News Scan for Apr 21, 2017

More avian flu outbreaks
Marker for pneumonia antibiotics
MCR-1 cases in Italy

H5N1 strikes Vietnamese poultry again; more H5N8 in Europe

In the latest avian flu outbreak developments, Vietnam reported another highly pathogenic H5N1 event in backyard birds and two European countries—Russia and Slovakia—reported two more H5N8 detections. Details shared by country officials appeared in the most recent notifications to the World Organization for Animal Health (OIE).

Vietnam's latest H5N1 outbreak involved backyard poultry in Can Tho province in the southern part of the country. The outbreak began on Apr 15, killing 75 of 2,500 birds. Authorities culled the remaining birds to control the spread of the virus.

Elsewhere, Russia reported an outbreak at a large commercial poultry farm in Rostov oblast in the western part of the country. The event started on Apr 13 and led to the deaths of 8,963 of 281,821 poultry. In Slovakia, officials reported an H5N8 outbreak in backyard birds in the Kosice region in the east. The outbreak began on Apr 15 and killed all 15 laying hens in the flock.
Apr 19 OIE report on H5N1 in Vietnam
Apr 20 OIE report on H5N8 in Russia
Apr 21 OIE report on H5N8 in Slovakia


Study shows promise for procalcitonin to guide pneumonia treatment

Spanish investigators reported in PLoS One yesterday that procalcitonin (PCT) level is an effective marker in point-of-care testing for selecting narrow-spectrum antibiotics in outpatients who have pneumonia.

PCT is a protein and precursor to the hormone calcitonin that is produced by immune cells after a bacterial infection. Increasing evidence has shown its usefulness as a biomarker for diagnosing sepsis and bacterial infections.

In the new study, the researchers used PCT levels as measured with rapid point-of-care testing to guide treatment for community acquired pneumonia. Based on test results, 216 adults (those with lower PCT levels) were prescribed azithromycin and 37 were prescribed levofloxacin. They compared the results in these patients to a control group of 493 adults who were treated using historical standard-of-care methods.

The researchers recorded clinical cure rates of 95.8% in the azithromycin group, 94.6% in the levofloxacin group, and 94.4% in the control group. No 30-day mortality or recurrences were noted, and all groups had low 3-year rates of recurrence and mortality and low rates of adverse events.

The authors conclude, "A PCT-guided strategy with a rapid point-of-care testing safely allowed selecting empirical narrow-spectrum antibiotics in outpatients with CAP."
Apr 20 PLoS One study


Italian scientists report 3 MCR-1 bloodstream infections

Italian scientists yesterday in Eurosurveillance detailed three cases of MCR-1–positive Escherichia coli bloodstream infections, a worrisome indication of resistance to colistin, an antibiotic of last resort.

The cases involved a woman in her 70s with cancer who was hospitalized for a respiratory infection in July 2016, a woman in her mid-60s with a diagnosis of non-Hodgkin's lymphoma treated in August 2016 who died within 5 days, and a woman in her early 80s with fever, diarrhea, and abdominal pain who was hospitalized in January. All had previously received chemotherapy for cancer. None had ever been treated with colistin, had recent contact with farm animals, or reported recent travel.

Whole-genome sequencing detected the MCR-1 gene in three E coli strains of different sequence types isolated from blood samples from the three women.

MCR-1, which confers resistance to colistin, was first identified in China in November 2015 in E coli samples from pigs, pork products, and humans. It has since been detected in more than 30 countries and is especially worrisome because it resides on small gene segments called plasmids that can transfer among various pathogens.
Apr 20 Eurosurveill report

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