Stewardship / Resistance Scan for Nov 08, 2018

News brief

Vermont tracks XDR Shigella outbreak in retirement community

The Vermont Department of Health (VDH) is investigating an outbreak involving an extensively drug-resistant (XDR) Shigella sonnei strain at a retirement community in Wake Robin. The outbreak involves 22 confirmed and 44 probable cases.

Vermont health officials began investigating the outbreak on Oct 18 and alerted the Centers for Disease Control and Prevention (CDC) of the outbreak on Oct 22. The CDC is assisting Vermont officials with the investigation because of the highly resistant nature of the bacteria.

"Antibiotic resistance means that the bacteria have developed the ability to prevent antibiotics from working. When bacteria are resistant to antibiotics, the treatment we would normally use may not work, and the bacteria can continue to multiply," said Vermont Health Commissioner Mark Levine, MD, in a VDH press release. "Fortunately, most people who get this will recover in five to seven days without the need for treatment."

Shigella infections commonly cause stomach cramps, diarrhea, and fever. Shigella is best prevented by washing hands thoroughly several times per day.

Levine said the most recent onset of illness was Nov 1.
Nov 6 VDH press release

Indian study links multidrug-resistant infections to higher mortality risk

A new study by researchers with the Center for Disease Dynamics, Economics and Policy has found a significant relationship between multidrug-resistant (MDR) bacterial infections and mortality in India.

In the retrospective study, published today in Clinical Infectious Diseases, researchers analyzed patient-level antimicrobial susceptibility tests (ASTs) results and patient mortality outcomes from 10 Indian hospitals. They focused on resistance patterns for drugs commonly used to treat ESKAPE pathogens—Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanniii, Pseudomonas aeruginosa, and Enterobacter spp—and resistance to Escherichia coli. To evaluate patient mortality in relation to MDR bacteria, they conducted multivariate regression analyses, adjusting for age, sex, hospital location, and specimen source.

The researchers analyzed data on 5,103 AST results. The overall mortality rate of patients was 13.1%, with increased odds of mortality among patients with MDR infections (odds ratio [OR], 1.57; 95% confidence interval [CI], 1.14 to 2.16) and XDR infections (OR, 2.65; 95% CI, 1.81 to 3.88). Infections with MDR and XDR E coli, XDR K pneumoniae, and MDR A baumannii were associated with 2-3 times higher mortality. Mortality in patients with methicillin-resistant S aureus (MRSA) infections that were also non-susceptible to aminoglycosides was significantly higher when compared with susceptible strains.

"While data were observational, preventing establishment of causality, our results provide strong quantification of the association between mortality and multidrug resistant patterns in a representative LMIC [low- and middle-income country], and highlight the significant threat MDR and XDR pathogens pose to human health in developing countries," the authors write.
Nov 8 Clin Infect Dis abstract

High MCR-1 prevalence found in Bolivian children not exposed to antibiotics

Scientists have found an almost 40% carriage rate of the colistin-resistance gene MCR-1 in children in the Chaco region of Bolivia, according to a report today in Eurosurveillance.

The study involved 337 children from eight villages in the semi-arid, sparsely populated region in eastern Bolivia. The children ranged in age from 7 to 11 years, with an average age of 9.2 years.

The researchers analyzed fecal samples and found that 129 of the children (38.3%) harbored pathogens that contained MCR-1. Some children had more than one positive sample, yielding a total of 173 MCR-1–positive isolates, 171 of which were Escherichia coli. All of those 171 isolates were susceptible to carbapenems and tigecycline.

Only 4 of the MCR-1 carriers had previous antibiotic exposure. Colistin is considered an antibiotic of last resort for MDR bacterial infections.

The authors conclude, "This high prevalence of mcr-1-like carriage, in absence of professional exposure, is unexpected. Its extent at the national level should be investigated with priority."
Nov 8 Eurosurveillance report

Study: Almost half of refugees to Finland harbor MDR bacteria

University of Helsinki researchers determined that 45% of asylum seekers and refugees treated at their hospital harbored MDR bacteria, including 21% who had MRSA, according to a separate study today in Eurosurveillance.

The investigators analyzed microbiological and clinical data from 447 refugees who were treated from January 2010 to August 2017. Iraq was the most common country of origin (46.5%), followed by Afghanistan (10.3%), Syria (9.6%), and Somalia (6.9%).

The authors found that 45.0% were colonized by MDR bacteria, 32.9% had extended-spectrum beta-lactamase-producing Enterobacteriaceae, 21.3% had MRSA, and 0.7% harbored carbapenemase-producing Enterobacteriaceae. As well, 12.5% had two or more MDR bacterial strains. Multivariable analysis revealed geographic region and previous surgery outside Nordic countries as risk factors for MRSA colonization.

The authors conclude, "The data suggest that these patients should be considered a risk group that requires both screening of MDR bacteria and infection control measures at entry to hospitals in low-prevalence countries."
Nov 8 Eurosurveillance study

News Scan for Nov 08, 2018

News brief

Saudi MOH records new MERS cases in Riyadh, Qassim region

The Saudi Arabian Ministry of Health (MOH) recorded two new cases of MERS-CoV for epidemiologic week 45.

The first MERS-CoV (Middle East respiratory syndrome coronavirus) patient is a 35-year-old male household contact of another case-patient from Riyadh. He is hospitalized. The second patient is a 75-year-old man from the Qassim region. The source of his infection is listed as primary, meaning it's unlikely he contracted the virus from another patient or through camel contact.

The new cases raise the global number of MERS-CoV infections reported since 2012 to 2,264, at least 803 of them fatal.
Nov 8 MOH update

FDA report highlights food safety issues in restaurants

A new report from the US Food & Drug Administration (FDA) shows that restaurants with in-place food safety management systems (FSMS) were much more likely to be in compliance with safe food handling regulations than those without.

The 2013-2024 FDA Retail Food Risk Factor Study is assessing both fast food restaurants and full-service restaurants. Yesterday's report looked at the first year of the study—2013-2014—to identify gaps and goals for restaurants in the next decade.

The best and most consistent food safety behaviors identified in the study was ensuring no bare-hand contact with ready-to-eat food and cooking raw meat to required temperatures. The report found employee hand washing and proper temperature maintenance of food that requires refrigeration to be lacking.

Established FSMS corresponded to much greater food safety ratings, the FDA said.

"Fast food restaurants with nonexistent FSMS averaged almost 4.5 data items out-of-compliance, while fast food restaurants with well-developed and documented FSMS averaged fewer than 1.7 data items out-of-compliance. For full-service restaurants, facilities with nonexistent FSMS averaged 5.8 data items out-of-compliance, while those with well-developed and documented FSMS averaged 2.1 data items out-of-compliance," the report concluded.
Nov 8 FDA report
Nov 8 FDA fact sheet