Stewardship / Resistance Scan for Jan 16, 2020

News brief

Antifungal stewardship tied to drop in antifungal drugs, candidemia

A team of Spanish scientists reports that after they implemented an antimicrobial stewardship program (ASP) focused on antifungal use at their university hospital in Seville, use of antifungal drugs dropped 38%, according to their findings published yesterday in the Journal of Infection.

Over a 9-year period, the team quarterly assessed antifungal consumption, incidence of hospital-acquired candidemia, Candida distribution, antifungal resistance, and crude death rate per 1,000 occupied bed days (OBDs) of hospital-acquired candidemia.

They observed a trend of decreased antifungal consumption throughout the 9 years, with a sustained 0.87% reduction per quarter and a final reduction of 38.4% over the entire study period. Reduced fluconazole use accounted for the lion's share of the drop, with a sustained reduction of 1.37% per quarter.

In addition, hospital acquired candidemia decreased 5.06% cases per 1,000 OBDs per year, and the crude death rate dropped 6.36% per 1,000 OBDs per year (from 0.044 to 0.017).

The authors conclude, "This ASP has succeeded in optimizing the use of antifungal with a long-lasting reduction without increasing the incidence, neither the mortality, of hospital-acquired candidemia."
Jan 15 J Infect abstract

University of Leeds launches website for AMR in lower-resource countries

Yesterday the Community Engagement for Anti-microbial Resistance (CE4AMR) project at the University of Leeds in England launched its website, which showcases the network it's building to champion the use of community engagement and participatory and creative approaches to tackle antibiotic resistance in low- and middle-income countries (LMICs).

"CE4AMR believes that if communities are fully informed and engaged with the concept of antimicrobial resistance (AMR) then subsequent behaviour change will be meaningful and sustainable, allowing global AMR objectives to be met," said Jessica Mitchell, PhD, of the University of Leeds, in a CE4AMR blog post yesterday. "To achieve this vision the CE4AMR website provides a collaborative hub to showcase current research utilising community engagement methods to tackle AMR, plus resources and guidance for those wishing to branch into this area."

The website highlights interventions in LMICs, primarily in Southeast Asia and Africa. Projects range from small-scale programs to established, long-term interventions. The site hosts material to support the methodological development of community engagement projects, background information on AMR, evaluation and monitoring resources, and practical toolkits, infographics, reports, and reflections from CE4AMR's network.

The site will also feature workshops, webinars, and conferences on AMR geared toward LMICs.
Jan 15 CE4AMR blog post
CE4AMR website

News Scan for Jan 16, 2020

News brief

One new MERS case in Saudi Arabia; WHO details December infections

Saudi Arabia's Ministry of Health (MOH) today reported one more MERS-CoV case recorded earlier this week, the fourth to be reported in January.

The patient is a 64-year-old man from the city of Al Majma'ah in the Riyadh region. The patient did not have camel contact, and his exposure is listed as primary, meaning he likely did not contract MERS-CoV (Middle East respiratory syndrome coronavirus) from another patient.

In a report on MERS cases recorded in December 2019, the World Health Organization's (WHO's) eastern Mediterranean office tracked five cases, four in Saudi Arabia and one in the United Arab Emirates. Three of the five cases were fatal, and four occurred in men. None of the cases involved clusters or healthcare workers.

Since the virus was identified in 2012, the WHO said 2,499 cases have been lab-confirmed, including 861 fatalities. Saudi Arabia has seen by far the most cases.
Jan 12 MOH report
Jan 15 WHO update

Tests negative in Kentucky infectious disease investigation

All tests are negative for a recent potential infectious disease case handled by Kentucky's Barbourville Regional Healthcare hospital, the Kentucky Department for Public Health (KDPH) said yesterday in a statement. KDPH commissioner Angela Dearinger, MD, MPH, said in the statement that tests revealed there was no high-level threat to hospital staff or the community.

"This was nothing out of the ordinary for any U.S. hospital," she said, saying state health officials followed proper infectious disease protocols. "After receiving the test results, as well other details about this incident, we can confirm there was never a risk of highly infectious disease."

According to an earlier report, a Union College student athlete was hospitalized, and social media speculation raised questions about Ebola, but the school said the student had not recently traveled outside the country.

In a Facebook update yesterday, school president Marcia Hawkins, PhD, said that a lengthy phone conference with the Centers for Disease Control and Prevention and other health officials indicated that the student was misdiagnosed and that early reports of an infectious disease involvement weren't cleared. She added that a great deal of fear and panic were generated without a cause, and that the real victim in the scenario is the student.
Jan 15 KDPH statement
Jan 15 Union College Facebook post
Jan 15 CIDRAP News scan "Unidentified infection in Kentucky college student prompts investigation

FDA grants Fast Track status to Novavax's Nano-Flu vaccine

Yesterday the US Food and Drug Administration (FDA) granted Fast Track Designation for NanoFlu, a next-generation flu vaccine by Novavax, of Gaithersburg, Maryland, that targets adults over the age of 65.

"The FDA's decision to grant Fast Track Designation for NanoFlu reflects the urgent unmet medical need for a more effective vaccine against influenza, particularly in the older adult population which often experiences serious and sometimes life-threatening complications, of the disease," said Stanley C. Erck, president and CEO of Novavax, in a company press release. "We believe that NanoFlu will offer an innovative improvement compared to traditional egg-based vaccines, which frequently result in mismatch and poor effectiveness."

The vaccine is being tested in a phase 3 trial for non-inferiority against Fluzone. Clinical data from that trial are expected by the end of March.

The recombinant quadrivalent (four-strain) seasonal flu vaccine candidate is adjuvanted with Matrix-M, which stimulates the entry of antigen-presenting cells into the injection site and enhancing antigen presentation in local lymph nodes, which is designed to produce a stronger immune response, Novavax said.
Jan 15 Novavax press release

E coli outbreak linked to bagged salad mix appears over

The Centers for Disease Control and Prevention (CDC) said yesterday that an outbreak of Escherichia coli O157:H7 illnesses tied to Fresh Express's Sunflower Crisp chopped salad kits appears to be over.

A total of 10 cases in 5 states were reported during the outbreak, including 4 hospitalizations. This represents 2 new cases, 2 newly affected states, and 1 new hospitalization since the CDC's first notice of this outbreak on Dec 9, 2019. No deaths were recorded. One person developed hemolytic uremic syndrome, a type of kidney failure.

Minnesota reported the most cases (4), followed by Wisconsin (3). Georgia, Illinois, and North Dakota each recorded a single case. The new cases are in Illinois and Georgia.

"Contaminated Fresh Express Sunflower Crisp chopped salad kits that made people sick in this outbreak are past their shelf-life and should no longer be available," the CDC said. "The affected salads had best-before dates up to and including December 7, 2019."

Illness-onset dates ranged from Nov 5, 2019, to Nov 16, 2019, and information collected during the outbreak showed a common exposure to the Fresh Express salad kits. Romaine lettuce was one of the ingredients in the salad kit, but the CDC said the investigation was not able to determine if romaine lettuce was the contaminated ingredient in the salad kit.

Yesterday the CDC said a 167-case, 27-state E coli O157:H7 tied to romaine lettuce was also likely over.
Jan 15 CDC update
Jan 15 CIDRAP News scan on larger outbreak

China, Romania, Hungary report high-path avian flu outbreaks

In the latest highly pathogenic avian flu outbreaks, China reported another H5N6 outbreak in wild swans, Romania became the latest European country to report a return of H5N8, and Hungary reported another outbreak involving the strain.

China's agriculture ministry said it detected H5N6 in a flock of 150 wild swans in Xinjiang province, where one bird was found dead with another found sick, Reuters reported today. Earlier this month, the ministry reported two similar outbreaks in swans in the same province. H5N6 is one of the avian flu strains known to infect people.

Meanwhile, Romania reported its first H5N8 outbreak since 2017, part of a recent uptick in activity involving the strain Europe. According to a report from the World Organization for Animal Health (OIE), the outbreak began on Jan 13 at a farm in Maramures county in the northwest of the country, killing 11,190 of 18,699 birds. The survivors are being culled to control the spread of the virus.

Also, Hungary reported another H5N8 outbreak, this time at a duck farm in Hajdu-Bihar county in the east, the OIE said in a separate report. The outbreak began on Jan 1, killing 10,449 of 115,548 susceptible birds, and the survivors were slated for culling. The source if the virus isn't known, but indirect contact with wild birds is suspected. A few days ago the country reported an outbreak at a turkey farm in the northwestern part of the country, signaling its first H5N8 outbreak since 2017.
Jan 16 Reuters story
Jan 14 OIE report on H5N8 in Romania
Jan 15 OIE report on H5N8 in Hungary