News Scan for Nov 24, 2021

Antibiotics for CRE infections
Low-path H5 avian flu in Minnesota
Slight global flu rise
Polio public health emergency

Study shows rising use of ceftazidime-avibactam for CRE infections

A large study of patients in Veterans Administration (VA) hospitals shows a significant increase in the use of ceftazidime-avibactam for carbapenem-resistant Enterobacterales (CRE) infections, US researchers reported today in Infection Control & Hospital Epidemiology.

Cefazidime-avibactam was approved by the Food and Drug Administration in 2015 and is now considered a primary option for CRE infections by the Infectious Diseases Society of America. To date, however, there have been no large national studies to evaluate prescribing trends in patients with confirmed CRE infections, who traditionally have been treated with polymyxins and the aminoglycoside antibiotic tigecycline.

The cross-sectional study of patients treated at 134 VA facilities from 2012 through 2018 identified 7,767 patients with positive CRE cultures, 65% of whom met the definition of receiving antibiotic treatment and were included in the cohort. Urine cultures were the major source (51.7%) of CRE, followed by respiratory (20.1%), blood (13.7%), and other cultures (14.5%). The frequency of bloodstream infection (BSI) CRE isolates increased over time, and the condition was more likely to be found in Black and Latino patients.

In patients with BSI and non-BSI CRE cultures, use of ceftazidime-avibactam increased significantly over time (by 154.0% and 433.0%, respectively), as did use of extended-spectrum cephalosporins (385.5% and 111.1%), while use of aminoglycosides (58.0% and 49.0%) and polymyxins (72.6% and 79.7%) fell significantly. In 2018, 54.1% of CRE BSI patients and 22.7% of CRE non-BSI patients received ceftazidime-avibactam.

"This large national cohort study of veterans with CRE showed an encouraging trend toward increased uptake and utilization of ceftazidime–avibactam for CRE, with decreased utilization of 'older' agents such as aminoglycosides and polymyxins," they write. "Future studies will need to assess uptake and utilization of other, more recently approved antibiotics targeting multidrug-resistant gram-negative bacteria."
Nov 24 Infect Control Hosp Epidemiol abstract


Low-path H5 avian flu turns up on Minnesota turkey farm

Routine testing in a Minnesota turkey flock turned up low-pathogenic H5 avian influenza, the Minnesota Board of Animal Health (MBAH) said yesterday in a statement. The affected farm is in Kandiyohi County, located about 90 miles west of Minneapolis.

The US Department of Agriculture (USDA) National Veterinary Services Laboratory in Ames, Iowa, confirmed the findings. The MBAH said the low-path H5 virus doesn't pose a health risk to the public and isn't the same one that caused highly pathogenic outbreaks in Midwestern poultry in 2015.

Beth Thompson, DVM, the state's veterinarian, said testing birds before they go to market is standard protocol for poultry in Minnesota, a step that ensures that healthy birds are sent to production and that diseases are identified early so producers can manage them.

The turkey flock is under quarantine, and surveillance is under way among backyard and commercial flocks within a 10-kilometer radius.

North American lineage low-pathogenic and highly pathogenic avian flu outbreaks occur in US poultry occasionally and pose a low threat to humans, according to the Centers for Disease Control and Prevention (CDC).

In the fall of 2018, low-pathogenic H5N2 was detected at eight Minnesota turkey farms in Kandiyohi and Stearns counties, according to the USDA. California this year has reported four low-path avian flu detections in domestic poultry, including two in October. All were related to spillovers from wildlife, according to the California Department of Food and Agriculture (CDFA).
Nov 23 MBAH statement
CDC avian flu background
USDA background
CDFA avian flu updates


WHO: Global flu activity rises slightly

Though global flu levels are still low, activity has increased slightly, with some regions showing a few signs of a return to pre-COVID patterns for this time of year, the World Health Organization (WHO) said in an update that covers the last week of October and the first week of November.

In Europe, flu levels are still low but appear similar to pre–COVID-19 levels for the reporting period in some countries. In North America, flu activity increased slightly but is still below the national threshold. Southern Asia also reported flu activity at levels seen in previous seasons.

The WHO also took note of South Africa's out-of-season flu rise and said several world regions are still reporting elevated respiratory syncytial virus (RSV) activity.

Of respiratory samples that tested positive for flu at national flu labs from Oct 25 to Nov 7, 54.6% were influenza B. Of subtyped influenza A viruses, 86.1% were the H3N2 strain.

The WHO included the caveat that flu patterns should be interpreted with caution, due to potential impacts from COVID-19 surveillance and public health measures.
Nov 22 WHO global flu update


WHO: Polio still public health emergency of international concern

During the WHO's 30th meeting of the polio emergency committee, the group agreed that the international polio situation still warrants a public health emergency of international concern (PHEIC), mainly due to cross-border spread of circulating vaccine-derived polioviruses (cVDPV) and the unpredictable situation of wild polio virus 1 (WPV1) transmission in Afghanistan.

Throughout 2021, WPV1 transmission has fallen to low levels, with no new cases reported since January 2021, when two WPV1 cases occurred, one each in Pakistan and Afghanistan. That compares with 129 WPV1 cases during the same period in 2020, the committee said. Despite this, both countries still have what the committee called a population of "persistently missed children" who have not been vaccinated against polio.

Currently cVDPV cases have been detected in 30 countries in Africa, Europe, and the Eastern Mediterranean region. Three new countries, Guinea Bissau, Mauritania, and Ukraine, have reported new cases of circulating vaccine derived poliovirus type 2 (cVDPV2) in 2021.

The number of cVDPV2 cases in 2021 is 420, of which 266 have occurred in Nigeria.

"The Committee recognizes the concerns regarding the lengthy duration of the polio PHEIC but concluded that there are still significant risks despite apparent progress made in the two endemic countries, and that the coming three months would be a critical period to monitor the situation there closely," the WHO said.
Nov 23 WHO

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