Stewardship / Resistance Scan for Jul 03, 2019

News brief

Multistate outbreak of multidrug-resistant Salmonella sickens 45

The Centers for Disease Control and Prevention (CDC) said today that it is investigating a multistate outbreak of multidrug-resistant Salmonella infections with suspected links to contact with pig-ear dog treats.

The CDC said that 45 people in 13 states have been infected with the outbreak strain of Salmonella I 4,[5],12:i:-, and 12 have been hospitalized. No deaths have been reported. Ill people range in age from 1 year to 81 years.

Whole-genome sequencing of isolates from 30 of the infected people predicted antibiotic resistance or decreased susceptibility to ampicillin, ciprofloxacin, gentamicin, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim sulfamethoxazole.

In interviews, 34 of 38 ill people indicated contact with a dog before getting sick, and 17 of 24 people with available information reported contact with pig-ear dog treats or with dogs who had been given the treats.

In Michigan, sampling of pig-ear dog treats from retail locations where ill people reported buying the products detected several Salmonella strains, but not the outbreak strain. A common supplier of the treats has not been identified.

The affected states are Iowa, Michigan, Kansas, Missouri, Illinois, Indiana, Wisconsin, North Dakota, California, South Carolina, New York, Massachusetts, and Pennsylvania. Iowa has the most cases, 12, followed by Michigan with 7 and New York with 6.
Jul 3 CDC investigation notice

Department of Defense grant to fund development of new antibiotic class

Canadian biopharmaceutical company Appili Therapeutics announced yesterday that it has received a $3 million grant from the US Department of Defense to develop a novel antibiotic class that targets multidrug-resistant gram-negative bacteria.

Appili, of Halifax, Nova Scotia, will use the money to advance the ATI-1503 antibiotic program, a new class of antibiotics that has shown the potential to address several gram-negative bacterial species deemed high priority pathogens by the World Health Organization, including Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. ATI-1503 is based on the negamycin scaffold, a naturally occurring compound with intrinsic activity against gram-negative bacteria.

The funding comes through the Peer Reviewed Medical Research Program (PRMRP), which supports military-related scientific and medical research.

"Multi-drug-resistant bacteria continue to spread throughout the world, making them one of the most urgent public health threat we are facing worldwide," Appili Therapeutics CEO Kevin Sullivan said in a company press release. "We believe that the ATI-1503 program has the potential to address several of the most dangerous superbugs for the military and civilians alike, and we are grateful for PRMRP's continued support of this promising novel antibiotic class."
Jul 2 Appili Therapeutics press release

Poor prognosis associated with carbapenem-resistant Klebsiella UTIs

New data indicate that urinary tract infections (UTIs) caused by KPC carbapenemase-producing K pneumoniae (KPC-Kp) are associated with higher clinical failure that may be due to inappropriate antibiotic treatment, Spanish investigators reported yesterday in The Journal of Infection.

The retrospective cohort study looked at all patients hospitalized with a UTI caused by K pneumoniae at a university hospital in Cordoba, Spain, from December 2012 through October 2015, a period that saw a hospital outbreak and subsequent endemicity of KPC-Kp. The researchers wanted to assess the impact of UTIs caused by KPC-Kp on clinical failure at day 21 and on 30-day all-cause mortality.

Of the 142 UTI cases included in the analysis, 46 (34.2%) were caused by KPC-Kp and 96 (67.6%) were caused by non–KPC-Kp strains. Clinical failure was more frequent in the KPC-Kp group (41.3% vs 15.6%, P = .001), and, in a non-adjusted analysis, KPC-Kp cause and inappropriate empirical antibiotic therapy were associated with clinical failure at day 21. When both were analyzed in separate models, inappropriate empirical therapy (odds ratio [OR], 2.51; 95% confidence interval [CI], 1.03 to 6.12, P = .04) and KPC-Kp (OR, 2.73; 95% CI, 1.03 to 7.22, P = .04) were both associated with clinical failure.

All-cause mortality (39.1% vs 15.6%, P = .002) and bacteremia (23.9% vs 10.4%, P = .034) were also higher in the KPC-Kp group, but the association was not confirmed in the separate analysis.

The authors of the study conclude, "Our study provides some insights about the association between KPC-Kp aetiology and clinical failure, as well as the implications of inappropriate empirical treatment. It is necessary to insist on the need to initiate appropriate early treatment using, whenever possible, an objective algorithm that helps to indicate empirical antibiotic coverage of KPC-Kp."
Jul 2 J Infect abstract

News Scan for Jul 03, 2019

News brief

CDC reports on workplace absenteeism during tough 2017-18 flu season

A system recently launched by the Centers for Disease Control and Prevention (CDC) to monitor health-related workplace absenteeism during influenza seasons has yielded more evidence that the 2017-18 flu season was unusually severe, the CDC reported today.

Under the system, the CDC's National Institute of Occupational Safety and Health uses data from the Current Population Survey (CPS) to estimate the prevalence of absenteeism among full-time workers, the CDC explained in Morbidity and Mortality Weekly Report (MMWR). The CPS is a monthly US Census Bureau survey of about 60,000 households, focusing on employment, demographic, and other characteristics of the adult civilian population. The survey data are "valid, reliable, and nationally representative," the CDC said.

In the 2017-18 flu season, the monitoring showed, absenteeism was 1.7% in October 2017, increased sharply in November, and peaked in January at 3.0%. The latter rate exceeded an epidemic threshold based on data from the five preceding flu seasons. After January the rate declined steadily to a low of 1.4% in July 2018.

The report said the epidemic threshold was significantly exceeded for certain subgroups in certain months, including, in January and February, male workers, workers aged 45 to 64 years, and workers in Department of Health and Human Services (HHS) Region 6. Also, workers in HHS Region 9 exceeded the threshold in December and March. Region 6 includes Arkansas, Louisiana, New Mexico, Oklahoma, and Texas, while Region 9 consists of Arizona, California, Hawaii, and Nevada.

"Workplace absenteeism is an important supplementary measure of influenza's impact on the working population that can inform prevention messaging and pandemic preparedness planning," the CDC said in the report.
Jul 5 MMWR article

Officials confirm MERS case in Najran, Saudi Arabia

Saudi Arabia's Ministry of Health (MOH) yesterday announced a new MERS-CoV case, the first since Jun 27, according to an epidemiologic week 27 update.

A 37-year-old man in Najran has contracted MERS-CoV (Middle East respiratory syndrome coronavirus), the MOH said, and it's not known whether he had recent camel contact. Officials list his case as "primary," meaning the disease did not likely transmit from another person.

So far this year Saudi Arabia has had 155 MERS cases. Since 2012 when the virus was first reported, the World Health Organization has confirmed at least 2,442 cases, the vast majority in Saudi Arabia. At least 842 patients have died from their infections.
Jul 2 Saudi MOH update

Company reports comparable flu results between Xofluza and osteltamivir

Genentech, a subsidiary of Roche, yesterday announced positive phase 3 results of its antiviral drug Xofluza (baloxavir marboxil), saying the drug was comparable to oseltamivir (Tamiflu) for treating flu and was well tolerated in children who had influenza.

The study assessed Xofluza versus oseltamivir in children 1 to 12 years old. The company did not provide data but said in a news release that it would provide full results of the trial, called MINISTONE-2, at "an upcoming medical meeting."Genentech is based in South San Francisco, California.

Sandra Horning, MD, Genentech chief medical officer and head of global product development, said, "As a one-dose oral suspension medicine, Xofluza could potentially provide a convenient treatment option for children with the flu, and we look forward to sharing these data with health authorities around the world."

Researchers are also testing the safety and efficacy of Xofluza in children with the flu under the age of 1 year in the global phase 3 MINISTONE-1 study. It is the first and only one-dose oral medicine approved to treat the flu and the first new flu medicine with a novel mechanism of action approved by the US Food and Drug Administration (FDA) in nearly 20 years.

The antiviral is approved in several countries, including Japan, for the treatment of influenza types A and B in children, adolescents and adults, and in the United States for treating acute, uncomplicated flu in people 12 years of age and older. In addition, the FDA recently accepted a supplemental New Drug Application for Xofluza as a one-dose oral treatment for people at high risk of complications from the flu. The agency is expected to decide on whether to approve this additional indication by Nov 4, Genentech said.
Jul 2 Genentech news release