

The CDC reported last week that 69 patients with carbapenem-resistant Enterobacteriaceae (CRE) were identified in the United States in 2013, and 44 of those involved NDM-producing Escherichia coli in northeastern Illinois. The CDC report said at least 32 cases were linked to the suburban hospital, which the Sun-Times identified as Advocate Lutheran General Hospital in Park Ridge.

"It's the largest outbreak that we’ve seen in the U.S. of this bacteria ever," Alex Kallen, an infectious diseases specialist who supervised the CDC investigation, told the Sun-Times.

Nine patients who tested positive for NDM-producing E coli were identified in northeastern Illinois from March through July of 2013, the CDC reported in Morbidity and Mortality Weekly Report (MMWR). Eight of them were treated at the same hospital, and a case-control study revealed that undergoing endoscopic retrograde cholangiopancreatography (ERCP) was a strong risk factor, the report said.

An NDM-producing E coli strain that was closely related to the outbreak strain was recovered from the device used. The hospital notified ERCP patients of the problems, and 109 returned for testing, according to the Sun-Times. The story indicated that 28 were colonized but not infected, while 10 others had signs and symptoms, and a "small percentage" were treated with antibiotics.

The CDC said investigators found no lapses in cleaning procedures used on the ERCP equipment, but the findings prompted the hospital to switch from high-level disinfection to gas sterilization of the devices. "The design of the ERCP endoscopes might pose a particular challenge for cleaning and disinfection," the report said.
Jan 5 Sun Times story
Jan 3 MMWR article


CDC submits IND for meningococcal vaccine use at UCSB

As part of the response to a serogroup B meningococcal disease outbreak at the University of California at Santa Barbara (UCSB), the CDC is taking steps to enable an unlicensed vaccine to be used to prevent additional infections.

The CDC said in a Dec 31 update that is submitting an investigational new drug (IND) application with the Food and Drug Administration (FDA), which would allow the vaccine to be used in at-risk groups at UCSB. In November the FDA approved an IND for Bexsero, made by Novartis, that cleared the way for the vaccine to be used to curb a separate outbreak at Princeton University.

The outbreak at UCSB has sickened four students, permanently disabling one of them, and the strain has a different genetic fingerprint than the serogroup B organism responsible for the Princeton illnesses. Bexsero, made by Novartis, targets serogroup B, which is not covered by the US meningococcal vaccines. Bexsero is approved in Europe, Australia, and Canada.

The CDC said the decision to pursue the IND was made after reviewing the cases and with the support of college, county, and state health officials. Health officials concluded that more cases were likely to occur at UCSB. It said IND clearance can take several weeks and that lab tests show that the serogroup B vaccine is effective against the strain that caused the UCSB cases.

In a Dec 23 letter to students, parents, and staff, UCSB health officials said the process to gain access to the vaccine is progressing as rapidly as possible, but there are still many steps that need to take place, including determining the population that should receive the vaccine.
Dec 31 CDC Q and A
Dec 23 UCSB letter


VA care facilities report drop in healthcare-related MRSA

Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections dropped 36% 4 years after Veterans Affairs (VA) long-term care facilities implemented a nationwide prevention initiative, according to a study in the January issue of the American Journal of Infection Control, published by the Association for Professionals in Infection Control and Epidemiology (APIC).

Staff implemented the MRSA Prevention Initiative in the VA's 133 long-term care facilities in January 2009. The initiative includes screening every patient for MRSA, use of gowns and gloves when caring for patients colonized or infected with MRSA, hand hygiene, and an increased focus on infection control. It also created a MRSA prevention coordinator at each center. 

From July 2009 to December 2012, the mean quarterly MRSA admission rate increased from 23.3% to 28.7%, but the overall rate of MRSA healthcare-associated infections (HAIs) dropped 36%, from 0.25 to 0.16 per 1,000 resident-days.

The authors note the decreased rate of MRSA HAIs despite no decrease in overall MRSA. "To our knowledge, declines in MRSA HAIs such as this have not been reported in other large long-term care settings," they conclude.
January Am J Infect Control abstract
Jan 6 APIC news release on the study

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