News Scan for Mar 05, 2020

More MERS in Saudi Arabia
Drug trial for highly resistant TB
Urine culture order intervention
Antibiotic use, resistance in African food animals

Latest Saudi MERS case confirmed in Al-Kharj man

Today Saudi Arabia's Ministry of Health (MOH) reported a new MERS-CoV case in Al-Kharj, bringing the country's March tally to four infections, after the ministry reported 18 in February and 15 in January.

The MERS-CoV (Middle East respiratory syndrome coronavirus) case involves a 39-year-old man who reported contact with camels, a known MERS risk factor. The MOH listed the case as primary, meaning he is unlikely to have contracted the virus from another person. The patient is not a healthcare worker.

Infection with MERS-CoV can cause severe illness and is associated with about a 34% death rate. The virus can transmit between humans but has done so mainly in healthcare settings, according to the World Health Organization (WHO).

As of Jan 31, 2020, the WHO said that it had received reports of 2,519 laboratory-confirmed MERS infections, including 866 associated deaths. The vast majority of these cases occurred in Saudi Arabia.
Mar 5 Saudi MOH report


Trial demonstrates effectiveness of highly-resistant TB regimen

The results of the clinical trial that helped pave the way for US Food and Drug Administration (FDA) approval of the new tuberculosis drug pretomanid appeared today in the New England Journal of Medicine.

The phase 3 Nix-TB trial, conducted at three sites in South Africa by a team of British, South African, and US researchers from April 2015 through November 2017, evaluated the safety and efficacy of 26 weeks of combined treatment with oral pretomanid, bedaquiline, and linezolid in patients with extensively drug-resistant tuberculosis (XDR-TB) and multidrug-resistant tuberculosis (MDR-TB) that was not responsive to treatment. The primary end point was incidence of an unfavorable outcome, defined as treatment failure or relapse during follow-up, at 6 months after the end of treatment.

Of the 109 patients enrolled in the trial, 11 (10%) had an unfavorable outcome and 98 patients (90%; 95% confidence interval [CI], 83% to 95%) had a favorable outcome at 6 months after the end of therapy. Among the 71 patients with XDR-TB, 63 (89%; 95% CI, 79% to 95%) had a favorable outcome, and 35 of 38 MDR-TB patients (92%; 95% CI, 79% to 98%) had a favorable outcome. Peripheral neuropathy occurred in 88 patients (81%) and myelosuppression in 52 patients (48%). Both adverse effects were linked to linezolid.

The FDA approved pretomanid—which was developed by the nonprofit TB Alliance, as part of the three-drug combination for patients with XDR- and MDR-TB—in August 2019. The 6-month regimen is significantly shorter than current treatment regimens for highly drug-resistant TB, which last 18 to 24 months, involve as many as eight drugs, and have low cure rates.

"For both individual patients with tuberculosis and national tuberculosis programs, a shorter duration of treatment that is effective is beneficial," the authors of the study wrote.

A secondary end point of treatment failure at 24 months after end of treatment is currently being measured. The authors note that there has been only one additional relapse among the 47 patients who have reached this point in the study.
Mar 5 N Engl J Med study
Aug 14, 2019, CIDRAP News story "FDA approves new drug for highly resistant tuberculosis"


Study: New urine culture order tied to less testing, antibiotic use

The addition of a new order set for urine cultures at five Texas hospitals was associated with decreases in the number of urine cultures performed and days of antibiotic therapy and substantial financial savings, researchers reported today in Infection Control and Hospital Epidemiology.

The study, led by researchers from Baylor College of Medicine, analyzed a newly added order set in the electronic health record at the five hospitals that requires practitioners to choose an indication for the type of urine culture being ordered. The main goal for implementing the new order set was to reduce unnecessary testing and antibiotic treatment in patients with asymptomatic bacteriuria.

The primary outcome was the number of urine cultures performed at the hospitals before and after implementation of the new order set, adjusted for the number of total patient-days. The researchers also assessed antibiotic days of therapy (DOT), catheter-associated urinary tract infection (CAUTI) rate, and the overall financial impact.

The total number of urine cultures at the five hospitals decreased from 32,598 before the new order set (June 2017 through May 2018) to 20,064 after (July 2018 through June 2019). Adjusted per patient-days, urine cultures decreased from 1,175.8 per 10,000 patient-days to 701.4 after the intervention (a 40.4% reduction). Antibiotic DOT for patients with a urinary tract infection fell from 102.5 to 86.9 per 1,000 patient-days (a 15.2% reduction), the CAUTI rate dropped from 11.5 to 9.3 per 10,000 catheter-days, and the estimated yearly savings following the intervention was $535,181.

The authors note that the results suggest the order set is not always being used correctly and that a follow-up quality improvement study may be warranted.
Mar 5 Infect Control Hosp Epidemiol abstract


Review finds high antibiotic use, resistance on African farms

An meta-analysis of previously published research has found high levels of antibiotic use and resistance in food-producing animals and the environment in Africa, a team of Tanzanian researchers reported in Antimicrobial Resistance and Infection Control.

The researchers reviewed and analyzed 176 articles published from 2005 through 2018 and found that the percentage of farms using antibiotics ranged from 77.6% in Nigeria to 100% in Tanazania, Cameroon, Zambia, Ghana, and Egypt. In total, 14 different classes of antibiotics were used, mainly tetracyclines, aminoglycosides, and penicillins. The prevalence of multidrug-resistant (MDR) Escherichia coli isolates in food-animals ranged from 20% in Nigeria to 100% in South Africa, Zimbabwe, and Tunisia, while the prevalence of MDR E coli in environmental samples ranged from 33.3% in South Africa to 100% in Algeria. Environmental E coli exhibited resistance to 16 different antibiotics.

The review also found that none of the countries studied had documented antibiotic use or antibiotic resistance surveillance programs specific for animals or the environment.

The authors of the study say the high levels of antibiotic use and resistance found in animal production systems in Africa is likely to escalate the already high prevalence of antibiotic resistance on the continent.

"This, coupled with weak regulations and antimicrobial resistance surveillance systems in the region is a great concern to the animals, environment and humans as well," they wrote.
Mar 3 Antimicrob Resist Infect Control study

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