Stewardship / Resistance Scan for May 30, 2017

Resistant gonorrhea in Hawaii
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Disinfectants for MDR pathogens

Gonorrhea isolates from Hawaii outbreak show high resistance profile

A new report in Clinical Infectious Diseases is providing some additional detail on a cluster of genetically related Neisseria gonorrhea isolates with high-level azithromycin resistance and decreased ceftriaxone susceptibility previously detected in Hawaii.

After demonstrating elevated minimum inhibitory concentrations (MICs) for azithromycin and ceftriaxone in antimicrobial susceptibility testing by the Hawaii Department of Health, the eight N gonorrhea isolates collected from seven patients on Oahu from April 2016 through May 2016 were sent to the University of Washington and the US Centers for Disease Control and Prevention (CDC) for further testing. That testing confirmed that all isolates showed high-level azithromycin resistance and five had reduced susceptibility to ceftriaxone. All isolates were also beta-lactam positive and resistant to penicillin, tetracycline, and ciprofloxacin. Genomic analysis revealed that the isolates were genetically related

The seven patients included six males and one female. All patients were successfully treated. Eight recent unique partners were reported by the patients, with two male patients identifying the same female sex worker from a Honolulu massage parlor as a recent contact. Only one of the eight partners was diagnosed and treated for gonorrhea.

The cases were first reported by the CDC in September 2016.

The authors of the study say they believe these are the first gonococcal isolates identified in the United States with both high-level azithromycin resistance and reduced ceftriaxone susceptibility. Because gonorrhea has developed resistance to previously recommended antimicrobials, the CDC currently recommends only the combination of ceftriaxone and azithromycin as the standard treatment for the sexually transmitted disease. The concern is that widespread transmission of such strains could complicate treatment.

The authors warn that clinicians should be on high alert so that any suspected gonorrhea treatment failures can be identified and reported to local health departments and the CDC.

"Rapid detection and effective treatment may prevent sequelae, allow partners to be identified and treated in a timely manner, and prevent or slow further transmission of resistant strains," they write.
May 26 Clin Infect Dis abstract
Sep 21, 2016, CIDRAP News story

Tests find cleaning-disinfection products work well on MDR pathogens

A study that compared seven different commercial products for cleaning and disinfecting hospital rooms found that nearly all were effective against three multidrug-resistant (MDR) outbreak pathogens, except for one that contained hydrogen peroxide.

Dutch researchers focused on three bacterial strains known to cause MDR outbreaks at hospitals in the Netherlands:  vancomycin-resistant enterococci (VRE), Klebsiella pneumoniae OXA-48, and Acinetobacter baumannii. The team published its findings yesterday in the American Journal of Infection Control.

Each ready-to-use cleaning and disinfecting product had a different active ingredient, and testing involved both wiping and spraying. Researchers assessed how well the products reduced microbial count and protein on tiles that were similar to those found in hospital settings.

All products reduced microbial count by more than 5 log10 with 5-minute exposure times, except for a hydrogen peroxide–based spray, which showed lower reduction against VRE. For the six other products, researchers saw no significant differences in bacterial load reduction between use of a wipe or a spray.
May 29 Am J Infect Control study

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