Stewardship / Resistance Scan for Sep 21, 2017

MDR malaria spread
Pediatric antimicrobial stewardship
New US Candida auris cases

Multidrug malaria lineage spreads to Vietnam

A multidrug-resistant parasite lineage that has become dominant in Cambodia, with spread to parts of Thailand and Laos, has now spread to southern Vietnam, where it has been linked to an alarming number of treatment failures in patients who were given the nation's first-line treatment.

Researchers from Vietnam and Thailand reported the development in a letter today in The Lancet Infectious Diseases. They said the PfPailin lineage, first identified in western Cambodia in 2008, acquired resistance to piperaquine and spread east, forcing that country to switch its first-line artemisinin combination treatment back to artesunate-mefloquine.

In Vietnam, the current national first-line treatment is dihydroartemisinin-piperaquine, the same as Cambodia's former first-line combination.

According to the report, microsatellite typing of 86 of 152 Plasmodium falciparum isolates from the Binh Phuoc province in 2016 shows the same genetic markers seen in parasites in other Greater Mekong countries. In 8 years, the lineage now encompasses all four countries of the eastern Greater Mekong region.

"The evolution and subsequent transnational spread of this single fit multidrug-resistant malaria parasite lineage is of international concern," the team wrote.
October Lancet Infect Dis letter


Study shows effectiveness of pediatric antimicrobial stewardship

Following implementation of a pediatric antimicrobial stewardship program (ASP) at a large Tokyo hospital, carbapenem resistance rates in Pseudomonas aeruginosa dropped significantly, as did the length of hospital stay and infection-related mortality, according to a study yesterday in the International Journal of Infectious Diseases.

Scientists analyzed data from April 2010 to September 2011 (pre-intervention) and October 2011 to March 2017, the intervention period. The pre-intervention period included only consultations with infectious disease services, while the latter period included those consultations plus the ASP. The team calculated carbapenem resistance rates in gram-negative bacteria in both periods and then compared the two.

The researchers found that both the carbapenem resistance rate in P aeruginosa and the length of carbapenem therapy decreased by a statistically significant amount during the intervention phase. Length of hospital stay and infection-related mortality also dropped significantly.
Sep 20 Int J Infect Dis study


More US Candida auris cases confirmed

The United States now has 126 confirmed cases of Candida auris as of Aug 31, according to a new case count update from the Centers for Disease Control and Prevention (CDC). Fourteen of those cases were reported since the previous update, on Aug 21.

In addition to the 126 confirmed cases, officials have reported 27 suspected cases, and an additional 143 patients have been found to be colonized with C auris by targeted screening in four states with clinical cases. Those patients are asymptomatic.

New York and New Jersey have by far the most cases, with 86 and 26 confirmed cases, respectively. No other state has more than 4 confirmed cases. New Jersey has an additional 23 probable cases, and New York has 4 probable cases.

C auris is an emerging infectious fungus that causes severe illness in hospitalized patients. Based on limited data, the CDC reports that 30% to 60% of patients have died. The fungus has shown resistance to three major classes of antifungal drugs and can live in healthcare settings for months.
Sep 18 CDC update

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